Public Health Team - Local Adult Health Area Profile
Argyll and Bute Council · 7 November 2023
Back to Helensburgh and Lomond Area Community Planning Group — 7 November 2023 and its agenda
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The Public Health Intelligence team are part of the Directorate of Public Health of NHS Highland and provide an expert resource on epidemiology, demography and population health evidence. Version Issued Next review Prepared by Authorised by 1 31/03/2023 Public Health Intelligence C Hunter-Rowe, Public Health Intelligence Manager 2 3 Distribution Method Distributed to NHS Highland stakeholders, Public Health Directorate staff, community planning partners and Public Health Intelligence intranet page Intranet with email link nhsh.publichealthintelligence@nhs.scot Public Health Intelligence team Directorate of Public Health NHS Highland Larch House Stoneyfield Business Park Inverness IV2 7PA
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Table of content Introduction .................................................................................................................................. 1 Geographies and populations ....................................................................................................... 1 Deprivation and Inequalities ......................................................................................................... 1 Indicator Definitions ...................................................................................................................... 2 Helensburgh and Lomond Summary ............................................................................................ 3 Life Expectancy ............................................................................................................................ 5 Health and income...................................................................................................................... 11 Mortality ...................................................................................................................................... 13 Deaths by Age Group and Sex ............................................................................................... 14 Leading causes of death ........................................................................................................ 17 Cause specific early deaths ........................................................................................................ 19 Early deaths from cancer ....................................................................................................... 19 Early deaths from coronary heart disease (CHD) ................................................................... 22 Deaths from suicide ............................................................................................................... 25 Chronic disease and long-term conditions .................................................................................. 26 Cancer registrations ............................................................................................................... 26 Type 2 diabetes prevalence ................................................................................................... 28 Coronary Heart Disease (CHD) patient hospitalisation ........................................................... 30 Asthma patient hospitalisation................................................................................................ 32 COPD patient hospitalisation ................................................................................................. 35 Dementia and frailty ............................................................................................................... 37 Population prescribed drugs for anxiety, depression or psychosis ......................................... 40 Psychiatric patient hospitalisations ......................................................................................... 41 Harm to health from alcohol and drug use .................................................................................. 42 Alcohol-related hospital admissions ....................................................................................... 43
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Alcohol-specific deaths .......................................................................................................... 46 Drug-related hospital admissions ........................................................................................... 47 External causes of harm to health .............................................................................................. 48 Road traffic accident patient hospitalisations .......................................................................... 48 Emergency care ......................................................................................................................... 50 Emergency patient hospitalisations ........................................................................................ 50 Patients 65 years and over with multiple emergency hospital admissions .............................. 54 End of life care ........................................................................................................................... 56 Place of death ........................................................................................................................ 56 Dementia and place of death ................................................................................................. 58 Glossary ..................................................................................................................................... 61 References ................................................................................................................................. 64
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NHS Highland, Public Health Intelligence team 2023 1 Introduction This report provides an overview of adult population health and wellbeing in Helensburgh and Lomond. Evidence for the health of the population is drawn from multiple sources including deaths, disease registrations and hospitalisations. It is a companion volume to a profile of demography and deprivation published in November 2022. All data are presented for Helensburgh and Lomond and, where available, intermediate zones or neighbourhoods within Helensburgh and Lomond. Comparisons are made to the Argyll and Bute local authority and Scotland. Further profile reports will present information covering a range of topics relating to the health of infants, children and young people and health inequalities. The reports do not cover information on the use or provision of health or social care services which other colleagues in NHS Highland may provide. Geographies and populations Profile reports are available for nine community planning partnerships in Highland local authority and four community planning partnerships in Argyll and Bute local authority. These partnership areas are the focus of action to improve the health of the people and communities in the area covered by NHS Highland Health Board. This report uses four levels of geography: local authority, partnership area, intermediate zone and datazone. Local authorities, intermediate zones and datazones are nationally agreed geographical areas with defined boundaries. Partnership areas are locally defined geographies created without reference to national geographies. Therefore, partnership areas and national geographies may not neatly align. The intermediate zone is the smallest spatial unit most commonly used for releasing and presenting potentially sensitive statistical data and reporting measures of population health. Most measures and figures presented in this report are aggregations from datazones to higher geographical levels. The number of events in the intermediate geographies that best align with a partnership area may not sum to the exact total. Deprivation and Inequalities This report presents some information on deprivation using the Scottish Index of Multiple Deprivation (SIMD)1. The SIMD is an area-based measure of relative deprivation rather than household or
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NHS Highland, Public Health Intelligence team 2023 2 individual deprivation. The SIMD can help to understand the life circumstances and health outcomes of people living in areas identified as experiencing high levels of deprivation. Health inequalities have been defined as the “unjust and avoidable differences in people’s health across the population and between specific population groups”2. Inequalities are not caused by a single issue, and can occur by gender, income, deprivation, ethnicity, disability, geography and other factors. The SIMD is used to monitor health inequalities by dividing the population into five groups (quintiles) or ten groups (deciles) based on their area deprivation level. The SIMD represents deprivation less accurately in rural areas3. The statistical indicators used in the index do not capture the nature of rural disadvantage, and poor households in rural areas are unlikely to be spatially concentrated. Rural areas tend to be less socially homogeneous than urban ones in terms of deprivation, and deprived households in rural areas are unlikely to make much statistical impact on a small area (datazone) basis. A consequence is that rural disadvantage is less visible and ‘less easily tractable’ than in urban areas. Indicator Definitions Many of the indicators presented in this report are published by the Scottish Public Health Observatory (ScotPHO). Full details of the indicator definitions used by ScotPHO are available within the ScotPHO online profiles tool4. Further information on the geographies, populations and other terms used within the report are available in the Glossary.
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NHS Highland, Public Health Intelligence team 2023 3 Helensburgh and Lomond Summary Male and female life expectancy is higher in the partnership area than in Scotland. Long-term trends for increasing life expectancy have stalled in recent years. It is a significant concern that a sentinel measure of population health and social progress is not improving. Social and economic inequalities in health and wellbeing are evident within the partnership area. Small areas with a higher proportion of people experiencing income deprivation generally rank more poorly according to the Scottish Index of Multiple Deprivation (SIMD) health domain. By presenting data for small areas, the profile highlights that systematic differences in population health are associated with income deprivation across a range of measures, providing further evidence of current health inequalities within the partnership and across the local authority. In common with other partnership areas, leading causes of death include ischaemic heart disease, dementia and Alzheimer’s disease, cerebrovascular diseases (including stroke), chronic lower respiratory diseases and certain cancers. There have been decreases in early deaths from cancer and coronary heart disease, but improvements have stalled in recent years. Common long-term conditions include cardiovascular diseases, cancers, neurological disorders, mental health disorders and musculoskeletal disorders5. The prevalence of many conditions and the number of people with frailty are likely to increase as the number of older people increases. Rates of cancer registrations have remained relatively constant, indicating earlier diagnosis and treatment may have driven previous improvements in premature deaths from cancer. Hospitalisations due to coronary heart disease (CHD) show decreases over time. Chronic obstructive pulmonary disease (COPD) admissions also reduced, although rates fluctuated during the reported period. Both remain significant causes of poor health. Psychiatric patient hospitalisations have markedly decreased over time, reflecting a change in the provision of care towards supporting people in the community. Prescriptions for anxiety, depression or psychosis have increased over time. Problem alcohol and drug use can significantly impact physical and mental health and have long- term social impacts, including family break-ups, domestic abuse, unemployment, homelessness and financial problems. There are increased risks of accidents, injuries, violence and antisocial behaviour.
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NHS Highland, Public Health Intelligence team 2023 4 Standardised rates of alcohol-related admissions vary significantly by intermediate geography area in the partnership area. Drug-related hospital admission for the partnership area is relatively low compared to Scotland, but the trend is increasing in common with the local authority. As the number of older people in the population increases, the number of people requiring support at the end of life is likely to increase. Trends have shown increases in deaths occurring in a homely setting. Increased primary, community and palliative care resources will be needed to support families and individuals at home if this pattern is sustained.
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NHS Highland, Public Health Intelligence team 2023 5 Life Expectancy Life expectancy provides a high-level measurement of the health of a population. Life expectancy at birth measures the average number of years a newborn is expected to live if they experienced the period’s age and sex-specific mortality rates. Areas in which the population experience more significant ill health and where people die at a younger age have a lower life expectancy. Male life expectancy in the UK is generally lower than female life expectancy. Across the UK and Scotland, life expectancy has tended to increase over time, except for the World Wars and the Spanish flu pandemic of 1918-19. This improvement in life expectancy has stalled in recent years (since around 2012-2014), and some areas have seen a decrease in life expectancy predating the COVID-19 pandemic6. It is a significant concern that a sentinel measure of population health and social progress is not improving. Table 1: Male life expectancy at birth by area Significance Life Expectancy Lower bound Upper bound Scotland Council Argyll and Bute 77.8 77.0 78.5 + NHS Highland 77.7 77.2 78.1 + Scotland 76.6 76.5 76.7 - Helensburgh and Lomond 80.2 79.3 81.2 + + Mid-Argyll, Kintyre and Islay 78.0 76.8 79.2 + Bute and Cowal 77.5 76.2 78.8 Oban, Lorn and the Isles 77.4 76.3 78.5 Source: ScotPHO Online Profiles 2019-2021 (3-year aggregate for Scotland, Council and Board); 2017-2021 (5-year aggregate for other areas)
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NHS Highland, Public Health Intelligence team 2023 6 Figure 1: Male life expectancy at birth over time Table 2: Male life expectancy at birth by intermediate geography in the area Significance Life Expectancy Lower bound Upper bound Scotland Council Lomond Shore 83.4 80.6 86.1 + + Helensburgh North 81.6 79.1 84.1 + + Garelochhead 81.5 80.0 83.0 + + Helensburgh West and Rhu 80.9 78.3 83.4 + Helensburgh East 76.6 73.6 79.5 Helensburgh Centre 76.5 73.6 79.5 Source: ScotPHO Online Profiles 2017-2021 (5-year aggregate)
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NHS Highland, Public Health Intelligence team 2023 7 Figure 2: Male life expectancy at birth by intermediate geography in the area Figure 3: Variation in male life expectancy associated with income deprivation by intermediate geography
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NHS Highland, Public Health Intelligence team 2023 8 Table 3: Female life expectancy at birth by area Significance Life Expectancy Lower bound Upper bound Scotland Council Argyll and Bute 82.0 81.3 82.6 + NHS Highland 82.0 81.6 82.4 + Scotland 80.8 80.7 80.9 - Helensburgh and Lomond 82.6 81.7 83.5 + Mid-Argyll, Kintyre and Islay 82.6 81.7 83.5 + Oban, Lorn and the Isles 82.5 81.5 83.6 + Bute and Cowal 80.3 79.1 81.4 Source: ScotPHO Online Profiles 2019-2021 (3-year aggregate for Scotland, Council and Board); 2017-2021 (5-year aggregate for other areas) Figure 4: Female life expectancy at birth over time
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NHS Highland, Public Health Intelligence team 2023 9 Table 4: Female life expectancy at birth by intermediate geography in the area Significance Life Expectancy Lower bound Upper bound Scotland Council Garelochhead 84.6 82.2 87.0 + Lomond Shore 83.8 81.9 85.7 + Helensburgh Centre 83.4 80.0 86.9 Helensburgh North 82.9 80.9 84.8 Helensburgh West and Rhu 82.4 79.9 85.0 Helensburgh East 80.3 78.0 82.6 Source: ScotPHO Online Profiles 2017-2021 (5-year aggregate) Figure 5: Female life expectancy at birth by intermediate geography
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NHS Highland, Public Health Intelligence team 2023 10 Figure 6: Variation in female life expectancy associated with income deprivation by intermediate geography
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NHS Highland, Public Health Intelligence team 2023 11 Health and income The Scottish Index of Multiple Deprivation (SIMD) health domain combines multiple population health measures to create a summary statistic for every small area (datazone) in Scotland. Areas are ranked from 1 (most deprived) to 6976 (least deprived). The SIMD income domain ranks datazones by estimating the proportion of the population who are income deprived. We highlight the correlation between the ranking of areas on the health and income domains. Those most income-deprived areas are also more likely to be amongst the most overall health deprived. Figure 7: Health domain rank by income domain rank for datazone geography
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NHS Highland, Public Health Intelligence team 2023 12 Table 5: Datazones in the most health deprived 20 percent in Scotland by area Total number of data zones in the area Areas in the 20% most deprived in Scotland Local share of the 20% most deprived areas in Scotland Argyll and Bute 125 11 8.8% Bute and Cowal 33 5 15.2% Helensburgh and Lomond 36 3 8.3% Mid-Argyll, Kintyre and Islay 29 2 6.9% Oban, Lorn and the Isles 27 1 3.7% Source: SIMD 2020v2 Table 6: Helensburgh and Lomond datazones within the most health deprived 20 percent in Scotland Datazone Intermediate zone Datazone name S01007399 Helensburgh East Helensburgh East - 02 S01007398 Helensburgh East Helensburgh East - 01 S01007395 Helensburgh Centre Helensburgh Centre - 02 Source: SIMD 2020v2
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NHS Highland, Public Health Intelligence team 2023 13 Mortality Mortality data provides information on causes of death and provides valuable insights into the general health of an entire population. The primary source of death data in Scotland (death registrations) is the National Records of Scotland (NRS). Table 7: Average annual deaths all ages by sex Number Percent Female 143 50.8 Male 139 49.2 Total 282 100.0 Source: National Records of Scotland; 2019-2021 Figure 8: Average annual deaths by age group and sex
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NHS Highland, Public Health Intelligence team 2023 14 Deaths by Age Group and Sex The number of deaths in an area depends on the population’s size, health, and external factors, e.g. traffic accidents and the environment. The number of deaths generally increases with age. We highlight all-cause mortality in those aged 15-44. Deaths in this age range typically result from external causes that are most likely preventable. Table 8: Deaths aged 15-44 years by area Significance Average number Rate Lower bound Upper bound Scotland Council Argyll and Bute 26 101.8 65.9 150.2 NHS Highland 117 115.5 95.4 138.4 Scotland 2,300 117.1 112.4 122.1 Bute and Cowal 8 149.0 61.1 302.5 Oban, Lorn and the Isles 7 109.7 42.7 229.9 Mid-Argyll, Kintyre and Islay 5 94.8 30.3 221.6 Helensburgh and Lomond 7 73.7 26.8 159.1 Source: ScotPHO Online Profiles; annual data calculated from 3 year time period, 2019-2021 Age-sex standardised rate per 100,000 population.
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NHS Highland, Public Health Intelligence team 2023 15 Table 9: Deaths aged 15-44 years by intermediate geography in the area Significance Average number Rate Lower bound Upper bound Scotland Council Helensburgh East 1.7 149.2 8.4 609.0 Helensburgh Centre 1.3 143.0 6.0 658.4 Helensburgh North 1.3 120.9 4.5 558.9 Lomond Shore 0.3 60.2 0.0 784.5 Helensburgh West and Rhu 0.7 36.9 0.0 275.3 Garelochhead 0.7 35.8 0.0 267.1 Source: ScotPHO Online Profiles; annual data calculated from 3 year time period, 2019-2021 Age-sex standardised rate per 100,000 population. Figure 9: Deaths aged 15-44 years by intermediate geography in the area
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NHS Highland, Public Health Intelligence team 2023 16 Figure 10: Deaths aged 15-44 years by income deprivation rank for intermediate geography
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NHS Highland, Public Health Intelligence team 2023 17 Leading causes of death The leading cause of death analysis uses a World Health Organisation (WHO) categorisation. There are over 60 categories, and cancers are reported according to the site. Lung, breast and bowel cancers are therefore assigned and counted separately. If all cancers were grouped, cancer would account for the most significant cause of death. Ischaemic heart disease, chronic lower respiratory diseases (including chronic obstructive pulmonary disease, COPD) and cerebrovascular disease (including stroke) are among the leading causes of death. Over recent years, the number of deaths caused by dementia and Alzheimer’s disease has increased. Figure 11: Top ten causes of death in the area
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NHS Highland, Public Health Intelligence team 2023 18 Table 10: Top ten causes of death in the area in 2019-2021 compared to 2001-2003 2019- 2021 2001- 2003 Percent change Dementia and Alzheimer’s disease 104 48 117 Other 101 95 6 Ischaemic heart diseases 78 175 -55 Malignant neoplasm of trachea, bronchus and lung 54 51 6 Cerebrovascular diseases 51 83 -39 Covid-19 40 Malignant neoplasm of colon, sigmoid, rectum and anus 27 25 8 Chronic lower respiratory diseases 25 43 -42 Influenza and pneumonia 20 42 -52 Symptoms, signs and ill-defined conditions 20 Source: National Records of Scotland; number of deaths over 3-year period Figure 12: Top ten causes of death in the area in 2019-2021 compared to 2001-2003
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NHS Highland, Public Health Intelligence team 2023 19 Cause specific early deaths Early deaths from cancer, coronary heart disease (CHD) and deaths from suicide, although not all preventable, can be influenced by appropriate interventions, provision of services and changes in health-related behaviours. Early deaths from cancer Table 11: Early deaths from cancer by area Significance Average number Rate Lower bound Upper bound Scotland Council Argyll and Bute 146 143.2 120.6 168.8 NHS Highland 501 141.3 129.1 154.3 Scotland 7,677 149.6 146.2 153.0 Oban, Lorn and the Isles 38 166.6 117.0 229.8 Bute and Cowal 41 151.3 107.0 207.4 Mid-Argyll, Kintyre and Islay 34 140.6 96.9 196.9 Helensburgh and Lomond 34 119.6 82.2 168.0 Source: ScotPHO Online Profiles; annual data calculated over 3 year time period, 2019-2021 Age-sex standardised rate per 100,000 population Early deaths are defined as those occurring in people aged under 75 years.
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NHS Highland, Public Health Intelligence team 2023 20 Figure 13: Early deaths from cancer over time Table 12: Early deaths from cancer by intermediate geography in the area Significance Average number Rate Lower bound Upper bound Scotland Council Helensburgh East 7.7 200.4 83.7 401.8 Helensburgh North 5.3 127.5 39.1 297.6 Helensburgh West and Rhu 5.7 115.7 40.2 258.0 Lomond Shore 4.3 110.3 31.4 273.7 Helensburgh Centre 3.7 98.8 23.4 265.5 Garelochhead 4.7 77.1 23.3 185.6 Source: ScotPHO Online Profiles; annual data calculated over 3 year time period, 2019-2021 Age-sex standardised rate per 100,000 population Early deaths are defined as those occurring in people aged under 75 years.
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NHS Highland, Public Health Intelligence team 2023 21 Figure 14: Early deaths from cancer by intermediate geography in the area Figure 15: Early deaths from cancer by income deprivation rank for intermediate geography
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NHS Highland, Public Health Intelligence team 2023 22 Early deaths from coronary heart disease (CHD) Table 13: Early deaths from coronary heart disease by area Significance Average number Rate Lower bound Upper bound Scotland Council Argyll and Bute 49 50.0 36.8 66.3 NHS Highland 159 45.9 39.0 53.7 Scotland 2,528 50.6 48.6 52.6 Bute and Cowal 16 62.2 34.1 103.6 Mid-Argyll, Kintyre and Islay 14 59.3 31.2 101.7 Helensburgh and Lomond 12 41.3 20.8 73.3 Oban, Lorn and the Isles 9 41.2 18.6 78.4 Source: ScotPHO Online Profiles; annual data calculated over 3 year time period, 2018-2020 Age-sex standardised rate per 100,000 population Early deaths are defined as those occurring in people aged under 75 years.
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NHS Highland, Public Health Intelligence team 2023 23 Figure 16: Early deaths from coronary heart disease over time Table 14: Early deaths from coronary heart disease by intermediate geography in the area Significance Average number Rate Lower bound Upper bound Scotland Council Helensburgh Centre 2.3 67.5 9.1 225.9 Lomond Shore 2.0 52.5 5.8 189.8 Garelochhead 3.0 48.9 9.8 142.9 Helensburgh West and Rhu 1.7 33.6 2.5 135.3 Helensburgh East 1.0 28.5 0.3 158.7 Helensburgh North 1.0 23.3 0.3 130.0 Source: ScotPHO Online Profiles; annual data calculated over 3 year time period, 2018-2020 Age-sex standardised rate per 100,000 population Early deaths are defined as those occurring in people aged under 75 years.
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NHS Highland, Public Health Intelligence team 2023 24 Figure 17: Early deaths from coronary heart disease by intermediate geography in the area Figure 18: Early deaths from coronary heart disease by income deprivation rank for intermediate geography
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NHS Highland, Public Health Intelligence team 2023 25 Deaths from suicide Table 15: Deaths from suicide by area Significance Average number Rate Lower bound Upper bound Scotland Council Argyll and Bute 13 15.5 8.1 26.8 NHS Highland 62 19.8 15.1 25.5 Scotland 759 14.1 13.1 15.2 Oban, Lorn and the Isles 20.6 5.3 53.2 Bute and Cowal 15.1 2.3 45.8 Mid-Argyll, Kintyre and Islay 14.7 2.5 43.8 Helensburgh and Lomond 11.6 2.2 34.0 Source: ScotPHO Online Profiles; annual data calculated over 5 year time period, 2017-2021 Age-sex standardised rate per 100,000 population. Some potentially disclosive values have been suppressed. Figure 19: Deaths from suicide over time
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NHS Highland, Public Health Intelligence team 2023 26 Chronic disease and long-term conditions As life expectancy has improved, the number of people living to older ages with chronic diseases and long-term conditions has increased7. This section looks at the number of people recorded with or estimated to have selected common conditions and those hospitalised as a result. Cancer registrations Most cancer cases occur in older age groups. Therefore, we show age and sex-standardised rates to allow a fairer comparison of cancer registration across areas and between periods. The differences in rates between areas might still be due to other influencing factors rather than an actual difference in cancer incidence. Higher levels of deprivation are associated with some types of cancer8. Differences in smoking prevalence and other risk factors may also contribute. Table 16: Cancer registrations by area Significance Average number Rate Lower bound Upper bound Scotland Council Argyll and Bute 626 592.6 545.9 642.2 NHS Highland 2,217 601.0 575.8 626.9 Scotland 33,473 625.2 618.4 632.0 Oban, Lorn and the Isles 142 637.7 532.8 756.7 Bute and Cowal 173 601.7 511.2 703.0 Helensburgh and Lomond 174 598.5 511.5 695.8 Mid-Argyll, Kintyre and Islay 138 550.9 459.8 654.3 Source: ScotPHO Online Profiles; annual data calculated over 3 year time period, 2018-2020 Age-sex standardised rate per 100,000 population.
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NHS Highland, Public Health Intelligence team 2023 27 Figure 20: Cancer registrations over time
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NHS Highland, Public Health Intelligence team 2023 28 Type 2 diabetes prevalence Type 2 diabetes is an important cause of morbidity. The condition is progressive and increases the risk of coronary heart disease and other health problems. Type 2 diabetes is more common at older ages and in deprived areas. Prevalence of type 2 diabetes is linked to continuing inequalities in diet, weight and physical activity that need to be addressed9. Table 17: Prevalence of type 2 diabetes by area Significance Number on type 2 diabetes register Crude prevalence (%) Age-adjusted prevalence (%) Lower bound Upper bound Health board Council NHS Highland 17,719 5.46 4.59 4.51 4.66 Argyll and Bute 4,902 5.69 4.56 4.42 4.69 Bute and Cowal 1,482 6.99 5.00 4.73 5.26 + + Helensburgh and Lomond 1,256 5.03 4.42 4.17 4.67 Mid-Argyll, Kintyre and Islay 1,193 5.96 4.65 4.38 4.92 Oban, Lorn and the Isles 971 4.85 4.15 3.89 4.41 - - Source: SCI-Diabetes as at January 2023. Age-adjusted prevalence based on direct age-sex standardisation using NRS mid-2021 population estimate for Scotland as the reference population.
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NHS Highland, Public Health Intelligence team 2023 29 Figure 21: Prevalence of type 2 diabetes by intermediate geography in the area
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NHS Highland, Public Health Intelligence team 2023 30 Coronary Heart Disease (CHD) patient hospitalisation Table 18: Coronary heart disease patient hospitalisations by area Significance Average number Rate Lower bound Upper bound Scotland Council Argyll and Bute 381 358.4 322.6 397.1 NHS Highland 1,274 341.8 323.0 361.3 Scotland 18,414 341.6 336.6 346.6 Oban, Lorn and the Isles 110 485.8 396.2 589.1 + Mid-Argyll, Kintyre and Islay 89 352.2 281.1 435.4 Helensburgh and Lomond 96 324.4 262.0 397.0 Bute and Cowal 86 311.3 245.7 388.2 Source: ScotPHO Online Profiles; annual data calculated over 3 year time period, 2019/20-2021/22 Age-sex standardised rate per 100,000 population. Figure 22: Coronary heart disease patient hospitalisations over time
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NHS Highland, Public Health Intelligence team 2023 31 Table 19: Coronary heart disease patient hospitalisations by intermediate geography in the area Significance Average number Rate Lower bound Upper bound Scotland Council Garelochhead 25.7 445.3 282.9 663.6 Helensburgh East 15.3 383.9 213.3 634.1 Helensburgh Centre 14.3 368.1 199.5 618.9 Lomond Shore 10.7 296.2 130.9 558.4 Helensburgh North 13.7 261.5 138.5 446.1 Helensburgh West and Rhu 11.3 199.6 99.2 356.6 Source: ScotPHO Online Profiles; annual data calculated over 3 year time period, 2019/20-2021/22 Age-sex standardised rate per 100,000 population. Figure 23: Coronary heart disease patient hospitalisations by intermediate geography in the area
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NHS Highland, Public Health Intelligence team 2023 32 Asthma patient hospitalisation Asthma is a common chronic disease of the small airways in the lung. Public Health Scotland, experimental prevalence data suggests that in 2021/22, 6.3% of the Scottish population registered with a GP had a diagnosis of asthma. The disease can affect anyone but usually begins in childhood. Hospital admission represents a loss of control of a person’s asthma and is a significant adverse outcome. Around three-quarters of emergency, admissions are estimated to be preventable. Higher rates of hospital admission are related to deprivation. Table 20: Asthma patient hospitalisations by area Significance Average number Rate Lower bound Upper bound Scotland Council Argyll and Bute 49 59.1 43.2 78.8 NHS Highland 212 67.9 58.9 77.9 Scotland 3,753 68.4 66.3 70.7 Mid-Argyll, Kintyre and Islay 14 73.3 38.8 124.8 Oban, Lorn and the Isles 12 63.0 32.1 110.8 Bute and Cowal 11 59.2 27.8 108.6 Helensburgh and Lomond 12 47.6 23.7 84.7 Source: ScotPHO Online Profiles; annual data calculated over 3 year time period, 2019/20-2021/22 Age-sex standardised rate per 100,000 population.
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NHS Highland, Public Health Intelligence team 2023 33 Figure 24: Asthma patient hospitalisations over time Table 21: Asthma patient hospitalisations by intermediate geography in the area Significance Average number Rate Lower bound Upper bound Scotland Council Lomond Shore 3.0 126.6 19.3 384.7 Helensburgh Centre 1.7 62.0 0.0 266.8 Helensburgh East 1.7 48.2 3.5 194.1 Helensburgh North 2.0 43.7 2.8 163.8 Garelochhead 2.0 34.3 3.5 124.8 Helensburgh West and Rhu 1.0 20.7 0.3 115.4 Source: ScotPHO Online Profiles; annual data calculated over 3 year time period, 2019/20-2021/22 Age-sex standardised rate per 100,000 population.
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NHS Highland, Public Health Intelligence team 2023 34 Figure 25: Asthma patient hospitalisations by intermediate geography in the area
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NHS Highland, Public Health Intelligence team 2023 35 COPD patient hospitalisation Chronic Obstructive Pulmonary Disease (COPD) is a smoking-related respiratory condition and a significant cause of hospital admission and mortality. The primary treatment is smoking cessation. Table 22: COPD patient hospitalisations by area Significance Average number Rate Lower bound Upper bound Scotland Council Argyll and Bute 138 150.2 125.7 178.0 - NHS Highland 428 134.6 122.0 148.1 - Scotland 9,463 207.4 203.2 211.7 + Oban, Lorn and the Isles 34 165.5 113.7 232.5 Bute and Cowal 38 152.2 106.5 210.5 Mid-Argyll, Kintyre and Islay 32 143.0 96.5 203.7 Helensburgh and Lomond 35 139.6 96.5 195.2 - Source: ScotPHO Online Profiles; annual data calculated over 3 year time period, 2019/20-2021/22 Age-sex standardised rate per 100,000 population. Figure 26: COPD patient hospitalisations over time
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NHS Highland, Public Health Intelligence team 2023 36 Table 23: COPD patient hospitalisations by intermediate geography in the area Significance Average number Rate Lower bound Upper bound Scotland Council Helensburgh East 9.3 279.3 124.5 532.9 Helensburgh Centre 8.0 228.2 93.9 457.2 Garelochhead 8.0 185.5 74.4 374.9 Helensburgh North 4.7 115.4 31.7 284.2 Helensburgh West and Rhu 2.7 53.5 9.0 166.5 - Lomond Shore 1.7 47.2 3.5 189.9 - Source: ScotPHO Online Profiles; annual data calculated over 3 year time period, 2019/20-2021/22 Age-sex standardised rate per 100,000 population. Figure 27: COPD patient hospitalisation by intermediate geography in the area
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NHS Highland, Public Health Intelligence team 2023 37 Dementia and frailty Dementia and frailty are a major cause of disability and dependency among older people. Frailty is a state of health and is related to the ageing process. It refers to a person’s mental and physical vulnerability and ability to recover from changes in health resulting from relatively minor injury and illness10. Prevalence estimates are based on recent population studies11 12. Being able to identify and assess dementia and frailty allows early intervention to increase independence, slow progression and reduce the risk of adverse outcomes. Table 24: Estimated prevalence of frailty in people aged 60 and over by area Significance Estimated number Crude prevalence (%) Lower bound Upper bound Health board Council NHS Highland 14,707 14.35 14.14 14.57 Argyll and Bute 4,274 14.41 14.01 14.81 Bute and Cowal 1,230 14.47 13.74 15.23 Helensburgh and Lomond 1,124 14.53 13.76 15.33 Mid-Argyll, Kintyre and Islay 1,032 14.58 13.78 15.42 Oban, Lorn and the Isles 889 13.99 13.16 14.86 Source: Gale C et al. Age-sex specific prevalence of frailty for people living in the community applied to NRS mid-2021 population estimates. Excludes residential care homes.
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NHS Highland, Public Health Intelligence team 2023 38 Figure 28: Estimated prevalence of frailty in people aged 60 and over by area
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NHS Highland, Public Health Intelligence team 2023 39 Table 25: Estimated prevalence of dementia by area Significance Estimated number Crude prevalence (%) Lower bound Upper bound Health board Council NHS Highland 6,242 1.92 1.88 1.97 - Argyll and Bute 1,810 2.10 2.01 2.20 + Bute and Cowal 516 2.43 2.23 2.65 + + Helensburgh and Lomond 483 1.93 1.77 2.11 Mid-Argyll, Kintyre and Islay 441 2.20 2.01 2.41 + Oban, Lorn and the Isles 371 1.85 1.68 2.05 Source: Alzheimer Europe. Age-sex specific prevalence of dementia applied to NRS mid-2021 population estimates. Figure 29: Estimated prevalence of dementia by area
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NHS Highland, Public Health Intelligence team 2023 40 Population prescribed drugs for anxiety, depression or psychosis The data are derived from prescriptions dispensed in the community. The prescribing rate has increased over the period, with higher levels seen with increasing levels of deprivation. Table 26: Population prescribed drugs for anxiety, depression or psychosis by area Significance Number Percent of population Lower bound Upper bound Scotland Council Argyll and Bute 16,081 18.8 18.6 19.1 - NHS Highland 57,125 17.8 17.7 17.9 - - Scotland 1,054,374 19.3 19.3 19.3 + Bute and Cowal 4,587 22.9 22.4 23.5 + + Mid-Argyll, Kintyre and Islay 3,894 19.6 19.1 20.1 Oban, Lorn and the Isles 3,465 17.5 16.9 18.0 - - Helensburgh and Lomond 4,135 16.1 15.6 16.5 - - Source: ScotPHO Online Profiles; 2020/21 Figure 30: Population prescribed drugs for anxiety, depression or psychosis over time
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NHS Highland, Public Health Intelligence team 2023 41 Psychiatric patient hospitalisations The indicator only includes patients treated in a psychiatric hospital or unit. There has been a long- term strategic shift in the care of people with mental health problems from inpatient treatment towards various forms of community care. Patients discharged from psychiatric specialties will have a range of diagnoses recorded. More common diagnoses will include mood (affective) disorders, diagnosis of schizophrenia and delusional disorders, mental disorders due to substance misuse and organic mental disorders, including conditions like dementia and delirium which predominantly affect older people. There is a profound socio-economic gradient with psychiatric admission rates known to increase with area deprivation. Table 27: Psychiatric patient hospitalisations by area Significance Number Rate Lower bound Upper bound Scotland Council Argyll and Bute 146 177.3 148.8 209.6 - NHS Highland 573 181.2 166.4 196.9 - Scotland 12,442 229.8 225.8 233.9 + Mid-Argyll, Kintyre and Islay 38 197.9 137.4 275.1 Helensburgh and Lomond 48 189.6 137.6 254.3 Bute and Cowal 30 165.3 108.0 240.6 Oban, Lorn and the Isles 31 164.1 110.6 234.1 Source: ScotPHO Online Profiles; annual data calculated over 3 year time period, 2019/20-2021/22 Age-sex standardised rate per 100,000 population.
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NHS Highland, Public Health Intelligence team 2023 42 Figure 31: Psychiatric patient hospitalisations over time Harm to health from alcohol and drug use Reducing the use of and harm from alcohol, drugs and other substances is a national public health priority9. There is no safe level of drinking alcohol and no completely safe level of drug use. People’s use of alcohol and drugs may incur harm from many issues. Alcohol and drug use can have a significant impact on physical and mental health, as well as long- term social impacts, including family break-ups, domestic abuse, unemployment, homelessness and financial problems. There are increased risks of accidents, injuries, violence and antisocial behaviour. Substance use by parents and carers can also have a huge adverse effect on children and young people’s health and wellbeing. There is a clear socio-economic gradient with alcohol and drug-related admission rates known to increase with area deprivation. For many people, multiple disadvantage contributes to substance use, which in turn contributes to further disadvantage.
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NHS Highland, Public Health Intelligence team 2023 43 Alcohol-related hospital admissions Table 28: Alcohol-related hospital admissions by area Significance Number Rate Lower bound Upper bound Scotland Council Argyll and Bute 468 524.9 476.8 576.4 - NHS Highland 1,974 606.5 579.6 634.4 + Scotland 33,432 621.3 614.6 628.0 + Bute and Cowal 108 556.0 448.5 680.1 Helensburgh and Lomond 150 552.9 465.5 651.5 Mid-Argyll, Kintyre and Islay 108 532.6 432.0 648.9 Oban, Lorn and the Isles 105 505.9 411.9 614.4 - Source: ScotPHO Online Profiles; 2020/21 Age-sex standardised rate per 100,000 population Figure 32: Alcohol-related hospital admissions over time
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NHS Highland, Public Health Intelligence team 2023 44 Table 29: Alcohol-related hospital admissions by intermediate geography in the area Significance Number Rate Lower bound Upper bound Scotland Council Helensburgh East 36 913.8 637.2 1,268.5 + + Helensburgh Centre 30 882.7 586.6 1,271.7 + Garelochhead 36 605.2 413.4 852.2 Lomond Shore 18 514.0 294.0 827.3 Helensburgh West and Rhu 15 366.6 192.4 623.2 Helensburgh North 9 234.0 99.9 449.9 - - Source: ScotPHO Online Profiles; 2020/21 Age-sex standardised rate per 100,000 population Figure 33: Alcohol-related hospital admissions by intermediate geography in the area
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NHS Highland, Public Health Intelligence team 2023 45 Figure 34: Alcohol-related hospital admissions by income deprivation rank for intermediate geography
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NHS Highland, Public Health Intelligence team 2023 46 Alcohol-specific deaths Table 30: Alcohol-specific deaths by area Significance Average number Rate Lower bound Upper bound Scotland Council Argyll and Bute 21.6 21.9 13.4 33.5 NHS Highland 78.6 22.1 17.5 27.7 Scotland 1,116.2 20.8 19.6 22.1 Mid-Argyll, Kintyre and Islay 7.4 30.1 12.1 61.4 Helensburgh and Lomond 6.2 22.0 8.1 47.5 Oban, Lorn and the Isles 4.4 21.4 5.4 54.1 Bute and Cowal 3.6 16.0 3.2 44.4 Source: ScotPHO Online Profiles; annual data calculated from 5 year time period, 2016-2020 Age-sex standardised rate per 100,000 population Figure 35: Alcohol-specific deaths over time
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NHS Highland, Public Health Intelligence team 2023 47 Drug-related hospital admissions Table 31: Drug-related hospital admissions by area Significance Average number Rate Lower bound Upper bound Scotland Council Argyll and Bute 111 153.2 125.4 185.2 - NHS Highland 384 134.9 121.7 149.2 - Scotland 12,099 228.3 224.2 232.4 + Oban, Lorn and the Isles 36 215.7 150.3 299.8 Bute and Cowal 30 201.8 135.2 288.6 Helensburgh and Lomond 30 135.4 90.5 194.2 - Mid-Argyll, Kintyre and Islay 12 80.0 41.5 138.8 - Source: ScotPHO Online Profiles; annual data calculated over 3 year time period, 2019/20-2021/22 Age-sex standardised rate per 100,000 population. Figure 36: Drug-related hospital admissions over time
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NHS Highland, Public Health Intelligence team 2023 48 External causes of harm to health External causes are a common cause of harm to health. They include accidents and unintentional injuries that occur in diverse settings, including the home, the workplace, leisure and sports activities and road transportation. The road traffic accident indicator only includes people admitted or who dies as a result of a road traffic accident. Road traffic accidents that result in slight injury, serious injury or death have been reducing over the last decade. Effective accident prevention requires multi-agency action within national and local policy and plans. Road traffic accident patient hospitalisations Table 32: Road traffic accident patient hospitalisations by area Significance Average number Rate Lower bound Upper bound Scotland Council Argyll and Bute 54 63.5 47.2 83.6 NHS Highland 224 70.5 61.4 80.6 + Scotland 3,103 57.3 55.3 59.4 Mid-Argyll, Kintyre and Islay 17 89.5 49.7 147.2 Oban, Lorn and the Isles 13 65.4 34.0 113.3 Bute and Cowal 12 57.8 27.2 105.3 Helensburgh and Lomond 13 49.9 25.9 86.3 Source: ScotPHO Online Profiles; annual data calculated from 3 year time period, 2018-2020 Age-sex standardised rate per 100,000 population.
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NHS Highland, Public Health Intelligence team 2023 49 Figure 37: Road traffic accident patient hospitalisations over time Table 33: Road traffic accident patient hospitalisations by intermediate geography in the area Significance Average number Rate Lower bound Upper bound Scotland Council Helensburgh West and Rhu 3.0 62.4 11.7 184.3 Helensburgh East 2.0 60.6 6.5 219.6 Helensburgh North 2.0 50.5 1.3 195.1 Helensburgh Centre 1.3 43.2 0.5 204.0 Garelochhead 3.3 38.8 4.8 116.8 Lomond Shore 0.3 27.3 0.0 355.9 Source: ScotPHO Online Profiles; annual data calculated from 3 year time period, 2018-2020 Age-sex standardised rate per 100,000 population.
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NHS Highland, Public Health Intelligence team 2023 50 Figure 38: Road traffic accident patient hospitalisations by intermediate geography in the area Emergency care Emergency patient hospitalisations An emergency admission is when a person is admitted to a hospital urgently and unexpectedly. Emergency admissions often occur via Accident and Emergency departments but can result directly from a GP consultation or consultant clinic. Emergency admission rates are highest in the very young and old. Generally, rates increase with patient age from young adulthood and are related to deprivation. A proportion of emergency hospital admissions are likely to be preventable. High emergency or multiple admissions rates can also indicate that primary and community services may be stressed or not in place to prevent hospital admission. Reducing emergency admission rates would indicate that people are being supported in managing their care appropriately at home with less reliance on hospital use. Work to achieve this includes health improvement and prevention, reducing accidents, improving home safety, and providing support to carers and social care.
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NHS Highland, Public Health Intelligence team 2023 51 Table 34: Emergency patient hospitalisations by area Significance Average number Rate Lower bound Upper bound Scotland Council Argyll and Bute 5,934 6,296.3 6,130.5 6,465.3 - NHS Highland 23,183 6,858.8 6,768.9 6,949.6 - + Scotland 392,280 7,234.0 7,211.1 7,257.0 + Bute and Cowal 1,583 6,828.9 6,468.1 7,203.4 - + Oban, Lorn and the Isles 1,385 6,569.8 6,216.4 6,937.6 - Mid-Argyll, Kintyre and Islay 1,414 6,336.3 5,994.2 6,692.1 - Helensburgh and Lomond 1,560 5,855.1 5,558.8 6,162.7 - Source: ScotPHO Online Profiles; annual data calculated from 3 year time period, 2019-2021 Age-sex standardised rate per 100,000 population. Figure 39: Emergency patient hospitalisations over time
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NHS Highland, Public Health Intelligence team 2023 52 Table 35: Emergency patient hospitalisations by intermediate geography in the area Significance Average number Rate Lower bound Upper bound Scotland Council Helensburgh East 291 7,652.4 6,773.5 8,611.1 + Helensburgh Centre 219 6,561.9 5,645.4 7,575.2 Garelochhead 329 6,095.1 5,412.4 6,836.1 - Lomond Shore 172 5,817.6 4,881.9 6,865.5 - Helensburgh West and Rhu 261 5,406.0 4,729.2 6,147.9 - Helensburgh North 241 4,956.4 4,308.0 5,669.7 - - Source: ScotPHO Online Profiles; annual data calculated from 3 year time period, 2019-2021 Age-sex standardised rate per 100,000 population. Figure 40: Emergency patient hospitalisations by intermediate geography in the area
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NHS Highland, Public Health Intelligence team 2023 53 Figure 41: Emergency patient hospitalisations by income deprivation rank for intermediate geography
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NHS Highland, Public Health Intelligence team 2023 54 Patients 65 years and over with multiple emergency hospital admissions While adjusted for age and sex differences, rates of patients with multiple emergency admissions may vary because of deprivation, patient case mix, and the availability of health and social care. Table 36: Patients 65 years and over with multiple emergency hospital admissions by area Significance Average number Rate Lower bound Upper bound Scotland Council Argyll and Bute 953 4,398.8 4,115.8 4,695.8 - NHS Highland 3,168 4,251.3 4,101.7 4,404.9 - Scotland 51,625 4,997.9 4,953.9 5,042.3 + Oban, Lorn and the Isles 223 4,956.7 4,300.3 5,681.8 Mid-Argyll, Kintyre and Islay 235 4,472.1 3,903.5 5,098.5 Helensburgh and Lomond 242 4,166.1 3,646.3 4,737.9 - Bute and Cowal 251 4,118.9 3,606.4 4,681.7 - Source: ScotPHO Online Profiles; annual data calculated from 3 year time period, 2019-2021 Age-sex standardised rate per 100,000 population. Figure 42: Patients 65 years and over with multiple emergency hospital admissions over time
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NHS Highland, Public Health Intelligence team 2023 55 Table 37: Patients 65 years and over with multiple emergency hospital admissions by intermediate geography in the area Significance Average number Rate per 100,000 Lower bound Upper bound Scotland Council Helensburgh East 40 5,367.4 3,776.2 7,384.4 Helensburgh Centre 40 5,063.5 3,503.6 7,038.9 Lomond Shore 29 4,915.4 2,976.7 7,479.1 Garelochhead 42 4,318.9 3,045.4 5,922.4 Helensburgh West and Rhu 41 3,503.0 2,505.0 4,761.9 - Helensburgh North 38 3,128.3 2,180.7 4,334.5 - Source: ScotPHO Online Profiles; annual data calculated from 3 year time period, 2019-2021 Age-sex standardised rate per 100,000 population. Figure 43: Patients 65 years and over with multiple emergency hospital admissions by intermediate geography in the area
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NHS Highland, Public Health Intelligence team 2023 56 End of life care Place of death Understanding mortality patterns and place of death is important to help provide appropriate care and resources. A 2012 report found that most people prefer not to die in a hospital but at home, in a care home or a hospice13. The proportion of deaths occurring outside of hospitals has increased in recent years. Patterns of the place of death changed further during the COVID-19 pandemic, with increased deaths at home during and between pandemic waves. If this pattern is sustained, primary, community and palliative care resources will be needed to support families and individuals at home. Table 38: Deaths by place of death over time Percentage Hospital Care Home Home / Non- institution Hospice Other places Average annual number of deaths 2001- 2003 55.8 19.0 24.4 0.7 0.1 277.7 2004- 2006 52.8 20.2 26.3 0.7 0.0 285.3 2007- 2009 48.3 21.8 28.6 1.3 0.0 276.3 2010- 2012 48.0 20.2 29.4 2.4 0.0 266.7 2013- 2015 46.7 18.8 31.8 2.4 0.3 259.0 2016- 2018 40.0 24.8 33.2 2.1 0.0 276.0 2019- 2021 37.5 20.4 40.7 1.3 0.1 281.7 Source: National Records of Scotland; 2019-2021
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NHS Highland, Public Health Intelligence team 2023 57 Table 39: Deaths by place of death Percentage Hospital Care Home Home / Non- institution Hospice Other places Average annual number of deaths Helensburgh and Lomond 37.5 20.4 40.7 1.3 0.1 282 Argyll and Bute 44.5 14.6 40.4 0.6 0.0 1,133 Source: National Records of Scotland; 2019-2021 Figure 44: Deaths by place of death
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NHS Highland, Public Health Intelligence team 2023 58 Dementia and place of death Patterns of the place of death vary by cause, sex, age and geographical location. The ageing of the population is projected to lead to an increase in dementia cases. Dementia is already a leading cause of death among all diseases and one of the most significant causes of disability and dependence among older people. Understanding the place of death of people with dementia is essential for the organisation and provision of end-of-life care that could help patients with dementia avoid dying in a hospital and support carers and families. Table 40: Dementia deaths in a homely setting as a percentage of all dementia deaths Significance Average annual number Percentage Lower bound Upper bound Council Argyll and Bute 102 81.8 77.6 85.4 Bute and Cowal 27 77.4 68.5 84.3 Helensburgh and Lomond 31 90.4 83.2 94.7 Mid-Argyll, Kintyre and Islay 22 76.7 66.8 84.4 Oban, Lorn and the Isles 21 82.1 72.1 89.0 Source: National Records of Scotland; 2019-2021 Deaths in a homely setting include deaths at home, in a care home or a hospice location.
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NHS Highland, Public Health Intelligence team 2023 59 Figure 45: Dementia deaths in a homely setting as a percentage of all dementia deaths Table 41: Dementia deaths in a homely setting as a percentage of all deaths in a homely setting Significance Average annual number Percentage Lower bound Upper bound Council Argyll and Bute 102 16.4 14.8 18.1 Bute and Cowal 27 16.3 13.4 19.8 Helensburgh and Lomond 31 18.2 15.1 21.8 Mid-Argyll, Kintyre and Islay 22 15.4 12.3 19.1 Oban, Lorn and the Isles 21 15.2 12.1 18.9 Source: National Records of Scotland; 2019-2021 Deaths in a homely setting include deaths at home, in a care home or a hospice location.
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NHS Highland, Public Health Intelligence team 2023 60 Figure 46: Dementia deaths in a homely setting as a percentage of all deaths in a homely setting
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NHS Highland, Public Health Intelligence team 2023 61 Glossary Term Description Age-sex standardised rate An age-sex standardised rate is a summary measure of the rate that a population would have if it had a standard age structure. Standardised rates are used to allow comparisons across geographical areas by controlling for differences in the age and sex structure of local populations. It is also used when comparing rates for one geography over time. All rates shown are standardised to the European standard population 2013. Confidence Interval (CI) A confidence interval (CI) is a range of values that describes the uncertainty around a point estimate of a quantity, for example a mortality rate, arising from either random or ‘natural’ variation. Confidence intervals quantify the uncertainty in point estimates: the wider the confidence interval the greater the uncertainty. The width of the confidence interval depends upon the size of the population from which an estimate is derived, the degree of variability in the indicator being measured, and the required level of confidence. In public health the conventional practice is to use 95% confidence intervals. Deprivation deciles or quintiles The SIMD deprivation analyses in this report rank datazones from 1 (most deprived) to 6,976 (least deprived). These are then split into five deprivation quintiles with 20% of the datazones in each quintile. Deprivation deciles have 10% of the datazones in each decile. Datazone The datazone is the standard national small area geography used in the production of statistics. There are 6,976 datazones in the 2011 release (125 in Argyll and Bute and 312 in Highland local authorities). Nationally datazones are used as the 'building bricks' for higher level geography such as intermediate zones and are the smallest spatial area that population estimates are published for in the inter-census period. Datazones are used routinely to provide ‘best fit’ populations for local geographies such as Community Partnerships. Details of the mapping are available in the Scottish Health and Social Care Open Data platform. Early deaths An early death is defined as a person dying whilst under the age of 75 years. Early deaths are also known as premature deaths. Emergency patient hospitalisations An emergency admission is one where a patient is admitted to hospital urgently and unexpectedly i.e. the admission is unplanned. Emergency admissions often occur via Accident and Emergency departments but can result directly from a GP consultation or consultant clinic. European Standard population (ESP) The European Standard Population (ESP) is an artificial population structure which is used in the weighting of mortality or incidence data to produce age standardised rates. The current version is the ESP2013, which is based on an average of states' population projections for 2011 - 2030. Intermediate zone Intermediate zones (also referred to as intermediate geographies or neighbourhoods) are constructed from aggregations of data zones and provide a small area geography
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NHS Highland, Public Health Intelligence team 2023 62 that is more suitable for the release of potentially sensitive data and for reporting routine measures of population health. The intermediate zone is the standard spatial unit of analysis used in the Scottish Public Health Observatory online profiles tool. Income deprivation Income deprivation, as defined by the SIMD, is a measure of the percentage of the population (adults and their dependents) in receipt of Income Support, Employment and Support Allowance, Job Seekers Allowance, Guaranteed Pension Credits, and Child and Working Tax Credits. Life expectancy Life expectancy (at birth) is an estimate of the average length of time a newborn can expect to live if the age and sex specific mortality rates of the local population applied throughout their lifetime. It is a theoretical measure as death rates may increase or decrease during a person's lifetime, and people may move to areas with different mortality risks. Long-term conditions Long-term conditions or chronic diseases are conditions for which there is currently no cure, and which are managed with drugs and other treatment, for example: diabetes, chronic obstructive pulmonary disease, arthritis and hypertension. Lower and Upper bounds The lower and upper bounds are the lower and upper limits of a 95% confidence interval. They represent the range of values between which the true value of a point estimate is expected to fall within. Morbidity Morbidity refers to the extent of illness (disease, injury or disability) in a given population. Palliative care Palliative care is about improving the quality of life of anyone facing a life-threatening condition. It includes physical, emotional and spiritual care. Population estimates The size of the population estimated on an annual basis, using 30th June (mid-year) as a reference point. Scotland’s Census is used as a base for the population estimates, with annual adjustments made for the number of births, deaths and estimates of migration. National Records of Scotland (NRS) are responsible for producing official population figures for Scotland. Prevalence Prevalence describes the proportion of a population with a particular disease or health condition at a given point in time or over a specified time period. SCI-Diabetes Scottish Care Information – Diabetes (SCI-Diabetes) is NHS Scotland’s diabetes patient management system. It provides a fully integrated shared electronic patient record to support treatment of people with diabetes. ScotPHO profiles tool The Scottish Public Health Observatory (ScotPHO) collaboration is led by Public Health Scotland. ScotPHO’s online profiles tool present a range of indicators intended to increase understanding of local health issues. The online profiles and indicator definitions are available at the following URL: https://scotland.shinyapps.io/ScotPHO_profiles_tool/ Scottish Index of Multiple Deprivation (SIMD) The Scottish Index of Multiple Deprivation (SIMD) identifies small area concentrations of deprivation. The latest version is the SIMD 2020 and is based on small areas called datazones. The SIMD is a measure of relative deprivation and takes
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NHS Highland, Public Health Intelligence team 2023 63 account of indicators across seven domains: income, employment, education, health, access to services, crime and housing. The seven domains are combined into a single index score and ranked. Statistical significance of differences Confidence intervals are used to interpret whether a measure is statistically higher or lower than another. If the confidence intervals of one particular area have no overlap with a comparison area confidence interval then it is statistically significantly higher/lower than the comparison. If there is overlap then there is no statistically significant difference between them. Statistical significance of differences are indicated by a + or - in the tables in this report.
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NHS Highland, Public Health Intelligence team 2023 64 References 1 Scottish Government. Scottish Index of Multiple Deprivation 2020. https://www.gov.scot/collections/scottish-index-of-multiple-deprivation-2020/ 2 NHS Health Scotland. Health Inequalities: what are they? How do we reduce them? Edinburgh: NHS Health Scotland; 2016. https://www.healthscotland.scot/media/1086/health-inequalities-what- are-they-how-do-we-reduce-them-mar16.pdf 3 Thomson J. Rural Deprivation Evidence Summary. Scottish Government. 2016. https://www.gov.scot/binaries/content/documents/govscot/publications/research-and- analysis/2017/02/scottish-index-of-multiple-deprivation-rural-deprivation-evidence-and-case- studies/documents/rural-deprivation-an-evidence-review/rural-deprivation-an-evidence- review/govscot%3Adocument/rural%2Bdeprivation%2Bevidence%2Breview.pdf 4 Scottish Public Health Observatory. Online Profiles Tool. https://scotland.shinyapps.io/ScotPHO_profiles_tool/ 5 Public Health Scotland. Scottish Burden of Disease Study [online]. https://www.scotpho.org.uk/comparative-health/burden-of-disease/overview/ 6 McCartney G, Walsh D, Fenton L, Devine R. Resetting the course for population health: evidence and recommendations to address stalled mortality improvements in Scotland and the rest of the UK. Glasgow; Glasgow Centre for Population Health/University of Glasgow: 2022. URL: https://www.gcph.co.uk/assets/0000/8723/Stalled_Mortality_report_FINAL_WEB.pdf 7 Scottish Burden of Disease study. Forecasting the future burden of disease: Incorporating the impact of demographic transition over the next 20 years. PHS; 2022. URL: https://www.scotpho.org.uk/media/2178/sbod-forecasting-briefing-english-november2022.pdf 8 Cancer Research UK. Cancer in the UK: Deprivation and cancer inequalities in Scotland. 2022. URL: https://www.cancerresearchuk.org/sites/default/files/cancer_in_the_uk_- _deprivation_and_cancer_inequalities_in_scotland.pdf 9 Scottish Government. Public Health Priorities for Scotland. 2018. URL: https://www.gov.scot/publications/scotlands-public-health-priorities/ 10 British Medical Association (BMA). Identification and management of patients with frailty. URL: https://www.bma.org.uk/advice-and-support/gp-practices/gp-service-provision/identification-and- management-of-patients-with-frailty 11 Alzheimer Europe. Dementia in Europe Yearbook 2019: Estimating the prevalence of dementia in Europe. 2019. URL: https://www.alzheimer- europe.org/sites/default/files/alzheimer_europe_dementia_in_europe_yearbook_2019.pdf 12 Gale C, Cooper C, Sayer A. Prevalence of frailty and disability: findings from the English Longitudinal Study of Ageing. Age Ageing. 2015;44(1):162–165. https://doi.org/10.1093/ageing/afu148 13 Georghiou T, Davies S, Davies A and Bardsley M. Understanding patterns of health and social care at the end of life. Research report. Nuffield Trust and National End of Life Care Intelligence Network; 2012. URL: https://www.nuffieldtrust.org.uk/research/understanding-patterns-of-health- and-social-care-at-the-end-of-life