2012 CHD Statistics Compendium

Coronary heart disease statistics
A compendium of health statistics 2012 edition

British Heart Foundation Health Promotion Research Group Department of Public Health, University of Oxford
British Heart Foundation, October 2012 ISBN 978-1-899088-12-6 All rights reserved. No part of this publication may be reproduced or transmitted, in any form or by any means, electronic, photocopying or otherwise without prior permission of the publishers. NHS workers and teachers may make photocopies for education purposes only, provided that no charge or profit is made for any course or event for which they are used. Published by the British Heart Foundation, Greater London House, 180 Hampstead Road, London NW1 7AW www.bhf.org.uk Registered Charity No 225971 Edited by Peter Weissberg, British Heart Foundation Compiled by Nick Townsend, Kremlin Wickramasinghe, Prachi Bhatnagar, Kate Smolina, Mel Nichols, Jose Leal, Ramon LuengoFernandez and Mike Rayner, British Heart Foundation Health Promotion Research Group, Department of Public Health, University of Oxford, Old Rd Campus, Headington, Oxford OX3 7LF http://www.publichealth.ox.ac.uk/bhfhprg Suggested citation: Townsend N, Wickramasinghe K, Bhatnagar P, Smolina K, Nichols M, Leal J, Luengo-Fernandez R, Rayner M (2012). Coronary heart disease statistics 2012 edition. British Heart Foundation: London.
Coronary heart disease statistics A compendium of health statistics 2012 edition
Nick Townsend, Kremlin Wickramasinghe, Prachi Bhatnagar, Kate Smolina, Mel Nichols, Jose Leal, Ramon Luengo-Fernandez and Mike Rayner British Heart Foundation Health Promotion Research Group Department of Public Health, University of Oxford
Coronary heart disease statistics 2012
Contents
Foreword Introduction Summary Glossary Chapter 1 Mortality Targets CVD mortality targets, by country, UK Tracking English CVD target Tracking English CVD inequalities target Tracking Scottish CHD target Tracking Welsh CHD target Deaths by cause Numbers of deaths, by sex and age, UK Numbers of deaths, by sex and country, UK Male deaths, by cause, all ages Female deaths, by cause, all ages Male deaths (premature), by cause, under 75 Female deaths (premature), by cause, under 75 Age-standardised death rates from myocardial infarction, England and Scotland Excess winter mortality Excess winter CVD mortality, by sex, England and Wales Time and geographical trends Age-specific CHD time trends, UK Time trends in myocardial infarction, by sex, England and Scotland Time trends in sudden deaths from myocardial infarction, by sex, England Time trends in CHD, by Government Office Region, UK Time trends in myocardial infarction, by Government Office Region, England CHD deaths and death rates (all ages and premature) by sex and local authority Socio-economic differences CVD, CHD, Stroke mortality rates, by sex and socioeconomic status, England and Wales Time trends in CHD, by sex and deprivation quintile, Great Britain Table 1.12, Figure 1.12 Table 1.13, Figure 1.13a,b 45, 46 47, 48 Table 1.6, Figure 1.6a,b Table 1.7 Table 1.8, Figure 1.8 Table 1.9a,b Table 1.10 Table 1.11, Figure 1.11a,b 24, 25 26 27 28, 29 30 3142 43, 44 Table 1.5 23 Table 1.2 Table 1.3 Figure 1.3a Figure 1.3b Figure 1.3c Figure 1.3d Table 1.4, Figure 1.4 19 20 21 21 21 21 22, 23 Table 1.1 Figure 1.1a Figure 1.1b Figure 1.1c Figure 1.1d 16 17 17 18 18 8 9 10 11 14
British Heart Foundation and University of Oxford
International differences Time trends in CVD death rates, Europe CVD death rates, selected European countries Time trends in CHD death rates, Europe Changes in CHD death rates, selected European countries Chapter 2 Morbidity Incidence Time trends in myocardial infarction, by sex and age, England and Scotland Myocardial infarction, by Government Office Region, England Time trends in hospitalised myocardial infarction, by sex and age, England Myocardial infarction, by sex and age, England Time trends in stroke, by sex and age, England and Scotland Angina, by sex, age and country, UK Heart Failure, by sex, age and country, UK Case-fatality Myocardial infarction, by sex, England and Scotland Time trends in myocardial infarction, by sex and age, England Time trends in myocardial infarction by Government Office Region, England Myocardial infarction, by sex and age, England Stroke, by sex and age, England and Scotland Prevalence CHD, stroke, myocardial infarction, angina, by sex and age, England CHD, stroke, myocardial infarction, angina, by sex and age, Scotland Heart conditions, stroke, myocardial infarction, angina, heart failure, by sex and age, Wales Stroke, myocardial infarction, angina, by sex and age, Northern Ireland Myocardial infarction, stroke, angina, by sex and country, UK Angina, by sex, age and country, UK Heart failure, by sex, age and country, UK CHD, stroke, hypertension by health authority (region), UK Time trend CVD, by sex and age, Great Britain Table 2.13 Table 2.14 Table 2.15 Table 2.16 Figure 2.16a,b,c Table 2.17 Table 2.18 Table 2.19 Table 2.20, Figure 2.20 73 74 75 76 7779 80 81 82 83, 84 Table 2.8 Table 2.9, Figure 2.9 Table 2.10, Figure 2.10 Table 2.11, Figure 2.11 Table 2.12 68 69 70 71 72 Table 2.1, Figure 2.1 Table 2.2, Figure 2.2 Table 2.3, Figure 2.3 Table 2.4, Figure 2.4 Table 2.5, Figure 2.5 Table 2.6 Table 2.7 60, 61 62 63 64 65 66 67 Table 1.14a,b Figure 1.14 Table 1.15a,b Figure 1.15 49 51 52, 53 54 56
Contents (Continued)
Chapter 3 Treatment Prescriptions for CVD Time trends, England Number of prescriptions, by country, UK Revascularisations Time trends in CABGs, PCIs, UK Inpatient episodes Main diagnosis, by sex, England, Scotland and Wales Main diagnosis, England Main diagnosis, Scotland Hospital discharges Time trends for CVD, by country, Europe Time trends for CHD, by country, Europe Time trends for stroke, by country, Europe Smoking cessation Time trends in smoking cessation service outcomes, England, Scotland and Northern Ireland Ambulance services Time trends in responses to emergency calls within eight minutes, England and Scotland Treatment after a heart attack Time trends in thrombolytic treatment and use of secondary prevention medication, England and Wales Chapter 4 Behavioural risk factors Smoking Time trends in smoking prevalence, by sex and age, Great Britain Time trends in smoking prevalence, by sex and age, Northern Ireland Prevalence of cigarette smoking, by sex and region, UK Prevalence of cigarette smoking, by sex and socioeconomic status, Great Britain and Northern Ireland Prevalence of cigarette smoking, by sex, age and ethnic group, England Time trends in prevalence of smoking in young people, by sex and age, England, Scotland, Wales and Northern Ireland Prevalence of tobacco use, by sex and country, the World Table 4.1, Figure 4.1 Table 4.2 Table 4.3 Table 4.4, Figure 4.4a,b Table 4.5 Table 4.6 Table 4.7 110112 113 114 115117 118 119 120 Table 3.10 104 106 Table 3.9 103 Table 3.8 102 Table 3.5 Table 3.6, Figure 3.6 Table 3.7, Figure 3.7 97 98, 99 100, 101 Table 3.4 Figure 3.4a,b Figure 3.4c,d 94 95 96 Table 3.3, Figure 3.3 92, 93 Table 3.1, Figure 3.1 Table 3.2 89, 90 91 86
Diet Time trends in consumption of fat, salt, sugar, fibre, fruit and vegetables, Great Britain Time trends in consumption of selected foods, UK Quality of diet, by sex, UK Consumption of salt, England, Scotland, Wales and UK Consumption of fat, salt, sugar, fibre, fruit and vegetables, by Government Office Region Consumption of fat, salt, sugar, fibre, fruit and vegetables, by income quintile, UK Consumption of fat, salt, sugar, fibre, fruit and vegetables, by ethnic group, UK Time trend in consumption of fruit and vegetables in children, by sex and age, England Total energy available from fat and availability of fruit and vegetables, by country, Europe Physical inactivity Time trends in prevalence, England, Scotland, Wales and Northern Ireland Prevalence, by sex and age, England, Scotland, Wales and Northern Ireland Prevalence, by sex and strategic health authority, England Prevalence, by sex and income quintile, England Prevalence, by sex and ethnic group, England Prevalence in childrens physical activity levels, England and Scotland Prevalence of exercise and sport, by country, European Union Prevalence outside of sport, by country, European Union Alcohol Consumption, by sex and age, Great Britain Time trends in heavy drinking, Great Britain Time trends in consumption in children, by sex and age, England Time trends in consumption in children, by sex and age, Scotland Heavy drinking, by sex and country or region, Great Britain Consumption, by sex and socioeconomic status, Great Britain Consumption, by sex and ethnic group, England Frequency of heavy drinking, by country, European Union Table 4.25, Figure 4.25 Table 4.26, Figure 4.26 Table 4.27 Table 4.28 Table 4.29, Figure 4.29a,b Table 4.30, Figure 4.30 Table 4.31 Table 4.32, Figure 4.32 145, 146 147, 148 149 150 151153 154, 155 156 157, 158 Table 4.17 Table 4.18 Table 4.19 Table 4.20, Figure 4.20 Table 4.21 Table 4.22 Table 4.23, Figure 4.23 Table 4.24, Figure 4.24 135 136 137 138 139 140 141, 142 143, 144 Table 4.8 Table 4.9, Figure 4.9a,b,c Table 4.10 Table 4.11 Table 4.12 Table 4.13, Figure 4.13 Table 4.14 Table 4.15 Table 4.16 124 125127 128 129 130 131 132 133 134
Contents (Continued)
Chapter 5 Medical risk factors Blood pressure Definitions and recommendation for treatment, UK Time trends in prevalence of hypertension, by sex and age, England Blood pressure levels, by sex and age, England Blood pressure levels, by sex and age, Scotland Prevalence of hypertension, by sex and age, Wales Blood pressure levels, by sex and strategic health authority, England Blood pressure levels, by sex and income, England Prevalence of hypertension, by ethnic group, England Prevalence of hypertension, by sex and country, Europe Cholesterol Recommendations and target, UK Time trends in high cholesterol prevalence, England Prevalence of low HDL-cholesterol, by sex and age, England Prevalence of total cholesterol and low HDL-cholesterol, by sex, English Government Office Region and Scotland Prevalence of total cholesterol and low HDL-cholesterol, by sex and income, England Prevalence of total cholesterol and low HDL-cholesterol, by sex and ethnic group, England Obesity Targets, UK Prevalence of BMI status categories, by sex and age, England Prevalence of raised waist circumference, by sex and age, England Overweight and obesity in children, by sex and age, England Prevalence of BMI status categories in children, by sex and school year, England Time trends in prevalence of obesity, by sex and age, England Time trends in prevalence of overweight and obesity in children, by sex, England, Scotland, Wales and Northern Ireland Prevalence of BMI status categories, by sex and Government Office Region, England Prevalence of BMI status categories, by sex and income, England Prevalence of raised waist circumference, by sex and income, England BMI, waist-hip ratio and waist circumference, by sex and ethnic group, England Prevalence of overweight and obese in children, by sex, Europe Table 5.16 Table 5.17, Figure 5.17 Table 5.18 Table 5.19 Table 5.20 Table 5.21, Figure 5.21 Table 5.22, Figure 5.22 Table 5.23 Table 5.24 Table 5.25 Table 5.26, Figure 5.26a,b Table 5.27 181 182, 183 183 184 185 186, 187 188, 189 190 191 191 192, 193 194 Table 5.10 Table 5.11, Figure 5.11 Table 5.12 Table 5.13 Table 5.14 Table 5.15 175 176, 177 177 178 179 180 Table 5.1 Table 5.2, Figure 5.2a,b Table 5.3, Figure 5.3 Table 5.4 Table 5.5 Table 5.6 Table 5.7 Table 5.8 Table 5.9, Figure 5.9 165 166, 167 168, 169 170, 171 172 172 173 173 174, 175 160
Diabetes Prevalence of diagnosed diabetes, by sex and age, England Prevalence of diagnosed diabetes, by sex and age, Scotland Prevalence of diagnosed diabetes, by sex and age, Wales Prevalence of diagnosed diabetes, by sex and age, Northern Ireland Time trends in the prevalence of diagnosed diabetes, by sex and country, UK Prevalence of diagnosed diabetes, by sex and strategic health authority, England Prevalence of diagnosed diabetes, by sex and income, England Prevalence of diagnosed diabetes, by sex and ethnic group, England Time trends in prevalence of diabetes, by country, Europe Chapter 6 Economic costs Health care costs CVD, CHD, stroke, UK Total costs CVD, CHD, stroke, UK International differences in costs CVD, CHD, stroke, by country, European Union Table 6.3 207 Table 6.2 206 Table 6.1, Figure 6.1a,b,c 205 Table 5.28 Table 5.29 Table 5.30 Table 5.31 Table 5.32, Figure 5.32a,b Table 5.33 Table 5.34 Table 5.35, Figure 5.35 Table 5.36 195 195 196 196 197, 198 199 199 200, 201 202 204
Foreword
This latest edition of Coronary Heart Disease Statistics documents major successes in the fight against coronary heart disease (CHD). However, it also highlights areas in which we must continue to make progress if we are to sustain and build on this good work.
Mortality rates from cardiovascular disease (CVD) continue to fall and in this publication we feature data showing that all countries in Great Britain have now reached mortality targets set by their governments. In England, the targets to reduce both premature CVD mortality and the inequality gap by 40% by 2010 were reached in 2005 and 2008 respectively. In Scotland the target to reduce premature CHD mortality by 60% by 2010 was achieved. Whilst in Wales the target of a onethird reduction in CHD mortality in 65 to 74 year olds by 2012 was met in 2006. These targets were achieved as a result of a concerted effort to tackle CVD, which has led to decreases in both the incidence of cardiovascular events and the case fatality associated with these events. Any public health approach to tackle conditions such as CHD must be multifactorial and within this publication we present statistics for a number of factors which will have influenced these mortality rates. In the last decade the treatment has changed dramatically, with huge increases in the prescription of both lipid-lowering and antihypertensive drugs to counter the medical risk factors of CVD. At the same time the use of percutaneous coronary interventions, which improve survival rates after a CHD event, have become more commonplace. We have also seen population changes in behavioural risk factors linked to CVD. The prevalence of regular smoking has fallen dramatically in the last forty years. Over a similar period of time the consumption of dietary fat has decreased, and the intake of fresh fruit has risen. These decreases in the mortality rates are not the only story. CVD still remains the biggest killer in the UK, resulting in more than 45,000 deaths amongst individuals aged less than 75 years in 2010. We still find regional and socioeconomic differences in both incidence and case fatality, along with behavioural inequalities. Regular smoking is more prevalent amongst the lower socioeconomic groups, whilst higher income individuals are more likely to eat fruit and vegetables and take physical activity. The United Kingdom also has one of the highest prevalence of heavy drinking amongst adults in Europe. Although mortality rates have fallen, the prevalence of some of the medical risk factors for CVD, including type 2 diabetes and obesity, has increased. If left unchecked these increases risk undoing the good work of the preceding decades. There are already signs that some of the improvements in behaviour, such as dietary choice, smoking and physical activity, have stalled and it is only with continued resolve that we will be able to maintain these. Although we should celebrate our successes it would be premature and dangerous to rest on our laurels. We must continue to target inequalities where they exist and build on our work by tackling the root causes of coronary heart disease throughout the population. Professor Peter Weissberg Medical Director, British Heart Foundation
Introduction
This is the eighteenth edition of Coronary Heart Disease Statistics published by the British Heart Foundation. The series of publications began over twenty years ago with the aim of documenting the burden of coronary heart disease (CHD) in the United Kingdom. Since then the publication has expanded to include information on other cardiovascular conditions including stroke and heart failure as well as dedicated sections on cardiovascular risk factors.
Coronary Heart Disease Statistics is designed for health professionals, medical researchers and anyone with an interest in CHD. It is a compendium of the latest statistics drawn from a variety of sources including national statistics, hospital episode statistics, national and international surveys and peer-reviewed journal articles. Most of the information that appears in the compendium has been previously published elsewhere, but there are a number of tables and figures that are new to this publication (for example: estimates of the incidence of heart attack by region in England). The compendium is divided into six chapters. Chapter one describes social, ethnic and geographic patterns in mortality from cardiovascular diseases. Chapter two describes the morbidity burden of cardiovascular diseases in the UK, focusing on estimates of incidence, case fatality and prevalence. Chapter three describes treatment levels for cardiovascular diseases. Chapter four details the prevalence of behavioural risk factors for CHD (smoking, poor diet, physical inactivity and alcohol consumption), describing differences in prevalence by social group, ethnicity, geographic region and describing the burden amongst children. Chapter five details the prevalence of medical risk factors for CHD (raised blood pressure, raised cholesterol, overweight and obesity, diabetes), describing differences in prevalence by social group, ethnicity and geographic region. Chapter six provides estimates of the economic costs of cardiovascular diseases to the UK economy and health systems. Wherever possible, the situation in the UK is contrasted with international data. Each chapter contains a set of tables and figures to illustrate key points and a brief review of the data presented. Where appropriate, public health targets for England, Wales, Scotland and Northern Ireland are also presented. All of the tables and figures in the compendium are also available from the British Heart Foundations website at bhf.org.uk/research/statistics.aspx. This website aims to be the most comprehensive and up-to-date source of statistics on cardiovascular disease in the UK. The website is updated on an ongoing basis and contains a wider range of tables and figures than is available in the Coronary Heart Disease Statistics series of publications. Further copies of this publication can be downloaded from the website, as well as copies of recent supplements to the Coronary Heart Disease Statistics series, including: European Cardiovascular Disease Statistics (2012) Physical Activity Statistics (2012) Trends in Coronary Heart Disease, 19612011 (2011) Ethnic Differences in Cardiovascular Disease (2010) Stroke Statistics (2009)
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Summary
In 2010, cardiovascular diseases (CVD) were the UKs biggest killer. In 2010, almost 180,000 people died from CVD around 80,000 of these deaths being from coronary heart disease (CHD) and around 49,000 from strokes. In 2010, CVD caused around 46,000 premature deaths in the UK; 68% of these were men. In recent years CHD death rates have been falling more slowly in younger age groups. In England, death rates from heart attack have halved since 2002. Death rates from CHD are highest in Scotland and lowest in England. Within England, death rates from CHD and heart attacks are highest in the North West and lowest in the South East and South West. Death rates from CHD are highest in areas of greatest deprivation. The incidence of myocardial infarction has decreased in all regions of England; the North West still has the highest incidence rate. There are around 150,000 incidents of stroke every year in the UK. For men the incidence of angina is highest in Wales, for women it is highest in Scotland. It is lowest for both sexes in England. In 2011, around 292 million prescriptions were issued for CVD in England. Over 87,000 percutaneous coronary interventions (PCIs) are now carried out every year in the UK, more than three times as many as a decade ago. In 2010/11, the number of inpatient episodes for CHD was 405,000 in England, 50,200 in Scotland, 24,300 in Wales and 14,600 in Northern Ireland. The prevalence of smoking amongst adults is lower in England (20%) than in Northern Ireland (24%), Scotland (25%) and Wales (25%). Less than one-third of both men and women consume the recommended five or more portions of fruit and vegetables a day. Only around one-fifth of boys and girls aged 5 to 15 consume the recommended five or more portions of fruit and vegetables a day. A higher percentage of men meet government recommendations for physical activity than women, although this is still under half of men in the UK. In 2010, more than a third of men (36%) and over a quarter of women (28%) regularly exceeded the Governments recommended alcohol intake. Around one in three adults in England and Scotland are hypertensive and nearly half of them are not receiving treatment. Around six in ten adults in England have high blood cholesterol levels (5mmol/l or above). More than a quarter of adults in England are obese. Around 30% of boys and girls aged 2-15 years in England and Scotland are overweight or obese. The prevalence of diabetes in the UK is around 5% among women and 6% among men. In 2009, CVD cost the UK health care system 8.7 billion. In 2009, CVD cost the UK economy 19 billion in total. The cost per capita for CVD in the UK is 156, which is lower than average for the European Union.
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Glossary
This section provides a definition for some of the terms used throughout Coronary heart disease statistics 2012 edition. Accelerometer hip mounted motion sensor that measures acceleration in 1, 2 or 3 dimensions. Accelerometers are used as an objective measure of physical activity or exertion. Age standardised rate a measure of the rate that a population would experience if it had a standard age structure. It is useful to present rates as age standardised as it allows for comparisons between populations with very different age structures. Angina the most common form of coronary heart disease. It is characterised by a heaviness or tightness in the centre of the chest which may spread to the arms, neck, jaw, face, back or stomach. Angina occurs when the arteries become so narrow that not enough oxygen-containing blood can reach the heart when its demands are high, such as during exercise. Angioplasty a technique to widen a narrowed or obstructed blood vessel by inflating tightly folded balloons that have been passed into the narrowed location via a catheter. This technique squashes the fatty tissue that has caused the narrowing, hence widening the artery. Atherosclerosis a disease characterised by chronic inflammation in the artery walls. The disease is commonly referred to as hardening or furring of the arteries. Blood pressure Blood pressure is simply the physical pressure of blood in the blood vessels. It is similar to the concept of air pressure in a car tyre. These values are quoted in units known as millimetres of mercury (mmHg). See systolic pressure and diastolic pressure. Body Mass Index (BMI) a formula relating body weight to height to assess whether a person is overweight. BMI is calculated by dividing a persons weight (in kilograms) by their height (in metres) squared. Adults with a BMI of 25-30 are considered to be overweight. Those with a BMI of over 30 are considered obese. British National Formulary (BNF) a publication that provides key information on the selection, prescribing, dispensing and administration of all medicines that are generally prescribed in the UK. Cardiovascular disease (CVD) the collective term for all diseases affecting the circulatory system (heart, arteries, blood vessels). Case fatality rate the ratio of the number of deaths caused by a specified disease to the number of diagnosed cases of that disease, it is commonly expressed as a percentage. Cerebrovascular disease the collective term for all diseases affecting blood vessels that supply the brain. Technically, stroke (and the many subtypes of stroke) is a subset of cerebrovascular disease, but the two terms are often used interchangeably. Coronary Artery Bypass Graft (CABG) an operation to bypass a narrowed section of a coronary artery and improve the blood supply to the heart. Coronary Heart Disease (CHD) the collective term for diseases that occur when the walls of the coronary arteries become narrowed by a gradual build-up of fatty material called atheroma. The two main forms of CHD are heart attack (also known as myocardial infarction) and angina. Diabetes a disease caused by a lack of insulin (type 1) or an increased resistance of the body to insulin (type 2). Diabetes is characterised by high blood glucose levels. The resulting chronic high blood glucose levels (hyperglycaemia) are associated with long-term damage, dysfunction and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels. Diastolic blood pressure A common blood pressure reading might be 120/80 mmHg. The lower pressure (80) represents the pressure in the arteries when the heart is relaxed between beats. This pressure is called diastolic pressure. HDL (High Density Lipoprotein) cholesterol the fraction of cholesterol that removes cholesterol (via the liver) from the blood. Low levels of HDL-cholesterol are associated with an increased risk of atherosclerosis. Heart attack the condition caused by a blockage of one of the coronary arteries when the heart is starved of oxygen. A heart attack usually causes severe pain in the centre of the chest. The pain lasts for more than fifteen minutes, and may last for many hours. The pain usually feels like a heaviness or tightness which may also spread to the arms, neck, jaw, face, back or stomach. There may also be sweating, light-headedness, nausea or shortness of breath. Sometimes a heart attack can be silent and produce little discomfort. Heart failure a clinical syndrome which occurs when the heart is unable to pump enough blood to meet the demands of the body. It occurs because the heart is damaged or overworked. Some people with moderate heart failure may have very few symptoms. People with moderate or severe heart failure suffer from a number of problems, including shortness of breath, general tiredness and swelling of the feet and ankles. Hospital Inpatient Episodes Periods of continuous admitted patient care under the same consultant.
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Glossary (Continued)
Hypertension Hypertension is a clinical condition of having a high blood pressure. Mostly it is considered blood pressures of 140/90 mmHg and greater to be high although this is influenced by other factors. For example, in patients with diabetes, the definition of hypertension is considered by some to be pressures greater than 130/80. Incidence a measure of morbidity based on the number of new episodes of an illness arising in a population over a defined time period. International Classification of Disease (ICD) a coding system published by the World Health Organization that provides an internationally recognised method of coding diseases in order to categorise mortality and morbidity statistics. The ICD is revised approximately every ten years. The tenth and most recent revision (ICD-10) was introduced in 2000. Change between revisions can result in discontinuities in mortality and morbidity trends, such as the move from ICD-9 to ICD-10 which resulted in an artificial increase in the number of reported stroke incidents and mortalities. LDL (Low Density Lipoprotein) cholesterol the more harmful fraction of cholesterol which carries cholesterol from the liver to the cells of the body and causes atherosclerosis. Meta-analysis methods which allow results from a number of different studies to be contrasted and combined. Myocardial infarction (MI) see heart attack. National Statistics Socio-Economic Classification (NS-SEC) a statistical classification based on occupation and details of employment status. Non-Milk Extrinsic Sugars (NMES) generally added sugars that are not integrally present in the cells of food like fruit and vegetables, and that are not naturally present in milk. Non-Starch Polysaccharides (NSP) complex carbohydrates that are the major part of dietary fibre and can be measured more precisely than total dietary fibre. Office of Population, Censuses and Surveys Classification of Surgical Operations and Procedures 4th Revision (OPCS-4) a classification system for surgical operations and procedures conducted in the National Health Service. Percutaneous Coronary Intervention (PCI) A minimally invasive approach to open narrowed coronary arteries (see angioplasty) by accessing them through small needle-size punctures in the skin. Prevalence a measure of morbidity based on the current level of a disease in the population at any particular time. Primary prevention interventions aimed at reducing the risk of disease before the disease has presented. Primary prevention interventions are usually aimed at populations, such as regulation of tobacco advertising. Secondary prevention interventions aimed at reducing the risk of disease recurrence after the disease has initially presented. Secondary prevention interventions are therefore targeted at individuals already at high-risk of disease. Stent a short tube of expandable mesh which is inserted at the part of the artery that is to be widened by coronary angioplasty. It helps to keep the artery open and prevent re-narrowing. Stroke the consequence of an interruption to the flow of blood to the brain. A stroke can vary in severity from a passing weakness or tingling of a limb to a profound paralysis, coma and death. Systolic blood pressure A common blood pressure reading might be 120/80 mmHg. The higher pressure (120) represents the pressure in the arteries when the heart beats, pumping blood into the arteries. This pressure is called systolic pressure. Waist Circumference (WC) a measure of central obesity, where fat is concentrated in the abdomen. For men, central obesity is defined as a waist circumference greater than 102cm. For women, central obesity is defined as a waist circumference of greater than 88cm. Waist to Hip Ratio (WHR) a measure of central obesity, where fat is concentrated mainly in the abdomen. For men, central obesity is defined as a WHR of 0.95 or over. For women, central obesity is defined as a WHR of 0.85 or over.
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1. Mortality
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1. Mortality
This chapter reports on mortality from cardiovascular disease (CVD), coronary heart disease (CHD) and heart attack in the UK. CVD and CHD mortality in the context of mortality from other chronic conditions are presented, as well as seasonal and temporal trends in CHD mortality. Regional, socioeconomic, and international differences are also described. Where possible, the latest data from routinely collected, national datasets have been used.
Public health targets Recent trends indicate that the Our Healthier Nation target, set in 1999, to reduce the death rate from CHD, stroke and related diseases in people under 75 years in England by at least two fifths by 2010 will be met in 2009, the figure was already below the target rate (Table 1.1, Figures 1.1a). The targets in Scotland and Wales have already been reached; the Scottish target for reduction in CVD death rates was met in 2010, and the Welsh target for a reduction in CHD deaths by 2012 was surpassed in 2006 (1.1c and 1.1d). Progress towards the 2010 target for reducing CVD inequalities in England has also been successful. The aim was for a 40% reduction in the gap for death rates between the population as a whole and the 20% of the most deprived areas; this target was met in 2008 (Figure 1.1b). Total mortality Diseases of the heart and circulatory system (cardiovascular disease or CVD) are the main cause of death in the UK and accounted for almost 180,000 deaths in 2010 around one in three of all deaths that year (Table 1.2). The main forms of CVD are CHD and stroke. Almost half (45%) of all CVD deaths are from CHD and over a quarter (28%) are from stroke. CHD by itself is the most common cause of death in the UK. In 2010, just below one in five male deaths and one in ten female deaths were from the disease a total of around 80,000 deaths. Stroke caused almost 50,000 deaths in the UK, and there were a further 49,000 deaths from other circulatory diseases. Acute myocardial infarction (or heart attack) is also a significant cause of death in the UK, with the majority of deaths happening over the age of 85 (Tables 1.3 and 1.4, Figures 1.3a and 1.3b). Premature mortality CVD is one of the main causes of premature death in the UK (death before the age of 75). 28% of premature deaths in men and 19% of premature deaths in women were from CVD in 2010. CVD caused 46,000 premature deaths in the UK in 2010 (Table 1.3, Figures 1.3c and 1.3d). CHD, by itself, is the most common cause of premature death in the UK. Just under one fifth (17%) of premature deaths in men and one in twelve (8%) premature deaths in women were from CHD, which caused over 25,000 premature deaths in the UK in 2010 (Table 1.3 and Figures 1.3c and 1.3d). Excess winter mortality There is a pattern of excess winter cardiovascular mortality in the UK. In 2009/10, almost 10,000 more people died of CVD in the winter months compared to the summer months. This amounts to about 18% more male deaths and 21% more female deaths. Excess winter mortality tends to increase with age (Table 1.5) 1. Recent trends in death rates in the UK Death rates from CVD have been falling in the UK since the early 1970s. For people under 75 years, death rates have fallen by 44% in the last ten years (Figure 1.1a). In recent years, CHD death rates have been falling more slowly in younger age groups and fastest in those aged 55 and over. For example, between 2000 and 2010 there was a 43% fall in the CHD death rate for men aged 55 to 64 in the UK, compared to a 21% fall in men aged 35 to 44 years. In women, there was a 52% fall in those aged 55 to 64 years and the rate in those aged 35 to 44 years barely changed. There is some evidence that these rates are beginning to level off in younger age groups 2. Death rates from all heart attacks and heart attacks that are immediately fatal have also declined, with around a 50% decrease in men and women since 2002. Premature death rates from heart attacks have also declined, with a 58% reduction between 2002 and 2010 (Tables 1.6 to 1.8, Figures 1.6a, 1.6b and 1.8). A 2004 study aimed to explain the decline in mortality from CHD over the last two decades of the twentieth century in England and Wales. Combining and analysing data on uptake and effectiveness of cardiologic treatments and risk factor trends, the authors examined how much of the decline in CHD mortality in England and Wales between 1981 and 2000 could be attributed to medical and surgical treatments and how much to changes in cardiovascular risk factors.
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They concluded that more than half (58%) of the CHD mortality decline in England and Wales during the 1980s and 1990s was attributable to reductions in major risk factors, principally smoking. Treatments to individuals, including secondary prevention, explained the remaining two-fifths (42%) of the mortality decline 3. National and regional differences Death rates from CHD are highest for both men and women in Scotland and lowest in England. In 2010, the premature CHD death rate in Scotland was 37% higher for men and 60% for women, as compared to England. Within England, premature CHD death rates are highest in the North West and lowest in the South East and South West. These rates have been consistently higher in Scotland for more than 25 years (Table 1.9a and 1.9b). A North-South gradient is apparent in death rates from myocardial infarction, as well as in maps of CHD mortality by local authority in the UK. These maps also demonstrate that the highest mortality rates are concentrated in urban areas of the UK (Tables 1.10 and 1.11, Figures 1.11a and 1.11b). Socioeconomic differences Socioeconomic differences in health can be measured using individual-level and area-level measures of socioeconomic status. Individual-level measures define socioeconomic status on the basis of an individuals occupation, income, wealth, education or a combination of these factors. Area-level measures define socioeconomic status on the basis of where an individual lives and tend to be based on a deprivation index a score for an area that is constructed using data on an areas population, resources, geographical features or a combination of these factors. Estimates of social differences in health are often based on area-level measures because deprivation indices are freely available and only require limited knowledge about individuals. However it should be remembered that not all people who live in affluent areas are themselves affluent, and vice versa. The most recent data for individual-level measures comes from 2001/03; death rates in 2001/03 from CVD, CHD and stroke were all highest in the lowest socioeconomic group and lowest in the highest socioeconomic group, with a clear gradient across the social groups. This inequality was more striking in women than men, with the CHD death rate in female workers with routine jobs five times higher than those with managerial or professional jobs (Table 1.12 and Figure 1.12). A more recent target within England concerns inequalities in CVD mortality on the basis of area-level measures of deprivation. This looks at the absolute difference in death rates between the most deprived groups and the rest of the population. Using this absolute measurement, inequalities in CVD mortality are declining, as the difference in the rate of deaths between these two groups is reducing. An alternative way of measuring inequality is to look at relative inequalities between the most and least deprived areas. When using the relative measure, Great Britain demonstrates a strong
positive relationship between CHD mortality rates and increasing level of deprivation. This relationship has persisted over the past 14 years, and shows little sign of improvement. While deaths from CHD have declined overall, there appears to have been no narrowing of the relative difference between the most deprived and the least deprived (Table 1.13, Figures 1.13a and 1.13b). International differences Despite the decline in death rates from CVD in the UK, rates are still relatively high compared to other Western European countries, at 211 per 100,000 CVD deaths in men in 2009. In Western Europe, only Ireland, Germany, Sweden and Luxembourg had a higher death rate than the UK in the same year. In countries of Eastern and Central Europe, where death rates have been rising rapidly recently, the death rates were generally higher than in the UK, with Russia and Ukraine having the highest CVD mortality in Europe for men; for women the Republic of Moldova and the Ukraine had the highest CVD death rates in 2009 (Tables 1.14a and 1.14b, Figure 1.14). CHD mortality is declining across most of Europe, with the exception of some Eastern European countries. While there were some fluctuations in death rates between 1998 and 2008, overall Russia and Ukraine both experienced an increase in CHD mortality, most notably death rates for men in the Ukraine rose by 16% between 1998 and 2008. However, data from 2009 and 2010 indicate that CHD death rates in both countries have decreased since 2008. The death rate from CHD in the UK has been falling at one of the fastest rates in Europe and decreased by 45% between 1998 and 2008, with only Ireland, Norway and Austria having a larger decrease over this time. The decline in female CHD mortality tells a similar story (Tables 1.15a and 1.15b, Figure 1.15).
1. Excess winter deaths are calculated by subtracting the actual number of deaths in winter (usually December to March), from the number of deaths which would have been expected for this period, calculated on the basis of the actual number of deaths occurring in the surrounding non-winter months. It is postulated that excess winter mortality is partially preventable through improvements to cold damp housing see Olsen N (2001) Prescribing warmer, healthier homes. BMJ, 322: 748-749. 2. Allender S, Scarborough P, OFlaherty M, Capewell S (2008). 20th century CHD morality in England and Wales: population trends in CHD risk factors and coronary death. BMC Public Health 8: 148. 3. Unal B, Critchley JA, Capewell S (2004). Explaining the decline in coronary heart disease mortality in England and Wales between 1981 and 2000. Circulation, 109: 1101-1107.
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Table 1.1 Cardiovascular disease (CVD) mortality targets for the United Kingdom
England 1,2 CVD Target Target set in 1999 To reduce the death rate from CHD, stroke and related diseases in people under 75 years by at least two fifths by 2010 saving up to 200,000 lives in total. Target set in 2004 To reduce the inequalities gap in death rates from CHD, stroke and related diseases between the fifth of areas with the worst health and deprivation indicators and the population as a whole in people under 75 years by 40% by 2010.
CVD Inequalities target
Wales 3 CHD Health outcome target CHD Health inequality target Scotland 4 Target set in 2007 To reduce mortality rates from CHD among people under 75 years by 60% between 1995 and 2010, from the 1995 baseline of 124.6 to 49.8 per 100,000 population (standardised to the European Standard Population). To reduce the death rate from CHD of those aged under 75 years living in the most deprived 15% of areas in Scotland. Reduce mortality from CHD among the under 75s in deprived areas. Target set in 2004 To reduce CHD mortality in 65-74 year olds from 600 per 100,000 in 2002 to 400 per 100,000 in 2012. To improve CHD mortality in all groups and at the same time aim for a more rapid improvement in the most deprived groups.
CHD Target
CHD Inequalities target Northern Ireland No target set.
1. Department of Health (1999) Our Healthier Nation. DH: London. 2. Department of Health (2004) National Standards, Local Action: Health and Social Care Standards and Planning Framework 2005/06 and 2007/08. DH: London. 3. Welsh Assembly Government (2008) See Chief Medical Officer Wales website http://wales.gov.uk/topics/health/research/research/gain/targets/health-gain (Accessed June 2010). 4. Scottish Executive (2008). Spending Review 2007, Scottish Government. The Scottish Executive: http://www.scotland.gov.uk/Publications/2007/11/30090722/34 and http://www.scotland.gov. uk/Publications/2004/12/20325/47433 (Accessed June 2010)
17
Figure 1.1a Tracking the English cardiovascular disease (CVD) mortality target: Age-standardised death rates per 100,000 from CVD, under 75s, England 1970 to 2009
300
250
Death rate per 100,000
200
150
100
50
0 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Persons under 75 Target for 2010
Figure 1.1b Tracking the English cardiovascular disease (CVD) inequality target: Absolute gap in CVD age-standardised death rates per 100,000 population between least and most deprived 20% of local authorities, under 75s, England 1996 to 2009
40
35
Absolute gap in death rates per 100,000
30
25
20
15
10
0 2006 2004 2000 2008 2009 2005 2002 2003 2007 1996 1997 1998 2001 1999
Persons under 75
Target for 2010
18
Figure 1.1c Tracking the Scottish coronary heart disease (CHD) mortality target: Age-standardised death rates per 100,000 from CHD, under 75s, Scotland 1995 to 2010
140
120
100 Death rate per 100,000
80
60
40
20
0 2006 2008 2009 2007 2004 2000 2005 2002 2003 1995 1996 1997 1998 2001 1999 2010 2010
Persons under 75
Target for 2010
Figure 1.1d Tracking the Welsh coronary heart disease (CHD) mortality target: Age-standardised death rates per 100,000 from CHD in adults aged 65 to 74, Wales 2001 to 2010
700
600
400
300
200
100
0 2006 2004 2008 2009 2005 2002 2003 2007 2001
Persons under 75
Target for 2010
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Table 1.2 Deaths by cause, by sex and age, United Kingdom 2010
All ages All causes Men Women Total All diseases of the circulatory system (I00-I99) Men Women Total Men Women Total Stroke (I60-I69) Men Women Total Other diseases of the circulatory system (I00-I19, I26-I59, I70-I99) Men Women Total Men Women Total Cancer (C00-D48) Men Women Total Colo-rectal cancer (C18-C21) Men Women Total Lung cancer (C33, C34) Men Women Total Breast cancer (C50) Men Women Total Other cancers (C00-C17, C22-C32, C35-C49, C51-D48) Men Women Total Men Women Total Injuries and poisoning (V01-Y98) Men Women Total All other causes Men Women Total 270,945 290,721 561,666 87,528 91,550 179,078 46,591 33,977 80,568 19,287 30,079 49,366 21,650 27,494 49,144 2,895 3,285 6,180 84,373 76,802 161,175 8,732 7,323 16,055 19,453 15,488 34,941 78 11,578 11,656 56,110 42,413 98,523 35,499 40,559 76,058 12,220 7,680 19,900 48,430 70,845 119,275 Under 35 8,015 4,639 12,654 504 274 778 102 36 138 91 62 153 311 176 487 51 40 91 682 664 1,346 40 30 70 13 12 25 1 57 58 628 565 1,193 216 192 408 2,960 871 3,831 3,602 2,598 6,200 35-44 6,997 4,209 11,206 1,409 566 1,975 681 166 847 224 131 355 504 269 773 79 58 137 1,131 1,612 2,743 95 96 191 160 117 277 0 547 547 876 852 1,728 261 199 460 1,975 597 2,572 2,142 1,177 3,319 45-54 14,120 9,531 23,651 3,984 1,523 5,507 2,539 586 3,125 515 425 940 930 512 1,442 140 85 225 4,108 4,607 8,715 449 360 809 841 753 1,594 5 1,270 1,275 2,813 2,224 5,037 670 542 1,212 1,805 683 2,488 3,413 2,091 5,504 55-64 30,587 20,366 50,953 8,982 3,382 12,364 5,899 1,495 7,394 1,126 813 1,939 1,957 1,074 3,031 261 168 429 12,604 10,956 23,560 1,339 782 2,121 3,301 2,607 5,908 11 2,056 2,067 7,953 5,511 13,464 2,416 1,878 4,294 1,387 601 1,988 4,937 3,381 8,318 65-74 54,052 38,205 92,257 16,766 9,004 25,770 9,952 4,084 14,036 2,883 2,326 5,209 3,931 2,594 6,525 563 386 949 23,033 17,593 40,626 2,423 1,419 3,842 6,220 4,461 10,681 17 2,287 2,304 14,373 9,426 23,799 6,092 4,731 10,823 1,029 652 1,681 6,569 5,839 12,408 75+ 157,174 213,771 370,945 55,883 76,801 132,684 27,418 27,610 55,028 14,448 26,322 40,770 14,017 22,869 36,886 1,801 2,548 4,349 42,815 41,370 84,185 4,386 4,636 9,022 8,918 7,538 16,456 44 5,361 5,405 29,467 23,835 53,302 25,844 33,017 58,861 3,064 4,276 7,340 27,767 55,759 83,526
Coronary heart disease (I20-I25)
Diabetes (E10-E14)
Respiratory disease (J00-J99)
Notes: ICD-10 codes in parentheses. Source: England and Wales, Office for National Statistics (2010) Deaths registered by cause, sex and age. www.statistics.gov.uk (accessed April 2011). Scotland, General Register Office (2011) Registrar General Annual Report. GRO: Edinburgh. Northern Ireland, Statistics and Research Agency (2011) Registrar General Annual Report. NISRA: Belfast.
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Table 1.3 Deaths by cause in all adults and adults under 75, by sex, England, Wales, Scotland, Northern Ireland and United Kingdom 2010
All ages England Wales Scotland Northern Ireland 7,066 7,391 14,457 2,200 2,277 4,477 1,271 963 2,234 489 750 1,239 440 564 1,004 94 109 203 2,165 1,946 4,111 239 185 424 539 370 909 5 266 271 1,382 1,125 2,507 856 1,030 1,886 565 275 840 1,186 1,754 2,940 United Kingdom 270,945 290,721 561,666 87,528 91,550 179,078 46,591 33,977 80,568 19,287 30,079 49,366 21,650 27,494 49,144 2,895 3,285 6,180 84,373 76,802 161,175 8,732 7,323 16,055 19,453 15,488 34,941 78 11,578 11,656 56,110 42,413 98,523 35,499 40,559 76,058 12,220 7,680 19,900 48,430 70,845 119,275 England Wales Under 75 Scotland Northern Ireland 3,408 2,250 5,658 881 434 1,315 566 193 759 140 122 262 175 119 294 54 29 83 1,188 976 2,164 139 76 215 327 227 554 1 171 172 721 502 1,223 209 453 662 474 161 635 602 197 799 United Kingdom 113,771 76,950 190,721 31,645 14,749 46,394 19,173 6,367 25,540 4,839 3,757 8,596 7,633 4,625 12,258 1,094 737 1,831 41,558 35,432 76,990 4,346 2,687 7,033 10,535 7,950 18,485 34 6,217 6,251 26,643 18,578 45,221 9,620 7,786 17,406 9,156 3,404 12,560 20,698 14,842 35,540
All causes
Men Women Total
222,966 239,079 462,045 72,247 75,496 147,743 38,034 27,439 65,473 15,824 24,743 40,567 18,389 23,314 41,703 2,228 2,664 4,892 69,789 62,990 132,779 7,186 6,002 13,188 15,781 12,347 28,128 56 9,653 9,709 46,766 34,988 81,754 29,566 33,370 62,936 9,579 6,108 15,687 39,557 58,451 98,008
14,950 16,247 31,197 5,013 5,328 10,341 2,687 2,036 4,723 1,085 1,711 2,796 1,241 1,581 2,822 165 166 331 4,478 4,189 8,667 514 400 914 1,026 823 1,849 7 637 644 2,931 2,329 5,260 1,997 2,343 4,340 717 443 1,160 2,580 3,778 6,358
25,963 28,004 53,967 8,068 8,449 16,517 4,599 3,539 8,138 1,889 2,875 4,764 1,580 2,035 3,615 408 346 754 7,941 7,677 15,618 793 736 1,529 2,107 1,948 4,055 10 1,022 1,032 5,031 3,971 9,002 3,080 3,816 6,896 1,359 854 2,213 5,107 6,862 11,969
91,814 61,765 153,579 25,663 11,778 37,441 15,384 4,976 20,360 3,927 2,984 6,911 6,352 3,818 10,170 771 532 1,303 34,002 28,830 62,832 3,553 2,170 5,723 8,484 6,235 14,719 26 5,157 5,183 21,939 15,268 37,207 7,896 5,994 13,890 7,072 2,650 9,722 16,410 11,981 28,391
6,227 4,260 10,487 1,747 850 2,597 1,081 359 1,440 246 235 481 420 256 676 60 38 98 2,239 1,925 4,164 262 147 409 549 426 975 3 339 342 1,425 1,013 2,438 575 429 1,004 524 189 713 1,082 829 1,911
12,322 8,675 20,997 3,354 1,687 5,041 2,142 839 2,981 526 416 942 686 432 1,118 209 138 347 4,129 3,701 7,830 392 294 686 1,175 1,062 2,237 4 550 554 2,558 1,795 4,353 940 910 1,850 1,086 404 1,490 2,604 1,835 4,439
All diseases of the circulatory system (I00-I99)
Men Women Total Men Women Total Men Women Total
Coronary heart disease (I20-I25)
Stroke (I60-I69)
Other diseases of the circulatory system (I00-I19, I26-I59, I70-I99) Diabetes (E10-E14)
Men Women Total Men Women Total
Cancer (C00-D48)
Men Women Total
Colo-rectal cancer (C18-C21)
Men Women Total
Lung cancer (C33,C34)
Men Women Total
Breast cancer (C50)
Men Women Total
Other cancers (C00-C17, C22-C32, C35-C49, C51-D48)
Men Women Total Men Women Total
Respiratory disease (J00-J99)
Injuries and poisoning (V01-Y98)
Men Women Total
All other causes
Men Women Total
Notes: ICD-10 codes in parentheses. Source: England and Wales, Office for National Statistics (2012) Deaths registered by cause, sex and age. www.statistics.gov.uk (accessed April 2012). Scotland, General Register Office (2011) Registrar General Annual Report. GRO: Edinburgh. Northern Ireland, Statistics and Research Agency (2011) Registrar General Annual Report. NISRA: Belfast.
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Figure 1.3a Deaths by cause in men, United Kingdom 2010

A J B I
Figure 1.3b Deaths by cause in women, United Kingdom 2010

A K B
J H D E F G H I F G C D E
A. B. C. D. E. F. G. H. I. J.
Stroke (7%) Coronary heart disease (17%) Other cardiovascular disease (8%) Diabetes (1%) Colo-rectal cancer (3%) Lung cancer (7%) Other cancers (21%) Respiratory disease (13%) Injuries and poisoning (5%) All other causes (18%)
A. B. C. D. E. F. G. H. I. J. K.
Stroke (10%) Coronary heart disease (12%) Other cardiovascular disease (9%) Diabetes (1%) Colo-rectal cancer (3%) Lung cancer (5%) Breast cancer (4%) Other cancers (14%) Respiratory disease (14%) Injuries and poisoning (3%) All other causes (24%)
Figure 1.3c Deaths by cause in men under 75, United Kingdom 2010
A J B
Figure 1.3d Deaths by cause in women under 75, United Kingdom 2010
A K B C D
I C D H F G E
G H
A. B. C. D. E. F. G. H. I. J.
Stroke (4%) Coronary heart disease (17%) Other cardiovascular disease (7%) Diabetes (1%) Colo-rectal cancer (4%) Lung cancer (9%) Other cancers (23%) Respiratory disease (9%) Injuries and poisoning (9%) All other causes (18%)
A. B. C. D. E. F. G. H. I. J. K.
Stroke (5%) Coronary heart disease (8%) Other cardiovascular disease (6%) Diabetes (1%) Colo-rectal cancer (4%) Lung cancer (10%) Breast cancer (8%) Other cancers (24%) Respiratory disease (10%) Injuries and poisoning (5%) All other causes (19%)
22
Table 1.4 Age-standardised death rates per 100,000 population for myocardial infarction, by sex and age, England and Scotland 2010
Men England 30-54 55-64 65-74 75-84 85+ Under 75 All ages Number of events Scotland 0-44 45-64 65-74 75+ Under 75 All ages Number of deaths 2 68 279 916 40 75 2,536 1 18 128 572 14 37 2,041 1 6 14 35 85 20 40 14,980 0 2 6 19 58 6 18 11,069 Women
Notes: ICD-10 codes I21-22. England rates are age-standardised to the European Standard Population. Scotland rates are age-sex-standardised to the European Standard Population. Source: Smolina K, Wright L, Rayner M, Goldacre M (2012). Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: linked national database study. BMJ; 344. DOI: 10.1136/bmj.d8059 Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford (2010) Personal communication. ISD Scotland Table MC1: Trends in mortality 2001-2010 (2012). http://www.isdscotland.org/Health-Topics/HeartDisease/Topic-Areas/Mortality (Accessed September 2012)
23
Figure 1.4 Age-standardised death rates per 100,000 population for myocardial infarction, by sex and age, England 2010
90 80 70 60 50 40 30 20 10 0 30-54 Men Women 55-64 65-74 75-84 <75 85
Table 1.5 Excess winter cardiovascular disease (CVD) mortality, by sex, England and Wales 2009/10
Men Excess winter mortality 0-64 65-74 75-84 85 + All ages 380 780 1,610 1,610 4,370 Excess winter mortality index 9.1 16.9 19.6 22.5 18.1 Women Excess winter mortality 240 400 1,540 3,070 5,240 Excess winter mortality index 15.1 16.4 20.4 22.5 20.8
Notes: Excess winter mortality calculation: winter deaths - average non-winter deaths. Excess winter mortality index calculation: (Excess winter mortality/average non-winter deaths) *100. Source: Office for National Statistics (2011). http://www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3A77-235062 (accessed September 2012).
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Table 1.6 Age-specific death rates per 100,000 population from coronary heart disease (CHD) by sex, United Kingdom 1968 to 2010
3544 Men 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 65 63 65 69 69 66 68 63 60 61 62 57 56 53 47 46 42 43 42 41 37 37 37 34 32 29 27 26 25 23 23 22 19 20 21 19 19 19 18 17 17 16 15 Women 11 11 11 10 11 11 12 11 12 11 11 9 9 9 8 7 7 7 6 6 6 6 6 6 6 5 5 5 5 5 4 5 5 4 4 5 4 4 4 4 4 3 4 4554 Men 253 262 267 280 297 296 298 298 279 281 288 286 270 260 245 242 227 221 217 201 188 170 159 153 142 136 118 117 112 107 103 97 92 93 89 85 81 73 72 69 67 61 62 Women 46 47 46 50 54 56 55 54 55 53 55 57 50 49 48 46 45 43 40 39 36 32 33 30 28 26 24 24 22 21 22 20 20 19 19 18 16 16 15 15 14 14 14 5564 Men 714 728 727 724 759 755 758 742 752 732 754 749 733 702 696 705 696 687 662 638 610 567 536 512 490 478 427 408 384 361 343 317 291 271 250 238 219 204 194 188 175 167 165 Women 198 202 204 200 218 220 226 215 220 209 216 215 215 203 206 213 213 213 204 201 191 180 179 169 155 147 131 124 119 110 104 94 84 79 72 66 57 54 52 49 47 41 40 6574 Men 1,639 1,660 1,631 1,634 1,718 1,692 1,696 1,684 1,687 1,678 1,705 1,665 1,621 1,601 1,588 1,618 1,591 1,601 1,529 1,489 1,441 1,373 1,352 1,312 1,274 1,266 1,173 1,133 1,073 983 952 902 823 763 707 660 599 558 500 471 443 397 396 Women 726 731 704 698 739 731 725 717 721 714 725 706 688 692 688 692 695 702 681 661 639 627 594 593 571 567 520 498 465 434 420 387 347 328 304 275 250 225 207 187 179 149 148
Source: 1968 to 1999: World Health Organization (2002) http://www.who.int/gho/en/ (accessed August 2012). From 2000: Office for National Statistics (personal communication).
Death rate as percentage of 1968 rate Death rate as percentage of 1968 rate
100
120
140
100
120
140
20
40
60
80
20
40
60
80
0 0
Figure 1.6a Age-specific death rates from coronary heart disease (CHD) as a percentage of the rate in 1968, in men, United Kingdom 1968 to 2010
Figure 1.6b Age-specific death rates from coronary heart disease (CHD) as a percentage of the rate in 1968 in women, United Kingdom 1968 to 2010
3544 3544 4554 5564 6574
4554
5564
6574
1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
25
26
Table 1.7 Death rates from myocardial infarction per 100,000 population, by sex and age, England and Scotland 2002 to 2010
England All ages Men 2002 2003 2004 2005 2006 2007 2008 2009 2010 78.7 73.6 66.5 60.3 54.6 49.9 46.1 42.7 39.2 Women 37.3 35.2 31.1 28.5 25.3 23.2 21.4 19.2 17.7 Under 75 Men 41.4 38.0 34.1 30.9 28.0 25.8 24.1 22.4 20.3 Women 14.9 13.3 11.4 10.5 9.2 8.2 7.8 6.8 6.3 All ages Men 132.8 125.9 112.2 107.4 93.6 93.8 84.3 77.9 74.7 Women 68.5 64.6 57.4 53.4 49.6 44.7 42.0 38.5 36.7 Scotland Under 75 Men 70.7 68.0 57.6 57.0 50.6 51.4 46.4 40.5 39.6 Women 29.3 26.7 22.5 21.3 20.6 18.2 16.8 15.4 14.4
Notes: ICD-10 codes I21-22. England rates are age-standardised to the European Standard Population. Scotland rates are age-sex-standardised to the European Standard Population. Source: Smolina K, Wright FL, Rayner M, Goldacre M. Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: A linked database study. BMJ 2012; 344. DOI: 10.1136/bmj.d8059. Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford (2012) Personal Communication. ISD Scotland Table MC1: Trends in mortality 2001-2010 (2012). http://www.isdscotland.org/Health-Topics/HeartDisease/Topic-Areas/Mortality (Accessed September 2012)
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Table 1.8 Age-standardised sudden death rate per 100,000 population for myocardial infarction, by sex and age, England 2002 to 2010
All ages Men 2002 2003 2004 2005 2006 2007 2008 2009 2010 Number of events (most recent year) 61 57 52 47 43 39 37 34 32 11,018 Women 27 26 22 20 19 17 16 14 13 7,369 Under 75 Men 34 31 28 26 24 21 20 19 18 5,000 Women 11 10 9 8 7 6 6 5 5 1,609
Notes: Sudden deaths were those deaths with acute myocardial infarction coded as the underlying cause of death on the death certificate and with no linked hospital admission for acute myocardial infarction in the previous 30 days. Rates are age-standardised to the European Standard Population. Source: Smolina K, Wright FL, Rayner M, Goldacre M. Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: A linked database study. BMJ 2012; 344. DOI: 10.1136/bmj.d8059 Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford (2012) Personal communication.
Figure 1.8 Age-standardised sudden death rate per 100,000 population for myocardial infarction, by sex and age, England 2002 to 2010
70
60
Sudden death rate per 100,000
50
40
30
20
10
0 2002 2003 2004 2005 2006 2007 2008 2009 2010
Under 75 women
Under 75 men
All ages women
All ages men
28
Table 1.9a Age-standardised death rates from coronary heart disease (CHD) per 100,000 population in men, by country and region of England, United Kingdom 1978 to 2010
United Kingdom Men aged 35-74 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 266 240 228 226 216 199 181 168 149 134 136 120 112 104 98 92 87 80 74 69 65 61 56 55 241 230 220 217 207 190 173 160 141 129 120 116 108 100 94 88 83 77 71 66 62 59 54 53 282 273 259 265 248 238 215 206 173 155 155 149 130 122 114 106 103 94 86 78 75 70 61 60 281 268 264 259 248 237 212 190 172 155 144 141 128 121 115 106 101 96 88 84 76 72 66 65 277 257 251 245 243 225 201 181 157 143 134 133 117 111 109 98 92 81 79 76 70 69 63 61 246 231 225 218 205 196 177 162 138 129 120 119 110 101 92 92 87 78 71 64 63 60 57 54 239 230 229 227 221 200 191 171 147 142 131 121 119 108 104 97 90 82 78 70 68 63 59 57 212 199 177 193 176 154 141 133 124 110 100 95 93 87 81 73 69 65 60 57 53 49 48 46 114 113 106 103 92 91 87 77 73 66 64 62 54 52 214 207 193 188 177 161 147 140 125 115 100 93 91 80 77 70 69 63 58 53 51 47 46 43 225 218 200 197 192 169 153 141 126 112 103 101 91 88 80 75 67 65 57 54 52 50 44 43 289 267 245 238 231 215 197 174 158 146 135 128 128 113 109 104 95 83 82 75 69 65 65 58 302 283 279 274 267 247 221 211 188 171 160 153 146 133 120 113 112 101 98 88 89 81 71 71 300 303 262 275 277 259 222 201 175 155 149 139 133 115 105 99 90 89 80 76 74 65 54 62 England North West Yorkshire and the Humber East Midlands West Midlands East of England London South East South West Wales Scotland Northern Ireland North East
Notes: ICD-9 codes 410-414 for pre-2001 data, ICD-10 codes I20-25 thereafter. Age-standardised using the European Standard Population. Government Office Regions replaced Standard regions in England in 1997. Pre-1997, North East was North; East Anglia was East. There was no data for London as a separate region. 1978 to 1996 are by standard region; 1997 to 2010 are by Government Office region. Source: Pre 1997: Office for Population Censuses and Surveys (1994) Mortality Statistics 1992, DH5 series, HMSO: London and previous editions; Office for National Statistics 1993-1996 figures, personal communication. 1997-2010: England and Wales: Office for National Statistics, personal communication. Scotland and Northern Ireland: raw data from the General Register Office for Scotland, and the Northern Ireland Statistics and Research Agency.
29
Table 1.9b Age-standardised death rates from coronary heart disease (CHD) per 100,000 population in women, by country and region of England, United Kingdom 1978 to 2010
United Kingdom Women aged 35-74 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 93 80 79 79 77 72 67 62 55 48 45 43 39 36 35 32 30 27 24 22 21 20 17 16 79 75 73 75 72 67 63 58 50 46 42 41 37 34 32 30 28 25 23 21 19 19 16 15 108 100 101 102 97 96 90 81 73 62 61 57 52 46 40 39 38 33 29 30 26 22 20 17 101 97 94 97 94 89 82 77 66 59 53 55 48 43 41 39 33 32 29 27 26 23 22 21 94 88 90 94 87 84 80 71 58 53 51 46 41 40 38 35 30 28 27 25 22 22 19 20 78 76 74 79 77 69 65 59 48 46 44 45 39 35 33 34 29 27 25 22 20 21 16 16 81 77 77 80 77 74 67 62 53 51 47 44 42 35 36 32 32 26 24 22 20 20 17 16 67 62 57 58 56 48 46 43 39 35 33 34 29 27 26 23 22 20 18 17 14 15 12 14 38 37 36 34 32 29 28 25 22 19 20 21 17 15 64 62 60 60 59 53 49 48 41 37 31 30 29 26 24 24 21 20 17 17 15 14 12 11 68 63 58 63 61 52 52 45 40 35 32 31 30 26 25 23 23 18 18 16 15 14 12 11 90 94 84 86 83 76 71 65 58 52 50 45 41 40 39 36 33 32 27 25 23 21 21 18 118 111 113 105 101 101 93 84 74 64 63 59 54 50 45 44 41 37 35 33 30 28 25 24 107 105 104 94 95 96 81 77 70 58 53 49 46 41 38 36 30 30 28 27 23 22 22 19 England North East North West Yorkshire and the Humber East Midlands West Midlands East of England London South East South West Wales Scotland Northern Ireland
Notes: ICD-9 codes 410-414 for pre-2001 data, ICD-10 codes I20-25 thereafter. Age-standardised using the European Standard Population. Government Office Regions replaced Standard regions in England in 1997. Pre-1997, North East was North; East Anglia was East. There was no data for London as a separate region. 1978 to 1996 are by standard region; 1997 to 2010 are by Government Office region. Source: Pre 1997: Office for Population Censuses and Surveys (1994) Mortality Statistics 1992, DH5 series, HMSO: London and previous editions; Office for National Statistics 1993-1996 figures, personal communication. 1997-2010: England and Wales: Office for National Statistics, personal communication. Scotland and Northern Ireland: raw data from the General Register Office for Scotland, and the Northern Ireland Statistics and Research Agency.
30
Table 1.10 Death rates from myocardial infarction per 100,000 population by Government Office Region, England 2002 to 2010
Yorkshire and the Humber 69.4 65.1 57.0 53.8 48.3 41.9 40.5 37.3 34.7
North East 2002 2003 2004 2005 2006 2007 2008 2009 2010 65.2 61.7 53.3 48.4 43.2 40.1 36.3 35.3 29.0
North West 67.9 64.8 58.1 52.2 48.8 47.2 41.7 38.8 35.4
East Midlands 55.3 49.6 44.3 41.4 37.5 36.4 33.2 29.1 27.0
West Midlands 58.3 54.7 49.1 47.7 42.7 37.5 34.3 31.6 30.1
East of England 48.0 45.7 41.9 36.7 34.5 29.5 28.1 26.1 25.2
London 47.9 46.7 42.3 38.4 32.4 31.5 30.7 29.1 27.0
South East 45.2 43.4 39.4 35.4 30.5 28.2 26.4 23.2 21.2
South West 51.7 45.0 40.7 35.7 33.3 30.0 26.6 23.8 21.3
Source: Smolina K, Wright FL, Rayner M, Goldacre M. Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: A linked database study. BMJ 2012; 344. DOI: 10.1136/bmj.d8059. Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford (2012) Personal Communication.
31
Table 1.11 Numbers of deaths and age-standardised death rates from coronary heart disease (CHD) in men and women, all ages and under 75, by local authority, United Kingdom 2008/10
Under 75 LA code LA name Number of deaths 20082010 Men Number of deaths 20082010 Age-standardised death rate/100,000 Women Number of deaths 20082010 Age-standardised death rate/100,000 Men Number of deaths 20082010 Age-standardised death rate/100,000 All ages Women Age-standardised death rate/100,000
United Kingdom England North East 00EJ 00EH 00CH 00EB 00EC 00CJ 00CK 00EM 00EE 00CL 00EF 00CM North West 16UB 16UC 00EX 00EY 00BL 30UD 00BM 16UD 00EQ 00EW 30UE 16UE 16UF 30UF 00ET 30UG Allerdale Barrow-in-Furness Blackburn with Darwen Blackpool Bolton Burnley Bury Carlisle Cheshire East Cheshire West and Chester Chorley Copeland Eden Fylde Halton Hyndburn County Durham Darlington Gateshead Hartlepool Middlesbrough Newcastle upon Tyne North Tyneside Northumberland Redcar and Cleveland South Tyneside Stockton-on-Tees Sunderland
59,236 47,468 2,902 621 129 232 106 149 274 224 348 141 168 193 317 8,119 117 80 170 244 310 135 206 130 348 299 105 95 57 62 143 103
57.9 55.7 64.0 63.7 73.9 68.2 69.9 71.0 70.2 66.1 54.2 54.7 64.3 61.2 66.7 68.4 67.8 50.1 69.1 101.3 71.8 82.8 67.3 68.0 50.9 49.0 53.7 70.4 40.6 40.3 32.1 67.4
20,221 15,737 985 214 30 84 28 54 106 73 97 47 66 60 126 2,911 54 36 78 70 112 31 74 47 103 104 39 32 19 23 64 44
17.9 16.8 19.9 21.1 15.6 22.0 16.2 22.9 24.2 19.2 14.4 16.6 21.7 17.4 23.7 22.5 25.4 24.4 35.8 23.4 23.9 20.2 21.2 22.1 13.7 15.3 18.9 21.9 15.5 12.3 30.2 29.4
143,026 116,720 6,611 1,383 271 512 213 330 662 514 858 329 428 393 718 17,972 293 189 373 484 684 266 441 322 892 751 233 179 166 206 319 248
114.3 112.5 123.7 121.9 132.2 130.7 127.2 132.0 133.5 123.9 113.4 107.8 131.4 112.0 132.3 131.4 139.9 102.6 139.1 175.5 141.5 140.3 130.1 141.8 107.2 103.6 109.9 119.6 99.1 96.6 64.7 145.5
107,783 87,124 4,743 1,027 179 399 148 234 457 375 595 229 329 233 538 13,792 237 151 303 324 476 187 346 241 715 611 178 139 130 184 233 212
53.1 50.8 55.8 61.3 48.1 62.5 52.7 58.7 56.9 53.9 49.2 47.1 59.8 44.0 63.1 62.4 66.6 60.4 90.1 62.5 61.2 66.2 61.8 61.8 49.8 51.5 55.5 60.7 58.7 44.9 77.8 83.6
32
Under 75 LA code LA name Number of deaths 20082010 Men Number of deaths 20082010 Age-standardised death rate/100,000 Women Number of deaths 20082010 Age-standardised death rate/100,000 Men Number of deaths 20082010 Age-standardised death rate/100,000
All ages Women Age-standardised death rate/100,000
00BX 30UH 00BY 00BN 00BP 30UJ 30UK 30UL 00BQ 30UM 00BR 00CA 16UG 30UN 00BZ 00BS 00BT 00BU 00EU 30UP 00BW 00CB 30UQ
Knowsley Lancaster Liverpool Manchester Oldham Pendle Preston Ribble Valley Rochdale Rossendale Salford Sefton South Lakeland South Ribble St. Helens Stockport Tameside Trafford Warrington West Lancashire Wigan Wirral Wyre
210 171 539 527 284 108 141 70 256 77 312 309 103 94 246 294 353 208 230 110 407 352 114 5,605 293 547 190 57 362 356 78 148 310 414 735 186
90.1 82.5 83.1 101.1 80.6 73.1 67.6 53.5 79.2 53.3 91.8 60.9 51.6 55.2 75.9 59.0 97.5 61.9 78.7 60.6 72.6 64.7 52.2 64.8 73.3 77.1 56.2 47.5 71.6 59.0 47.1 63.3 90.6 64.4 66.5 44.8
70 48 185 187 109 47 58 19 103 31 88 109 37 35 103 121 117 62 86 40 135 142 49 1,960 118 198 61 19 125 109 34 56 107 138 252 68
25.4 18.5 25.0 33.8 28.8 29.5 27.6 15.4 28.9 26.7 23.1 17.3 15.4 16.1 29.3 22.1 30.3 15.5 22.6 17.5 22.6 21.9 17.1 20.4 27.5 25.6 16.5 14.0 21.8 13.9 15.9 17.1 26.7 20.1 20.3 21.8
377 397 1,017 958 576 232 303 175 531 178 615 761 309 215 502 739 742 550 514 264 756 877 338 13,357 622 1,193 442 168 850 959 214 401 619 954 1,756 437
148.9 152.2 138.4 158.8 151.4 139.0 121.3 116.8 145.4 110.4 157.0 119.8 124.7 111.2 151.1 125.8 185.3 126.9 164.2 132.2 134.0 130.3 121.4 130.7 143.7 145.0 113.7 110.5 142.6 135.7 108.9 135.5 156.5 130.3 129.6 88.6
267 274 728 721 395 206 233 138 394 123 447 557 271 185 373 644 640 386 408 196 546 718 275 10,016 487 823 357 132 571 693 162 347 429 791 1,279 322
63.3 53.3 62.3 75.8 66.7 74.5 68.4 60.5 70.4 64.9 66.0 49.8 51.8 52.0 70.3 62.9 96.0 52.7 70.0 54.1 63.2 59.9 52.3 59.4 70.6 62.3 54.0 48.2 60.9 50.5 47.8 53.5 63.5 64.9 57.0 60.0
Yorkshire & The Humber 00CC 00CX 00CY 36UB 00CE 00FB 36UC 36UD 00FA 00CZ 00DA 00FC Barnsley Bradford Calderdale Craven Doncaster East Riding of Yorkshire Hambleton Harrogate Kingston upon Hull, City of Kirklees Leeds North East Lincolnshire
33
00FD 36UE 00CF 36UF 36UG 36UH 00CG 00DB 00FF
North Lincolnshire Richmondshire Rotherham Ryedale Scarborough Selby Sheffield Wakefield York
191 60 304 65 134 68 539 410 158 4,469 157 135 132 83 104 75 108 120 129 58 70 245 74 188 51 111 124 84 110 85 83 342 76 124 39 121
65.5 48.4 67.4 36.5 72.3 48.2 64.9 72.3 50.8 57.5 82.6 62.0 66.2 43.9 61.7 54.0 52.9 46.9 65.3 49.0 40.3 70.1 49.6 71.7 38.8 56.3 59.7 50.7 67.4 38.4 56.2 91.8 62.1 67.2 34.8 56.0
66 13 134 23 63 18 174 131 53 1,466 49 43 32 24 38 31 33 42 35 20 8 111 11 53 16 36 38 17 34 26 27 135 28 54 11 44
19.7 12.5 27.9 17.5 24.5 11.5 18.6 21.7 14.3 17.7 19.7 19.3 14.0 12.3 25.2 23.8 15.1 15.1 17.4 19.5 5.4 28.9 8.0 14.7 10.0 17.1 16.4 10.2 20.1 12.2 16.5 33.0 20.7 28.0 11.4 19.1
447 138 754 183 410 176 1,344 875 415 10,676 366 290 284 223 234 180 257 336 319 122 165 612 197 472 142 273 270 202 243 213 187 723 174 269 111 283
129.6 96.3 150.6 81.7 174.4 111.4 131.7 138.0 106.5 114.2 163.3 115.8 128.1 99.5 115.0 109.5 108.9 103.5 133.7 83.2 80.3 136.0 107.9 144.2 94.8 115.3 108.4 102.1 124.4 81.1 110.0 162.3 110.1 124.1 81.6 110.8
321 75 615 152 356 139 987 602 376 7,818 288 226 220 120 180 131 175 245 201 70 87 530 126 335 120 204 217 130 180 144 121 508 174 224 80 208
57.2 42.2 78.2 64.9 70.2 52.3 56.1 60.0 52.0 53.3 63.8 58.9 55.2 38.0 71.2 58.4 46.1 48.2 50.6 48.4 34.7 71.3 38.8 54.4 42.1 52.4 51.2 42.9 58.0 39.8 41.7 74.9 60.4 70.4 43.5 51.6
East Midlands 17UB 37UB 37UC 31UB 17UC 32UB 37UD 31UC 17UD 34UB 34UC 00FK 17UF 32UC 34UD 17UG 37UE 31UD 17UH 31UE 34UE 00FN 32UD 37UF 31UG 37UG Amber Valley Ashfield Bassetlaw Blaby Bolsover Boston Broxtowe Charnwood Chesterfield Corby Daventry Derby Derbyshire Dales East Lindsey East Northamptonshire Erewash Gedling Harborough High Peak Hinckley and Bosworth Kettering Leicester Lincoln Mansfield Melton Newark and Sherwood
34
17UJ 32UE 31UH 34UF 00FY 31UJ 37UJ 00FP 17UK 32UF 32UG 34UG 34UH 32UH
North East Derbyshire North Kesteven North West Leicestershire Northampton Nottingham Oadby and Wigston Rushcliffe Rutland South Derbyshire South Holland South Kesteven South Northamptonshire Wellingborough West Lindsey
104 107 101 170 284 41 93 29 88 90 114 65 70 85 5,510 985 84 91 273 323 118 192 108 64 121 74 123 80 85 371 297 195 104 107 103 255
51.1 42.3 56.2 66.6 110.9 42.0 48.4 16.3 53.4 54.4 47.2 40.3 36.7 45.7 59.9 73.9 44.8 52.7 62.0 57.3 75.3 52.6 56.0 33.1 55.6 48.7 65.2 55.2 54.9 82.1 46.2 54.1 45.7 46.3 49.0 73.0
45 27 33 57 103 7 19 13 28 34 34 16 18 36 1,803 373 30 30 88 104 34 61 28 23 43 16 39 19 21 152 96 42 23 41 32 97
20.5 11.8 18.9 17.2 28.0 6.1 8.8 14.6 16.6 16.3 12.1 9.6 13.0 18.3 17.9 25.4 15.1 17.4 17.7 16.7 15.8 16.0 13.2 12.6 16.9 12.6 17.0 14.0 11.7 31.0 14.3 10.1 9.5 14.7 14.7 22.4
261 271 234 404 614 143 241 81 188 244 305 157 164 222 12,654 2,166 209 209 626 683 271 539 261 199 319 172 282 168 180 761 766 442 285 281 252 590
109.7 87.9 113.6 133.2 195.8 107.1 101.4 37.4 102.6 113.3 103.7 89.6 74.8 97.1 115.0 132.3 89.0 101.5 113.2 105.7 144.7 115.8 124.7 78.5 124.3 93.9 128.8 100.7 101.7 143.0 98.1 101.3 113.7 100.3 106.4 147.1
236 171 155 290 431 87 175 60 170 201 245 114 100 139 8,776 1,468 154 163 391 509 190 347 176 150 232 90 181 93 125 551 617 301 156 232 176 445
64.7 42.6 52.4 49.5 65.4 37.0 40.7 41.1 60.6 53.5 48.9 41.8 41.7 44.9 49.4 56.9 41.8 58.1 43.4 47.7 51.0 44.8 49.3 40.0 51.9 44.1 49.0 44.0 38.2 66.5 50.0 37.0 37.3 47.2 46.5 59.2
West Midlands 00CN 47UB 41UB 00CQ 00CR 41UC 00GA 41UD 47UC 41UE 44UB 44UC 47UD 44UD 00CS 00GG 00CT 41UF 41UG 41UH 00GL Birmingham Bromsgrove Cannock Chase Coventry Dudley East Staffordshire Herefordshire, County of Lichfield Malvern Hills Newcastle-under-Lyme North Warwickshire Nuneaton and Bedworth Redditch Rugby Sandwell Shropshire Solihull South Staffordshire Stafford Staffordshire Moorlands Stoke-on-Trent
35
44UE 41UK 00GF 00CU 44UF 00CW 47UE 47UF 47UG
Stratford-on-Avon Tamworth Telford and Wrekin Walsall Warwick Wolverhampton Worcester Wychavon Wyre Forest
90 83 175 335 108 254 97 104 111 4,734 84 148 141 95 121 56 96 62 59 81 209 108 108 87 57 89 117 104 44 89 77 61 103 105 171 205
37.8 50.0 57.2 78.4 51.2 67.3 61.6 49.7 58.9 47.7 45.0 60.0 54.0 35.3 45.3 31.6 39.6 36.2 46.2 39.3 49.7 47.2 43.8 39.7 29.7 45.1 49.5 60.3 40.3 41.3 46.2 34.3 41.4 56.9 59.2 72.4
32 24 61 97 25 85 31 29 27 1,499 16 44 43 49 45 22 25 24 15 16 70 28 35 27 22 27 33 29 21 46 25 9 30 44 50 57
11.7 18.1 20.9 20.1 10.2 20.5 18.9 11.2 12.9 13.6 8.2 13.5 16.4 18.5 15.7 14.6 8.4 13.9 9.6 7.0 15.0 8.8 11.4 11.1 14.1 11.4 13.6 15.7 21.2 22.1 18.3 5.3 9.5 21.2 15.2 21.2
251 140 370 694 260 569 203 274 232 13,039 245 385 332 283 401 171 307 166 159 214 517 300 291 270 170 260 333 257 126 259 166 205 264 333 447 403
89.1 78.1 107.8 138.0 101.3 118.2 109.3 113.0 108.8 104.7 107.2 121.1 111.2 83.6 117.6 74.9 100.2 85.2 93.2 85.1 109.4 107.5 99.6 94.8 72.4 110.5 112.4 121.6 98.5 92.6 82.7 84.8 94.7 133.6 118.6 126.3
166 112 222 446 146 430 148 207 152 9,804 177 277 249 262 269 122 237 121 139 166 387 229 237 207 139 201 255 163 99 227 135 138 205 237 321 252
34.0 59.5 52.3 54.3 31.3 56.0 52.9 42.9 40.6 47.0 43.3 49.2 54.7 53.7 47.9 42.3 41.2 44.0 39.1 44.6 50.8 40.2 40.8 42.7 47.4 46.4 53.2 45.3 56.3 59.1 54.1 34.2 38.5 58.7 50.8 59.6
East of England 42UB 22UB 00KB 22UC 33UB 22UD 33UC 26UB 12UB 22UE 00KC 22UF 22UG 26UC 12UC 26UD 22UH 12UD 42UC 33UD 22UJ 26UE 12UE 42UD 33UE 00KA Babergh Basildon Bedford Braintree Breckland Brentwood Broadland Broxbourne Cambridge Castle Point Central Bedfordshire Chelmsford Colchester Dacorum East Cambridgeshire East Hertfordshire Epping Forest Fenland Forest Heath Great Yarmouth Harlow Hertsmere Huntingdonshire Ipswich Kings Lynn and West Norfolk Luton
36
22UK 42UE 26UF 33UF 33UG 00JA 22UL 12UG 33UH 00KF 26UG 42UF 26UH 42UG 22UN 26UJ 00KG 22UQ 26UK 42UH 26UL London 00AB 00AC 00AD 00AE 00AF 00AG 00AA 00AH 00AJ 00AK 00AL 00AM 00AN 00AP
Maldon Mid Suffolk North Hertfordshire North Norfolk Norwich Peterborough Rochford South Cambridgeshire South Norfolk Southend-on-Sea St Albans St Edmundsbury Stevenage Suffolk Coastal Tendring Three Rivers Thurrock Uttlesford Watford Waveney Welwyn Hatfield
53 94 98 109 115 181 57 90 104 149 84 79 72 116 179 66 123 49 50 110 79 5,282
32.1 55.9 45.9 48.2 53.8 72.6 39.0 40.0 43.5 57.4 44.8 40.7 48.3 48.3 68.9 40.5 51.1 33.6 43.2 50.0 52.2 56.2 75.1 47.4 50.1 61.9 38.7 66.8 39.4 46.1 75.4 51.8 69.2 77.2 53.7 66.5
13 24 31 33 42 52 16 26 27 50 27 29 27 34 60 11 40 12 15 43 35 1,843 53 47 65 67 73 41 0 74 86 72 81 65 33 63
9.3 11.7 14.1 11.6 21.7 17.9 9.7 10.0 9.4 16.6 11.5 12.7 19.7 11.6 16.1 6.7 15.0 8.3 12.1 16.1 19.5 17.5 24.3 8.9 15.7 17.5 12.7 15.7 0.0 14.1 20.3 16.3 27.0 29.5 15.4 22.9
125 256 284 367 308 405 201 239 286 437 253 229 184 358 525 193 288 141 140 339 217 12,239 347 612 454 436 604 325 14 594 546 486 417 313 198 324
66.5 128.9 106.2 113.3 105.8 131.9 105.3 84.7 88.9 127.0 104.5 91.6 101.0 112.2 142.9 90.6 107.4 80.1 96.4 110.6 106.6 108.3 137.9 102.3 103.3 111.2 92.3 121.5 75.4 101.2 122.7 102.0 135.5 132.3 92.0 126.9
91 178 272 262 240 294 120 171 198 344 181 177 127 301 366 117 228 106 119 259 202 8,981 274 502 392 295 478 185 3 448 310 386 321 222 152 227
38.7 47.4 57.3 43.2 54.7 59.0 37.3 34.8 38.7 55.9 41.0 43.9 56.1 49.4 45.2 31.3 44.9 38.6 47.9 46.4 56.0 49.3 62.0 43.6 51.8 49.9 41.0 44.5 10.5 49.9 48.0 48.8 60.7 67.4 42.0 58.7
Barking and Dagenham Barnet Bexley Brent Bromley Camden City of London Croydon Ealing Enfield Greenwich Hackney Hammersmith and Fulham Haringey
151 218 175 209 185 150 6 220 293 204 187 160 96 161
37
00AQ 00AR 00AS 00AT 00AU 00AW 00AX 00AY 00AZ 00BA 00BB 00BC 00BD 00BE 00BF 00BG 00BH 00BJ 00BK South East 45UB 45UC 29UB 11UB 24UB 00MA 00ML 29UC 38UB 45UD 11UC 45UE 29UD 29UE 24UC 21UC
Harrow Havering Hillingdon Hounslow Islington Kensington and Chelsea Kingston upon Thames Lambeth Lewisham Merton Newham Redbridge Richmond upon Thames Southwark Sutton Tower Hamlets Waltham Forest Wandsworth Westminster
141 225 187 179 156 70 91 167 184 122 223 189 97 153 96 180 168 129 110 6,431
43.9 59.6 53.1 63.0 86.0 30.5 43.2 65.4 66.4 50.1 89.3 54.1 37.6 55.9 35.5 99.3 64.4 48.6 38.8 45.6 26.9 47.9 59.4 44.9 46.8 40.7 62.2 62.4 43.5 56.6 33.0 31.2 51.2 52.1 33.5 71.6
52 72 50 58 58 23 30 65 82 46 73 81 25 47 45 44 72 48 52 1,957 18 45 28 36 43 14 48 37 19 25 21 26 25 39 23 17
14.0 15.7 12.8 19.1 28.2 8.1 12.8 22.0 26.0 17.0 28.6 21.5 9.0 15.4 14.9 23.3 25.0 15.8 16.4 12.5 12.4 11.7 12.7 11.7 15.4 5.2 12.8 12.5 7.8 8.8 11.2 17.1 16.4 15.6 9.9 8.1
405 571 419 360 304 176 221 342 438 281 393 488 265 324 279 338 371 344 250 17,495 150 467 257 310 294 173 493 386 252 320 178 177 157 326 233 300
100.7 116.9 100.4 116.5 147.2 57.6 85.7 115.5 138.6 93.7 148.3 115.3 83.9 101.0 82.0 156.6 127.1 102.1 70.0 97.6 70.9 109.1 120.9 103.5 105.8 86.1 122.7 131.0 97.4 117.7 81.5 60.8 83.9 111.8 95.0 147.4
285 423 315 248 172 118 202 242 314 232 223 370 198 224 286 169 308 286 171 13,428 133 370 198 222 249 96 353 297 156 249 140 131 95 260 178 234
44.3 48.5 43.4 52.8 59.6 24.3 45.3 56.5 63.1 44.4 64.3 56.0 34.3 43.7 48.1 61.3 65.3 48.8 35.5 42.8 44.1 39.7 49.4 42.3 56.0 22.0 44.1 46.0 34.0 39.5 39.1 45.9 38.9 54.2 39.2 38.3
Adur Arun Ashford Aylesbury Vale Basingstoke and Deane Bracknell Forest Brighton and Hove Canterbury Cherwell Chichester Chiltern Crawley Dartford Dover East Hampshire Eastbourne
45 140 103 122 116 76 197 138 96 111 58 62 83 119 65 95
38
24UD 43UB 43UC 24UE 24UF 29UG 43UD 24UG 21UD 24UH 45UF 00MW 21UF 29UH 00LC 45UG 00MG 43UE 24UJ 38UC 00MR 00MC 43UF 21UG 43UG 24UL 29UK 29UL 00MD 11UE 38UD 00MS 43UH 43UJ 29UM 43UK 24UN
Eastleigh Elmbridge Epsom and Ewell Fareham Gosport Gravesham Guildford Hart Hastings Havant Horsham Isle of Wight Lewes Maidstone Medway Mid Sussex Milton Keynes Mole Valley New Forest Oxford Portsmouth Reading Reigate and Banstead Rother Runnymede Rushmoor Sevenoaks Shepway Slough South Bucks South Oxfordshire Southampton Spelthorne Surrey Heath Swale Tandridge Test Valley
91 63 37 83 66 77 78 46 95 105 74 147 46 123 266 63 218 62 139 73 171 130 83 105 52 57 52 117 115 44 79 178 67 66 146 47 81
40.5 27.8 23.3 40.6 42.5 49.0 38.4 26.2 68.0 54.2 31.2 49.8 24.3 50.8 73.4 31.1 71.7 42.9 46.6 43.4 58.2 74.5 38.6 55.8 37.0 36.0 26.1 51.3 59.5 25.0 34.7 55.4 38.3 46.9 64.6 31.1 30.1
19 36 13 19 22 28 22 14 22 29 30 37 20 40 80 38 74 17 43 31 45 29 26 22 18 9 21 30 45 14 25 60 21 11 41 22 27
8.7 15.8 9.7 7.3 13.7 15.6 9.1 8.4 13.0 11.3 11.8 11.2 9.2 14.4 21.4 14.0 23.5 9.4 10.5 17.8 14.3 13.4 11.0 9.7 12.0 6.9 8.8 13.8 27.3 10.4 10.1 19.4 12.3 6.9 16.9 13.5 12.1
255 219 130 235 154 162 232 125 223 301 271 424 236 307 519 237 464 195 483 189 391 264 262 294 149 144 195 328 226 151 221 437 178 151 314 145 218
97.8 69.2 58.2 87.1 81.5 87.0 87.3 58.6 132.4 113.9 83.4 107.6 74.1 105.0 131.0 83.6 144.8 99.3 109.5 83.8 111.9 127.7 92.1 109.1 78.8 71.7 79.1 116.3 103.2 68.3 80.6 104.9 77.1 91.8 123.1 69.4 62.5
191 216 105 175 141 147 154 97 165 205 225 290 175 258 417 250 305 150 367 159 271 172 193 263 119 92 157 224 159 105 150 317 155 109 213 125 171
43.6 44.9 36.5 35.8 47.4 46.9 33.1 34.1 43.7 40.0 42.9 38.6 32.4 51.0 69.3 49.5 64.0 39.5 36.9 45.6 39.5 41.4 37.6 41.3 39.4 32.2 34.3 49.0 56.5 39.9 33.2 50.2 45.9 38.0 53.6 37.5 38.4
39
29UN 29UP 29UQ 38UE 43UL 21UH 00MB 38UF 24UP 00ME 43UM 00MF 45UH 11UF South West 00HA 00HN 00HB 23UB 19UC 00HE 23UC 18UB 19UD 18UC 23UD 23UE 00HF 40UB 18UD 18UE 19UE 00HC 00HG 00HP 19UG
Thanet Tonbridge and Malling Tunbridge Wells Vale of White Horse Waverley Wealden West Berkshire West Oxfordshire Winchester Windsor and Maidenhead Woking Wokingham Worthing Wycombe
155 87 78 78 74 98 90 63 65 108 53 99 87 128 4,416
67.7 40.5 38.9 40.0 39.2 36.7 29.1 32.1 37.2 51.3 37.4 44.4 43.7 54.6 45.6 36.9 45.9 71.4 31.8 28.7 46.2 39.6 40.8 41.3 51.0 46.1 62.8 0.0 39.8 41.8 47.8 38.3 32.5 64.5 36.0 23.6
52 20 36 19 26 33 19 20 29 32 16 29 29 33 1,313 33 41 101 25 12 157 27 26 18 25 25 25 1 14 16 25 13 46 77 36 14
18.4 8.5 18.1 8.7 11.0 9.0 8.2 9.7 12.6 14.3 10.3 10.7 14.2 11.1 12.4 9.7 14.1 17.3 12.7 8.7 12.8 14.3 7.8 7.4 13.2 14.0 12.7 35.0 6.1 9.8 11.5 8.8 10.3 25.5 12.5 11.9
450 224 196 232 227 320 251 189 217 285 159 239 316 288 12,677 381 458 816 235 158 1,525 202 425 270 206 200 297 8 234 197 255 153 481 597 356 118
145.2 91.6 76.7 91.2 91.2 85.5 73.4 75.0 93.4 107.7 84.4 93.9 109.9 104.3 99.5 86.9 102.3 138.3 70.4 82.3 102.9 95.7 103.8 103.0 99.7 95.4 131.9 40.0 92.2 74.7 108.9 83.4 78.5 122.0 91.1 59.8
358 188 159 176 228 286 152 153 215 235 117 148 261 204 9,766 281 375 589 237 126 1,182 204 342 189 198 164 160 3 144 125 194 118 405 427 304 78
59.2 46.1 42.0 39.1 42.8 38.0 36.4 35.9 45.7 56.2 36.5 33.9 46.5 39.3 44.2 38.7 47.6 49.8 47.7 38.3 48.0 52.4 37.9 34.7 45.3 49.9 43.1 45.0 29.5 40.4 43.2 38.5 42.8 75.7 41.6 35.5
Bath and North East Somerset Bournemouth Bristol, City of Cheltenham Christchurch Cornwall Cotswold East Devon East Dorset Exeter Forest of Dean Gloucester Isles of Scilly UA Mendip Mid Devon North Devon North Dorset North Somerset Plymouth Poole Purbeck
121 138 331 70 33 547 65 112 71 85 80 111 0 79 83 87 48 149 267 96 31
40
40UC 00HD 18UG 40UD 23UF 00HX 40UE 18UH 23UG 00HH 18UK 18UL 19UH 40UF 19UJ 00HY Wales 00PL 00PB 00PK 00PT 00NU 00NQ 00NE 00NG 00NJ 00NC 00NA 00PH 00PP 00NZ 00PR 00NS 00NN 00PF 00NX
Sedgemoor South Gloucestershire South Hams South Somerset Stroud Swindon Taunton Deane Teignbridge Tewkesbury Torbay Torridge West Devon West Dorset West Somerset Weymouth and Portland Wiltshire
111 192 75 138 93 140 93 121 77 156 57 49 73 31 60 346 3,412
59.3 44.7 44.3 49.2 47.0 48.7 45.1 51.7 46.7 88.4 34.7 30.8 38.0 17.8 51.0 42.1 63.2 90.1 46.2 65.9 73.7 76.3 34.6 68.8 58.6 60.6 54.9 34.4 68.5 54.5 70.1 81.4 61.5 44.7 82.1 75.0
37 58 30 33 35 53 29 53 14 43 14 12 27 10 17 91 1,181 42 52 86 91 78 22 47 45 47 43 21 32 28 73 55 56 41 113 88
15.8 12.3 14.9 9.2 15.1 16.8 12.6 17.5 7.7 12.4 9.4 11.5 11.4 9.0 12.1 10.0 19.9 20.5 18.9 33.0 22.1 22.1 11.0 18.8 18.7 16.6 19.6 10.1 14.7 15.2 22.3 23.5 23.8 15.0 29.6 20.8
304 487 225 411 259 368 279 343 192 419 177 130 277 102 163 969 8,359 200 325 480 599 572 197 414 322 417 354 208 181 219 438 385 402 397 664 656
129.1 92.6 103.2 110.1 106.3 99.2 101.9 106.0 93.1 168.1 88.7 61.6 97.7 42.6 102.6 94.3 127.3 150.7 91.3 128.5 138.7 156.3 86.3 151.4 125.0 131.6 113.7 81.9 112.5 111.0 129.8 155.3 125.4 109.7 162.6 147.9
236 356 186 252 230 282 213 306 150 323 139 91 225 95 126 711 6,404 187 270 359 461 501 157 365 287 297 279 148 130 173 300 279 288 271 515 483
50.8 43.4 47.9 33.9 49.5 49.0 42.8 48.1 42.0 42.0 44.0 38.4 39.4 37.6 42.6 39.8 58.8 55.8 56.4 87.1 59.7 75.0 37.2 66.2 57.5 60.5 64.7 33.7 35.3 48.4 52.0 64.5 67.5 49.0 78.4 60.6
Blaenau Gwent Bridgend Caerphilly Cardiff Carmarthenshire Ceredigion Conwy Denbighshire Flintshire Gwynedd Isle of Anglesey Merthyr Tydfil Monmouthshire Neath Port Talbot Newport Pembrokeshire Powys Rhondda, Cynon, Taff Swansea
106 135 215 259 230 60 134 122 158 134 70 96 90 198 171 158 130 291 256
41
00PD 00PM 00NL Scotland 00QA 00QB 00QC 00QD 00QF 00QH 00QJ 00QK 00QL 00QM 00QN 00QP 00RJ 00QQ 00QR 00QS 00QT 00QU 00QW 00QX 00QY 00QZ 00RA 00RB 00RC 00QE 00RD 00RE 00RF 00RG 00QG 00RH
The Vale of Glamorgan Torfaen Wrexham
118 120 161 6,668
49.8 57.4 71.5 74.7 69.1 51.1 50.2 46.1 56.2 77.5 100.9 99.8 43.1 52.6 44.8 97.8 45.3 72.8 90.9 119.7 87.7 70.1 33.4 28.7 70.0 125.4 25.7 65.5 87.2 46.6 43.2 76.3 92.0 74.3 79.1 61.5
35 47 39 2,673 79 102 51 44 26 71 81 77 51 52 38 179 14 86 182 370 88 54 38 31 94 192 11 61 104 65 1 61 161 34 68 107
12.9 27.1 13.8 26.2 19.6 23.3 16.1 19.9 19.1 21.9 38.0 34.6 19.3 22.2 18.4 31.3 13.1 33.8 24.1 56.3 15.7 12.7 15.1 18.0 35.8 39.8 8.1 13.9 43.5 23.7 0.6 33.6 32.3 9.9 37.3 35.5
300 281 348 14,051 457 553 317 293 134 526 478 335 193 282 212 1,146 100 404 989 1,607 589 236 221 233 408 856 50 407 478 393 51 403 836 187 273 404
103.8 114.8 135.1 126.7 120.4 96.6 94.2 85.6 87.8 141.0 158.7 160.6 83.3 98.6 84.6 166.5 79.7 138.5 158.2 179.8 150.0 113.7 60.7 52.4 110.5 189.3 54.7 121.6 143.1 95.9 101.7 127.3 151.9 129.9 131.0 101.8
196 201 257 11,202 404 481 254 236 115 371 363 258 196 228 190 934 55 315 783 1,327 450 185 162 179 337 655 44 348 355 269 37 302 661 158 258 292
42.1 69.6 51.8 68.0 53.5 67.4 48.3 61.6 55.6 69.6 96.9 78.2 47.2 58.2 55.8 85.1 31.4 81.0 61.9 122.5 48.2 26.8 40.5 60.1 88.6 98.7 21.8 49.8 101.2 60.4 14.2 94.0 84.3 29.4 91.2 78.6
Aberdeen City Aberdeenshire Angus Argyll & Bute Clackmannanshire Dumfries & Galloway Dundee City East Ayrshire East Dunbartonshire East Lothian East Renfrewshire Edinburgh City Eilean Siar Falkirk Fife Glasgow City Highland Inverclyde Midlothian Moray North Ayrshire North Lanarkshire Orkney Islands Perth & Kinross Renfrewshire Scottish Borders Shetland Islands South Ayrshire South Lanarkshire Stirling West Dunbartonshire West Lothian
202 230 130 129 73 219 232 172 78 114 82 502 46 169 437 897 268 125 103 108 221 494 20 161 239 153 18 188 414 87 137 220
42
Northern Ireland 95T 95X 95O 95G 95D 95Q 95Z 95V 95Y 95C 95I 95N 95A 95R 95M 95L 95F 95B 95S 95H 95E 95P 95U 95W 95K 95J Antrim Ards Armagh Ballymena Ballymoney Banbridge Belfast Carrickfergus Castlereagh Coleraine Cookstown Craigavon Derry Down Dungannon Fermanagh Larne Limavady Lisburn Magherafelt Moyle Newry & Mourne Newtownabbey North Down Omagh Strabane
1,688 45 76 49 55 28 43 321 41 52 55 38 108 113 60 43 63 42 29 77 27 17 78 69 70 53 36
60.4 32.2 47.7 57.0 47.4 45.7 52.3 122.9 60.4 27.4 65.3 56.2 89.8 98.6 52.2 42.4 61.4 66.0 44.0 59.2 48.6 21.7 70.2 71.2 49.8 57.2 41.2
630 17 73 16 27 20 20 90 18 18 16 15 23 27 20 18 14 16 17 43 14 12 28 12 25 15 16
21.0 20.8 50.4 16.1 22.7 36.4 26.0 19.5 24.5 14.7 14.9 27.8 15.7 16.7 17.6 22.6 13.3 27.7 34.3 22.8 22.0 39.6 19.2 7.5 15.7 19.2 24.7
3,896 95 168 138 150 79 98 668 92 136 149 93 211 216 146 114 141 92 66 219 77 38 182 164 177 110 77
127.0 62.9 96.7 160.9 113.7 112.5 111.6 217.8 129.5 59.7 155.7 117.5 163.5 200.5 113.6 110.4 125.5 130.4 96.4 157.0 128.4 47.0 164.5 151.7 111.9 110.4 79.4
3,053 85 318 102 109 114 109 384 82 106 85 80 114 114 94 77 101 58 64 198 87 55 129 93 154 73 68
63.0 75.0 139.7 67.8 57.6 137.4 91.1 48.0 71.8 46.3 46.2 88.3 49.9 52.2 50.9 62.1 53.4 64.6 91.0 71.2 87.6 106.6 59.6 35.8 50.3 60.8 76.6
Notes: ICD-10 codes I20-I25; directly standardised using the European Standard Population. Source: England and Wales: rates calculated in partnership with the Office for National Statistics. Scotland: Rates calculated in partnership with the General Register Office for Scotland. Northern Ireland: Rates calculated in partnership with Northern Ireland Statistics and Research Agency.
43
Figure 1.11a Age-standardised death rates from coronary heart disease (CHD) per 100,000, for men under 75 by local authority, 2008/10, United Kingdom
Under 46 47 to 55 56 to 66 66 to 77 Over 77
London
Contains Ordnance Survey data Crown copyright and database right 2012
44
Figure 1.11b Age-standardised death rates from coronary heart disease (CHD) per 100,000, for women under 75 by local authority, 2008/10, United Kingdom
Under 12 12 to 17 17 to 21 21 to 27 Over 27
London
Contains Ordnance Survey data Crown copyright and database right 2012
45
Table 1.12 Cardiovascular disease (CVD) mortality rates, by sex and socioeconomic status, England and Wales 2001-03
CVD Men High managerial and professional Lower managerial and professional Intermediate Small employers and own account workers Lower supervisory and technical Semi-routine Routine Rate ratio 61 84 90 100 125 158 172 2.8 Women 13 19 19 27 34 35 51 3.8 CHD Men 41 56 60 66 86 107 119 2.9 Women 5 7 7 10 15 15 24 5.0 Stroke Men 8 12 12 15 17 23 23 2.9 Women 5 7 7 9 11 11 14 3.0
Notes: Rates are directly age-standardised to the European Standard Population, and presented per 100,000. Socioeconomic status categories defined by National Statistics Socio Economic Classification (NS-SEC). Age range for men is 25 to 64. Age range for women is 25 to 59. Rate ratio compares the routine and high managerial and professional categories. Source: Langford A, Johnson B (2009). Social inequalities in female mortality by region and by selected causes of death, England and Wales, 200103. Health Statistics Quarterly; 44: 7-26 White C, Edgar G and Siegler V (2008). Social inequalities in male mortality for selected causes of death by the National Statistics Socio-economic Classification, England and Wales, 200103. Health Statistics Quarterly; 38: 34-46
46
Figure 1.12 Coronary heart disease (CHD) death rates per 100,000 population, by sex and socioeconomic status, England and Wales 2001/03
140
120
80
60
40
20
0 A. Men Women B. C. D. E. F. G.
A. High managerial and professional B. Lower managerial and professional C. Intermediate D. Small employers and own account workers E. Lower supervisory and technical F. Semi-routine G. Routine
47
Table 1.13 Trends in coronary heart disease (CHD) death rates per 100,000 population, by sex and deprivation quintile, Great Britain 1994 to 2008
1994 Men, all ages Quintile 1 Quintile 2 Quintile 3 Quintile 4 Quintile 5 Ratio 222 240 255 276 296 1.3 211 233 249 272 292 1.4 207 223 239 259 280 1.4 193 209 221 248 268 1.4 186 199 213 236 256 1.4 172 191 210 226 240 1.4 164 181 191 210 231 1.4 152 167 184 203 221 1.4 146 164 178 192 208 1.4 138 154 170 182 203 1.5 128 146 154 171 183 1.4 122 131 143 157 173 1.4 110 122 133 145 162 1.5 104 116 125 140 156 1.5 98 105 118 131 142 1.5 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Women, all ages Quintile 1 Quintile 2 Quintile 3 Quintile 4 Quintile 5 Ratio Men, under 75 Quintile 1 Quintile 2 Quintile 3 Quintile 4 Quintile 5 Ratio 113 124 137 156 172 1.5 104 121 133 151 170 1.6 101 114 127 142 162 1.6 93 105 116 134 156 1.7 91 98 110 128 146 1.6 81 94 107 123 135 1.7 79 88 97 109 129 1.6 71 79 92 104 122 1.7 66 76 85 97 115 1.7 60 69 81 91 113 1.9 58 66 74 85 99 1.7 53 58 69 79 95 1.8 48 56 64 72 89 1.8 46 52 60 69 85 1.9 44 48 57 68 81 1.8 105 112 119 134 146 1.4 98 107 117 129 140 1.4 96 103 115 123 132 1.4 92 100 104 115 130 1.4 86 98 103 116 124 1.4 82 89 95 104 119 1.5 74 85 91 101 108 1.5 72 80 85 97 105 1.5 67 76 85 94 101 1.5 66 75 81 88 96 1.5 60 67 71 80 89 1.5 55 61 69 76 84 1.5 52 56 63 70 76 1.5 47 53 59 67 72 1.5 44 50 55 61 69 1.6
Women, under 75 Quintile 1 Quintile 2 Quintile 3 Quintile 4 Quintile 5 Ratio 37 41 47 58 66 1.8 34 39 45 55 63 1.8 33 37 44 51 59 1.8 31 36 39 47 59 1.9 28 35 40 48 54 1.9 26 30 36 40 52 2.0 23 29 33 40 47 2.1 22 26 31 36 45 2.1 20 23 30 35 42 2.1 18 24 27 30 39 2.1 16 19 22 27 37 2.3 15 19 23 25 33 2.1 15 16 20 24 31 2.1 12 16 18 23 28 2.3 12 15 17 21 28 2.3
Notes: Quintile 1 is the least deprived and quintile 5 is the most deprived. Ratio refers to quintile 5 compared to quintile 1. Deprivation measured using the Carstairs index for local authorities. Source: McCartney D, Scarborough P, Webster P, Rayner M (2012). Trends in social inequalities for premature coronary heart disease mortality in Great Britain, 1994 2008: a time trend ecological study. BMJ Open; 2: e000737.
48
Figure 1.13a Trends in coronary heart disease (CHD) death rates per 100,000 population in men , by deprivation quintile, Great Britain 1994 to 2008
200 180 160 140 Death rates per 100,000 120 100 80 60 40 20 0 2006 2004 2000 2008 2008 2005 2002 2003 2007 2007 1994 1996 1998 1995 1997 2001 1999
Quintile 1
Quintile 2
Quintile 3
Quintile 4
Quintile 5
Figure 1.13b Trends in coronary heart disease (CHD) death rates per 100,000 population in women, by deprivation quintile, Great Britain 1994 to 2008
70
60
50 Death rates per 100,000
40
30
20
10
0 2004 2000 2006 2005 2002 2003 1994 1995 1996 1997 1998 2001 1999
Quintile 1
Quintile 2
Quintile 3
Quintile 4
Quintile 5
49
Table 1.14a Age-standardised cardiovascular disease (CVD) death rates per 100,000 population in men, WHO European region 1980 to 2010
Men Albania Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan TFYR Macedonia Turkmenistan Ukraine United Kingdom Uzbekistan European Region EU 675 570 620 831 931 566 708 671 551 833 742 475 721 607 497 445 568 485 743 729 663 401 527 419 507 774 557 337 446 377 558 722 464 289 393 318 711 670 1,033 1,000 413 898 651 453 1,002 332 873 601 384 986 327 842 592 374 1040 317 866 601 368 1063 305 841 613 362 1063 281 799 582 338 1094 264 858 582 328 550 310 529 300 515 289 495 282 492 280 1057 246 235 1038 225 970 211 957 826 946 600 1,270 473 510 738 567 940 403 843 470 705 518 517 424 852 421 655 417 460 776 689 975 775 594 629 461 505 781 527 978 836 950 696 382 819 555 850 513 1,013 671 345 873 834 473 927 563 267 777 510 416 806 360 547 360 374 766 666 879 738 454 474 391 464 768 467 682 775 863 708 408 930 476 241 1,012 443 398 752 376 495 365 343 1,040 826 1,048 768 375 349 358 396 687 394 910 877 1,065 344 577 316 768 390 222 694 365 380 660 274 401 238 294 1,071 809 803 660 316 398 303 319 576 323 1,001 772 1,056 253 733 662 407 239 330 265 664 657 677 669 387 231 319 250 672 631 681 660 373 227 308 238 726 689 676 655 376 227 299 236 762 682 647 627 354 211 278 216 712 568 321 777 368 215 817 355 365 635 280 373 228 280 1033 788 816 704 301 334 287 310 560 311 980 772 1068 349 361 639 283 354 216 274 1057 831 814 722 314 349 283 301 531 310 1020 822 1109 346 355 648 264 323 210 270 1135 841 796 725 341 351 274 273 536 299 1015 808 1184 1070 775 792 706 290 294 253 255 510 271 965 762 1126 1024 755 1145 242 670 635 360 209 274 219 673 633 628 322 195 262 208 604 607 322 193 252 202 578 583 290 184 245 562 559 278 175 235 228 943 727 1053 1091 841 804 750 271 317 239 237 493 315 344 619 281 306 199 561 307 753 361 210 569 300 754 352 208 716 525 638 580 599 775 830 462 492 826 701 671 493 724 704 364 614 813 668 871 586 877 680 854 586 873 590 868 601 841 498 298 531 278 706 335 191 833 526 291 508 258 692 321 186 796 304 321 644 220 285 188 822 505 261 478 244 689 317 175 768 286 310 591 229 266 176 225 1078 870 779 741 284 318 222 222 480 657 312 169 744 277 299 585 230 263 182 219 1068 872 781 745 255 273 210 223 473 223 880 683 994 264 282 554 220 240 158 214 977 841 717 701 248 274 197 214 464 216 837 665 979 818 836 673 672 247 263 187 198 465 208 860 656 927 875 647 213 181 191 634 299 166 638 257 271 548 219 238 144 246 589 295 567 288 796 499 268 454 751 486 245 437 745 461 235 436 424 771 440 1980 1985 1990 1995 514 782 464 821 856 328 2000 656 617 385 775 901 2001 450 684 374 707 953 2002 479 736 351 731 991 2003 525 751 321 737 988 298 720 967 258 996 244 224 287 278 272 617 866 874 894 2004 491 659 259 640 259 252 2005 2006 2007 2008 2009 2010
Source: European Health for All database (HFA-DB). http://data.euro.who.int/hfadb/ (Accessed April 2012).
50
Table 1.14b Age-standardised cardiovascular disease (CVD) death rates per 100,000 population in women, WHO European region 1980 to 2010
Women Albania Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan TFYR Macedonia Turkmenistan Ukraine United Kingdom Uzbekistan European Region EU 451 379 367 602 657 334 526 452 363 588 499 281 517 400 323 326 324 308 519 495 444 293 295 247 408 479 371 246 256 225 423 473 308 201 221 187 562 546 758 642 248 698 415 290 650 204 690 388 250 639 202 669 381 244 648 198 690 385 241 666 193 659 388 240 646 177 612 366 223 656 167 662 364 216 347 204 333 196 324 189 311 184 309 182 637 156 149 614 144 590 134 591 719 610 432 959 270 288 464 418 609 327 574 256 452 427 354 338 557 255 402 336 309 524 510 647 530 369 461 251 268 494 368 781 718 634 383 230 543 316 552 293 647 356 206 584 513 280 558 312 159 529 327 330 524 225 319 273 249 499 457 543 483 306 383 217 252 462 338 519 645 561 455 247 530 267 139 641 278 314 476 207 297 268 228 651 568 573 498 224 291 205 217 421 285 658 641 634 165 379 196 448 220 127 574 239 299 421 188 244 165 195 621 570 465 418 190 271 182 190 353 233 731 581 629 147 592 439 251 162 197 168 554 519 546 444 239 156 194 156 546 494 562 432 235 153 192 153 561 548 557 435 236 153 183 152 539 530 528 412 223 141 172 141 504 382 195 432 207 126 528 234 296 409 156 221 156 184 659 561 475 432 209 247 174 182 344 227 715 573 633 237 290 408 166 213 153 179 667 620 462 434 200 245 173 179 329 223 756 601 650 239 297 410 161 200 146 182 697 616 465 424 213 240 165 169 331 221 759 592 673 666 578 444 428 189 222 156 159 314 194 701 558 639 750 557 640 156 545 417 235 140 163 137 486 508 408 212 128 163 131 488 395 211 127 159 129 473 373 191 122 154 455 364 192 115 148 145 683 531 607 679 609 434 436 191 233 148 141 304 219 285 394 148 186 139 379 193 435 209 123 384 184 427 198 125 568 331 434 472 391 509 560 285 438 636 508 489 321 463 447 227 491 586 472 601 419 620 495 591 413 602 404 587 425 560 356 193 357 171 393 182 111 551 372 207 351 160 377 178 110 454 211 266 401 142 169 139 541 350 188 318 154 360 171 101 430 198 259 366 152 160 130 151 659 620 421 440 193 218 139 144 292 343 168 97 397 192 251 354 128 164 128 148 643 597 423 420 178 196 134 138 285 165 656 493 571 186 236 339 136 150 113 142 595 595 374 401 158 187 129 130 277 159 629 472 559 493 575 354 385 144 172 121 124 276 152 613 462 525 628 454 167 119 119 337 164 96 368 180 219 331 132 151 102 173 320 158 311 154 526 353 177 307 500 335 171 292 492 327 153 296 282 504 313 1980 1985 1990 1995 322 556 304 527 476 207 2000 421 497 262 565 510 2001 299 477 252 529 533 2002 332 537 241 541 532 2003 369 536 231 563 514 210 553 495 169 508 162 149 203 192 186 489 427 417 428 2004 355 463 177 451 177 171 2005 2006 2007 2008 2009 2010
Source: European Health for All database (HFA-DB). http://data.euro.who.int/hfadb/ (Accessed April 2012).
51
Figure 1.14 Cardiovascular disease (CVD) death rates per 100,000, by sex, selected countries 2008
Israel France Spain Netherlands Italy Norway Portugal United Kingdom Ireland Sweden Austria Germany Greece Slovenia Finland Czech Republic Poland Hungary Slovakia Estonia Lithuania Latvia Kazakhstan Russian Federation Ukraine 800 Men 600 Women 400 200 0 200 400 600 800 1000 1200
52
Table 1.15a Age-standardised coronary heart disease (CHD) death rates per 100,000 population in men, WHO European region 1980 to 2010
Men Albania Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan TFYR Macedonia Turkmenistan Ukraine United Kingdom Uzbekistan European Region EU 331 228 380 497 630 367 475 331 225 565 427 309 472 292 209 115 405 184 322 310 186 114 354 174 283 432 161 106 270 163 332 387 156 103 230 157 358 146 648 623 260 559 325 194 663 200 521 303 166 656 191 473 297 160 697 182 467 301 156 711 174 453 306 153 707 161 431 288 144 738 150 454 290 139 274 131 264 126 258 120 246 116 245 113 713 138 132 700 124 662 116 656 114 184 540 258 309 173 131 248 317 174 118 677 230 531 194 278 194 114 426 241 458 164 224 168 98 607 311 559 57 200 518 641 122 318 341 387 272 179 130 333 304 399 231 149 437 396 641 591 223 260 434 112 410 383 439 345 686 427 112 491 439 293 608 359 91 487 225 136 332 233 339 188 135 422 355 549 560 163 280 355 227 594 304 81 520 217 130 345 225 307 194 127 582 428 603 534 142 215 256 154 468 255 76 490 177 124 302 166 234 128 106 589 437 465 417 120 228 96 125 164 205 86 700 283 544 20 168 367 148 95 176 129 304 150 162 367 147 92 171 118 291 155 161 362 130 90 167 113 331 156 164 369 140 90 161 112 315 151 157 351 115 83 147 101 304 142 117 160 194 84 676 282 551 109 155 182 88 718 295 573 106 138 181 83 704 290 612 93 126 170 79 662 277 579 710 273 594 31 178 338 117 82 144 103 284 142 144 130 124 119 113 169 316 99 76 137 98 154 337 97 74 130 93 155 357 102 69 125 89 148 339 94 67 116 85 140 334 95 65 111 80 639 269 556 253 155 488 237 72 465 170 124 299 160 213 116 102 576 422 450 463 104 204 166 121 293 171 203 109 102 594 454 436 473 108 190 162 126 309 167 180 110 106 615 476 419 480 129 189 512 428 436 459 109 173 525 476 433 491 90 199 111 87 115 164 149 124 309 171 174 95 243 134 460 234 70 238 127 445 222 68 233 196 229 389 240 481 594 171 126 296 137 463 221 524 459 129 144 288 124 306 236 247 261 244 214 254 210 240 242 225 198 115 220 119 414 211 64 219 220 122 231 107 388 203 62 226 141 112 347 128 159 92 203 208 112 223 98 376 201 57 186 133 108 319 129 148 89 89 510 501 410 476 103 194 93 80 104 160 350 193 55 164 126 106 303 138 159 96 86 511 497 440 467 86 162 86 73 103 151 64 582 255 532 117 96 289 134 144 82 84 475 494 397 449 87 161 83 68 99 148 60 550 248 527 330 182 53 299 179 52 155 116 97 289 117 144 74 80 334 520 378 429 69 155 83 63 92 140 57 578 240 505 59 88 133 57 597 238 515 266 534 375 436 69 132 131 111 295 177 188 200 123 239 174 205 106 227 159 201 108 218 156 207 95 213 1980 1985 1990 1995 121 533 212 576 578 127 2000 171 435 183 543 618 2001 115 480 176 492 653 2002 143 480 175 515 677 2003 168 491 162 481 678 152 352 631 104 694 99 87 147 145 142 149 606 618 643 2004 156 417 131 407 131 133 2005 2006 2007 2008 2009 2010
Source: European Health for All database (HFA-DB). http://data.euro.who.int/hfadb/ (Accessed October 2012).
53
Table 1.15b Age-standardised coronary heart disease (CHD) death rates per 100,000 population in women, WHO European region 1980 to 2010
Women Albania Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan TFYR Macedonia Turkmenistan Ukraine United Kingdom Uzbekistan European Region EU 183 108 164 324 422 167 333 186 107 376 253 145 317 156 101 51 194 73 185 169 89 50 158 70 205 240 95 48 120 71 230 220 81 46 102 71 254 71 426 370 123 417 172 95 405 94 394 164 84 400 91 357 161 82 408 87 351 163 80 421 83 330 164 79 409 76 312 153 74 425 71 321 150 71 145 67 142 64 138 61 132 58 132 56 416 65 61 402 58 390 52 391 50 126 314 108 128 60 65 101 122 55 57 528 163 315 82 116 65 59 313 168 251 71 94 61 50 424 197 272 31 98 334 377 45 162 143 182 169 90 53 167 147 182 151 69 268 264 370 379 95 151 171 48 219 187 224 166 397 172 48 313 220 148 334 158 39 310 107 61 171 118 157 118 63 239 213 293 340 68 189 192 116 309 141 33 306 108 58 179 97 145 124 61 319 262 288 318 55 147 137 79 259 120 30 301 92 56 173 90 111 71 52 294 277 233 240 48 130 55 56 79 96 45 499 187 268 18 93 234 75 41 83 65 219 74 92 232 68 40 82 60 204 72 100 229 62 39 80 59 229 75 98 236 63 39 77 57 182 79 95 221 58 37 71 51 186 80 52 73 91 43 486 184 269 50 71 85 44 517 188 280 47 66 85 46 517 182 294 43 60 80 39 470 175 280 502 174 285 8 107 219 54 36 67 50 173 72 74 70 64 63 57 103 197 45 32 68 47 94 216 44 31 64 45 91 223 42 29 62 43 91 217 42 28 58 41 82 210 41 27 54 38 448 169 280 136 79 240 114 30 286 89 56 173 70 102 66 50 322 276 218 266 52 125 89 56 171 78 101 62 50 333 318 207 261 50 117 88 59 178 71 91 62 55 345 324 212 257 57 118 277 302 206 260 48 99 286 327 199 267 44 111 49 39 52 79 81 57 180 66 85 54 134 71 240 115 28 132 66 233 108 28 142 81 103 291 110 288 378 75 62 201 52 307 109 302 262 55 68 180 44 175 146 149 158 145 125 150 121 138 147 127 121 47 123 59 203 97 25 117 130 51 138 55 192 97 24 113 76 49 201 63 77 55 104 124 49 129 52 183 90 22 86 71 48 185 68 71 52 45 279 347 196 263 53 103 47 35 53 76 170 91 21 73 66 47 172 49 78 51 44 280 338 211 255 43 86 50 33 50 70 34 425 158 269 62 41 166 61 68 46 42 264 351 184 240 36 90 47 31 46 69 32 408 151 266 163 88 20 150 80 20 77 59 41 163 55 69 38 40 175 370 178 229 25 85 40 28 45 66 31 402 148 256 27 42 60 30 424 146 263 124 373 174 239 27 85 61 57 144 79 94 119 52 146 88 120 44 137 82 124 36 134 81 131 35 123 1980 1985 1990 1995 53 348 108 339 287 56 2000 90 316 95 355 321 2001 61 288 93 336 339 2002 78 314 99 350 333 2003 94 312 96 328 325 89 207 307 47 13 44 38 86 81 77 93 276 275 284 2004 90 260 73 252 73 69 2005 2006 2007 2008 2009 2010
Source: European Health for All database (HFA-DB). http://data.euro.who.int/hfadb/ (Accessed October 2012).
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Figure 1.15 Percentage change in coronary heart disease (CHD) death rates, by sex, selected countries 1998 to 2008
Netherlands Norway Israel Ireland United Kingdom Germany Slovenia Estonia Austria Sweden Spain France Finland Italy Latvia Greece Kazakhstan Czech Republic Hungary Lithuania Russian Federation Kyrgyzstan Ukraine -60 Men -50 Women -40 -30 -20 Percentage decrease -10 0 10 20 30 40
Percentage increase
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2. Morbidity
56
2. Morbidity
This chapter reports on country-level estimates of incidence, case fatality and prevalence of the following conditions: myocardial infarction (heart attack), stroke, angina and heart failure. Additional estimates for coronary heart disease (CHD) and cardiovascular disease (CVD) are provided where possible. Measuring the morbidity of a disease is much more complicated than counting the number of deaths that have occurred due to a disease. For example, people may be suffering from a disease and not be aware of it or the exact time of onset of disease may not be known. As such, the estimates provided in this chapter should be treated with more caution than those from chapter one, yet they represent the best available estimates of the morbidity from CHD for countries within the UK. The estimates provided in this chapter are drawn from a number of different data sources, including samples of GP registers, hospital episode and mortality statistics and national survey data, each of which have their own strengths and limitations.
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Incidence Incidence of myocardial infarction has decreased in a number of developed countries during the past three decades, including the UK, driven by favourable changes in risk factors. The most recent estimates of incidence of myocardial infarction in the UK are based on national-level data from linked hospital and mortality statistics. These suggest that in Scotland the incidence rate of myocardial infarction decreased by about 25% between 2000 and 2009 in both men and women whilst the incidence rate in England decreased by around a third between 2002 and 2010 (Table 2.1, Figure 2.1). Although decreases have been found for all regions in England over this period, some regional differences are still apparent with the highest incidence rates found in the North and the lowest in the South (Table 2.2, Figure 2.2). The incidence of acute myocardial infarction resulting in hospitalisation has also decreased in both sexes over this period of time (Table 2.3, Figure 2.3). In general, incidence of myocardial infarction increases sharply with age. It is also higher in men than in women but the difference between sexes decreases with increasing age (Table 2,4, Figure 2.4). Using the most recent data available from Scotland and England, we estimate that there are around 50,000 heart attacks in English men and 32,000 in English women every year, and 8,000 heart attacks in Scottish men and 5,000 in Scottish women every year. If the rates of heart attack in Wales and Northern Ireland were comparable to that in England, then there would be approximately 103,000 heart attacks in the UK every year (Table 2.1 and Figure 2.1). Similar to rates of myocardial infarction, incidence of stroke has decreased in many developed countries during the past three decades, including the UK. On average around the world, stroke occurs around 30% more often in men than in women but the difference between sexes decreases with increasing age 2. Data from the South London Stroke Register suggest that stroke incidence decreased by 18% in men and by 24% in women from 1995/96 to 2003/04 3, while the Oxford Vascular Study reported a 40% reduction in stroke incidence over the past two decades 4,5. Recent national-level data from England and Scotland also show that stroke incidence rates are around 25% higher in men than in women and increase with age. They also show that the incidence of stroke is higher in Scotland than in England, but the difference is not as large as for myocardial infarction (Table 2.5 and Figure 2.5).
Using the most recent data available from Scotland and England, we estimate that there are around 57,000 strokes in English men and 68,000 in English women every year, and 6,500 strokes in Scottish men and 8,000 in Scottish women every year. Despite higher incidence rates in men than in women, there are a greater number of events in women because women tend to live longer than men. If the rates of stroke in Wales and Northern Ireland were comparable to that in England, then there would be approximately 152,000 strokes in the UK every year (Table 2.5). Estimates of the incidence of angina and heart failure can be provided from representative samples of GP registries. The General Practice Research Database (GPRD) contains anonymised records from such a sample in England, Wales, Scotland and Northern Ireland. GPRD data suggest that in 2011 the incidence rate of angina was highest amongst men in Wales and highest amongst women in Scotland, it was lowest for both sexes in England. Overall in the UK, incidence rates were 80% higher in men compared to women. Incidence rates generally increase with age and are highest in the 65-74 age group in both men and women. Using these incidence rates, we estimate there are over 20,000 new cases of angina in the UK every year (Table 2.6). Data from the GPRD were used to provide the most recent estimates of occurrence of heart failure in the UK. In 2011, incidence of heart failure was highest in Northern Ireland and lowest in England for both men and women. Overall in the UK, incidence rates of heart failure were about 60% higher in men compared to women. Incidence of heart failure increased with age and was highest in adults over 75 years. Using these incidence rates, we estimate there are over 25,000 new cases of heart failure in the UK every year (Table 2.7). Case fatality A case fatality rate is the ratio of the number of deaths caused by a specified disease to the number of diagnosed cases of that disease; it is commonly expressed as a percentage. In England, over 10% men and 15% of women who were admitted to hospital with myocardial infarction in 2010 had died within 30 days (Table 2.8). Case fatality rates in Scotland in 2008 were higher, with 12% of men and 19% of women admitted with myocardial infarction dying within 30 days. Case fatality rates in England have dropped since 2002 (Table 2.9, Figure 2.9). Although there have been decreases in all regions in England the highest case fatality rates are found in London and the West Midlands with the lowest rates found in the North East (Table 2.10, Figure 2.10).
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Case fatality from myocardial infarction increases with age and is higher in women than in men. However, this gender difference is largely a reflection of the different age distribution of the female patient population, with more elderly women surviving to be admitted for myocardial infarction compared to elderly men (Table 2.11, Figure 2.11). Case fatality rates for stroke are higher than for myocardial infarction, but are measured over a different time period (60 days rather than 30 days). In England, estimates based on linked hospital and mortality data show that about 17% of men and 25% of women admitted to hospital for stroke in 2006 died within 60 days. In Scotland, similar analysis shows that 19% of men and 25% of women admitted to hospital for stroke in 2008 died within 60 days (Table 2.12). In both England and Scotland, case fatality rates for myocardial infarction and stroke were substantially lower in individuals under 75 years of age compared to the rate in all age groups (Tables 2.8, 2.9, 2.11 and 2.12). Prevalence The prevalence of cardiovascular conditions such as myocardial infarction, stroke and angina increases with age and is higher in men than in women. The most recent national survey data suggests that in comparison with the rest of the UK, the prevalence of previous myocardial infarction, those who have ever suffered a heart attack, is in Wales and Northern Ireland, whilst the prevalence of angina is highest in Northern Ireland. However, the differences between countries are not very large (Tables 2.13 to 2.16 and Figures 2.16a, b and c). Age and sex-specific prevalence estimates from national surveys can be used to estimate the number of people living in the UK who have previously had a myocardial infarction or stroke, or are currently suffering from angina or coronary heart disease. It must be noted, however, that the most recent data from England and Northern Ireland come from 2006, whilst those from Wales and Scotland from 2010. This means that direct comparisons between countries are difficult and that data from different years are being used to calculate current population estimates for the UK. Using these figures, we estimate that there are around 1 million men and nearly 500,000 women who have had a myocardial infarction; nearly 600,000 individuals of each sex in the UK who have had a stroke; and over 1.6 million men and more than 1 million women in the UK with CHD (Tables 2.13 and 2.14).
The GPRD can also be used to estimate the prevalence of angina and heart failure within the UK, leading to different population estimates than obtained from national survey data. The prevalence of angina calculated using the GPRD data are lower than estimates provided by national survey data. For example, the prevalence of angina in English men aged 75 and over is estimated as 16% using 2010 GPRD data (Table 2.17) but 23% using the 2006 Health Survey for England (Table 2.13). Overall estimates on prevalence from health surveys results in national estimates of 1.2 million men and over 900,000 women in the UK suffering from the chronic condition angina (Tables 2.13 to 2.16), whilst estimates calculated from the GPRD suggests around 725,000 men and 575,000 women currently suffer from the condition (Table 2.17). Using GPRD data to calculate the number of people in the UK suffering heart failure leads to an estimate of around 800,000 individuals. Comparing heart failure estimates from survey data in Wales to GPRD data from the same country and same year suggest that this leads to similar estimates in the number of men with heart failure (around 20,000) but a difference of around 5,000 individuals when calculating national estimates for women. National survey data suggests an estimated 16,000 women in Wales are currently being treated for heart failure; whilst the GPRD estimates that over 22,000 women in the country have been diagnosed with the condition (Tables 2.15 and 2.18). These discrepancies illustrate the difficulties in interpreting morbidity data and using them to calculate population estimates. This is complicated further as both data describe diagnosed conditions, therefore we are unable to estimate the hidden burden of heart disease which comes from undiagnosed CVD. Estimates derived from national survey data of the number of people in the UK who have CHD or have had a stroke (given above) are broadly supported by results from the Quality Outcomes Framework. This framework became part of general practice contracts in 2004, and rewards GPs for keeping up-to-date records of the number of patients within their practices who are suffering from certain conditions. Data from the Quality Outcomes Framework suggest that in 2010/11 there were around 2.3 million people suffering from CHD and 1.1 million people suffering from stroke. The prevalence of CHD was higher in Scotland (4.4%), Wales (4.0%) and Northern Ireland (4.0%) than in England (3.4%). Prevalence rates were also higher in the North of England than in the South. Prevalence rates for stroke follow a similar geographic pattern. Prevalence rates for CHD show a wide variation, with lowest rates in London (2.2%) and highest rates in the Western Isles of Scotland (6.1%). However, these rates have not been adjusted to account for differences in the age structure of populations, and so differences in rates should be treated with caution (Table 2.19).
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Temporal trends in the prevalence of CHD and CVD can be estimated using data from national health surveys. The Health Survey for England series suggest that between 1994 and 2006 the prevalence of CHD increased from 6.0% to 6.5% in men and remained stable for women (from 4.1% in 1994 to 4.0% in 2006). An increase in the prevalence of CVD (defined here as either CHD or stroke) was also obtained in the Health Survey for England, increasing from 7.1% to 8.1% in men and from 5.2% to 5.6% in women between 1994 and 2006. These increases were found in the majority of age groups in both men and women, with the most consistent increase in trend found in the oldest age group (75 years and over) 6. Age-specific prevalence rates for CVD have been measured since 1988 in the General Household Survey series. They suggest that for men prevalence of CVD increased between 1988 and the mid-2000s. Although there have been some decreases since then 2010 data suggest that the prevalence for all men in 2010 (11.7%) is close to the peak found in 2002 (11.9%). For women, prevalence rates also peaked in the early to mid-2000s and have declined since. Although prevalence rates in 2010 were slightly higher than in recent years the overall prevalence of CVD in women in 2010 (10.1%) was still lower than the peak in 2002 (11.9%) (Table 2.20 and Figure 2.20).
1. Age-specific rates have been calculated but are not presented in this publication. 2. Appelros P, Stegmayr B, Terent A (2009). Sex differences in stroke epidemiology. A systematic review. Stroke, 40; 1082-1090. 3. Heuschmann P, Grieve A, Toschke A, Rudd A, Wolfe C (2008). Ethnic group disparities in 10-year trends in stroke incidence and vascular risk factors: The South London Stroke Register (SLSR). Stroke, 39: 2204-2210. 4. Rothwell P, Coull A, Giles M, Howard S, Silver L, Bull L, Gutnikov S, Edwards P, Mant D, Sackley C, Farmer A, Sandercock P, Dennis M, Warlow C, Bamford J, Anslow P (2004). Change in stroke incidence, mortality, case-fatality, severity and risk factors in Oxfordshire, UK, from 1981 to 2004 (Oxford Vascular Study). Lancet, 363 (9425): 1925-1933. 5. Scarborough P, Peto V, Bhatnagar P, Kaur A, Leal J, LuengoFernandez R, Gray A, Rayner M, Allender S (2009). Stroke Statistics. British Heart Foundation & The Stroke Association: London. 6. Joint Health Surveys Unit (2007). Health Survey for England 2006. The Information Centre: Leeds.
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Table 2.1 Incidence of myocardial infarction, by sex and age, Scotland 2000 to 2009 and England 2002 to 2010
Incidence rate per 100,000 2000 Scotland Men Under 75 All ages Women Under 75 All ages England Men Under 75 All ages Women Under 75 All ages 95 52 93 49 90 47 85 44 80 42 77 40 74 39 71 37 66 34 10,478 32,181 156 230 149 222 145 215 134 201 129 191 124 183 118 175 115 168 104 154 29,027 50,071 90 152 71 127 66 118 62 107 61 109 67 113 2,087 5,330 242 334 190 275 175 252 172 245 179 248 183 255 5,026 7,971 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Number of events (most recent year)
Notes: Incident cases include all mortalities and hospital admissions for myocardial infarction (ICD-10 I21-22) with no previous hospital admission for the same condition in the previous 30 days. Incident cases potentially include misdiagnoses and further investigation of earlier myocardial infarctions. Rates are age-standardised to the European Standard Population. Source: Smolina K, Wright FL, Rayner M, Goldacre M. Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: A linked database study. BMJ 2012; 344. DOI: 10.1136/bmj.d8059. Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford (2012) Personal communication. Information Services Division Scotland (2010) Personal communication.
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Figure 2.1 Incidence of myocardial infarction, by sex and age, Scotland 2000 to 2009 and England 2002 to 2010
400
350
300 Incidence rate per 100,000
250
200
150
100
50
0 2006 2008 2009 2007 2004 2000 2005 2003 2002 2001 2010
Women, Scotland
Men, Scotland
Women, England
Men, England
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Table 2.2 Incidence of acute myocardial infarction, by Government Office Region, England 2002-10
Incidence rate per 100,000 2002 Government Office Region North East North West Yorkshire and the Humber East Midlands West Midlands East of England London South East South West 206 192 183 163 163 148 126 129 141 205 186 175 157 158 143 124 126 137 187 178 164 155 154 140 119 126 135 171 165 154 149 142 134 117 120 123 155 158 152 142 130 128 109 113 119 138 155 150 146 127 118 107 105 112 125 146 147 141 120 116 110 101 103 150 140 142 127 115 103 111 95 96 143 136 123 120 114 91 98 82 91 2003 2004 2005 2006 2007 2008 2009 2010
Notes: Incident cases include all mortalities and hospital admissions for myocardial infarction (ICD-10 I21-22) with no previous hospital admission for the same condition in the previous 30 days. Incident cases potentially include misdiagnoses and further investigation of earlier myocardial infarctions. Rates are age-standardised to the European Standard Population. Source: Smolina K, Wright FL, Rayner M, Goldacre M. Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: A linked database study. BMJ 2012; 344. DOI: 10.1136/bmj.d8059. Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford (2012) Personal communication.
Figure 2.2 Incidence of acute myocardial infarction, by Government Office Region, England 2002 and 2010
250
200
Incidence rate per 100,000
150
100
50
0 North East 2002 North West 2010 Yorkshire and the Humber East Midlands West Midlands East of England London South East South West
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Table 2.3 Incidence of hospitalised acute myocardial infarction, by sex and age, England 2002 to 2010
Incidence rate per 100,000 2002 England Men Under 75 All ages Women Under 75 All ages 41 68 39 68 38 67 36 65 35 62 34 60 32 59 32 56 29 53 8,869 24,811 123 169 117 165 117 163 108 154 106 148 103 144 98 138 96 134 86 122 24,027 39,053 2003 2004 2005 2006 2007 2008 2009 2010 Number of events (most recent year)
Notes: Hospitalised acute myocardial infarction (AMI) was defined as a hospitalization for AMI an emergency hospital admission with a primary diagnosis of AMI (ICD-10 codes I21-I22) and a length of stay of more than one day for someone discharged alive. Rates are age-standardised to the European Standard Population. Source: Smolina K, Wright FL, Rayner M, Goldacre M. Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: A linked database study. BMJ 2012; 344. DOI: 10.1136/bmj.d8059. Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford (2012) Personal communication.
Figure 2.3 Incidence of hospitalised acute myocardial infarction, by sex and age, England 2002 to 2010
250
200
150
100
50
0 2006 2008 2009 2007 2004 2005 2002 2003 2010
Men all ages
Women all ages
Men under 75
Women under 75
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Table 2.4 Incidence of acute myocardial infarction, by sex and age, England 2010
Incidence per 100,000 Age 30-54 55-64 65-74 75-84 85 <75 All ages Number of events Men 9 32 53 102 199 104 154 50,071 Women 2 9 24 60 139 34 66 32,181
Notes: Incident cases include all mortalities and hospital admissions for myocardial infarction (ICD-10 I21-22) with no previous hospital admission for the same condition in the previous 30 days. Incident cases potentially include misdiagnoses and further investigation of earlier myocardial infarctions. Rates are age-standardised to the European Standard Population. Source: Smolina K, Wright FL, Rayner M, Goldacre M. Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: A linked database study. BMJ 2012; 344. DOI: 10.1136/bmj.d8059. Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford (2012) Personal communication.
Figure 2.4 Incidence of acute myocardial infarction, by sex and age, England 2010
250
200
150
100
50
0 30-54 Men Women 55-64 65-74 75-84 85
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Table 2.5 Incidence of stroke, by sex and age, Scotland 2000 to 2009 and England 2005 to 2007
Incidence rate per 100,000 2000 Scotland Men Under 75 All ages Women Under 75 All ages England Men Under 75 All ages Women Under 75 All ages 71 152 68 144 66 139 19,047 68,457 105 193 101 184 99 178 26,835 57,488 108 208 94 180 86 169 84 159 84 162 87 160 2,673 7,830 163 277 133 227 128 216 124 208 127 209 122 202 3,409 6,532 2005 2006 2007 2008 2009 Number of events (most recent year)
Notes: Incident cases include all mortalities and hospital admissions for stroke (ICD-10 I60-69) with no previous hospital admission for the same condition in the previous 60 days. Incident cases potentially include misdiagnoses and further investigation of earlier strokes. Rates are age-standardised to the European Standard Population. Estimates for England are provisional, and may be updated in future publications. Source: Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford (2010) Personal communication. Information Services Division Scotland (2010) Personal communication.
Figure 2.5 Incidence of stroke, by sex and age, England and Scotland 2007
250 All ages 200 Under 75s
150
100
50
0 Men Scotland England Women Men Women
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Table 2.6 Incidence of angina, by sex and age, England, Scotland, Wales and Northern Ireland 2011
Incidence rate per 100,000 England Men 0-44 45-54 55-64 65-74 75+ All ages Women 0-44 45-54 55-64 65-74 75+ All ages Number of cases Men Women 1,695 1,096 231 199 260 178 72 43 2,258 1,516 1.4 29.0 45.3 96.4 74.2 19.7 2.5 46.2 119.3 166.5 120.9 37.7 1.8 30.3 85.1 118.4 127.5 28.1 1.2 39.7 80.8 98.8 77.4 25.2 1.5 24.2 55.7 104.0 82.2 21.0 3.2 44.7 109.3 151.5 98.3 34.9 1.7 59.2 142.8 263.5 125.9 48.6 4.6 55.1 195.0 225.4 139.5 53.5 1.4 56.8 134.4 248.1 155.6 47.2 3.2 47.0 119.7 169.3 105.2 37.9 Scotland Wales Northern Ireland United Kingdom
Notes: Estimates are based on records from a sample of general practices in each of the constituent countries of the United Kingdom. Incidence rates are provided per 100,000 person years, as opposed to per 100,000 persons per year. These two denominators are broadly comparable provided that mortality rates in the groups are reasonably low. Estimates for all ages are age-standardised to the European Standard Population. Source: General Practice Research Database (2012) Personal communication. This table is based on data from the General Practice Research Database, 2012. Copyright and database rights over the data belong to the Crown. The interpretation and conclusions contained in this report are those of the authors alone.
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Table 2.7 Incidence of heart failure, by sex and age, England, Scotland, Wales and Northern Ireland 2011
Incidence rate per 100,000 England Men 0-44 45-54 55-64 65-74 75+ All ages Women 0-44 45-54 55-64 65-74 75+ All ages Number of cases Men Women 2,161 1,916 291 242 310 260 103 89 2,865 2,507 0.9 9.4 26.6 90.2 229.4 20.3 2.5 19.5 46.5 114.9 303.9 29.6 2.7 10.1 48.3 144.7 263.8 29.1 0.0 17.0 64.3 154.2 306.3 32.5 1.2 10.5 31.0 98.7 239.8 22.1 1.9 18.1 63.1 160.2 272.3 32.8 3.9 32.8 121.2 199.7 365.5 49.0 4.6 30.3 96.1 234.0 329.3 47.3 1.4 22.7 93.8 288.4 412.2 51.1 2.3 20.4 71.5 173.1 287.5 35.8 Scotland Wales Northern Ireland United Kingdom
Notes: Estimates are based on records from a sample of general practices in each of the constituent countries of the United Kingdom. Incidence rates are provided per 100,000 person years, as opposed to per 100,000 persons per year. These two denominators are broadly comparable provided that mortality rates in the groups are reasonably low. Estimates for all ages are age-standardised to the European Standard Population. Source: General Practice Research Database (2012) Personal communication. This table is based on data from the General Practice Research Database, 2012. Copyright and database rights over the data belong to the Crown. The interpretation and conclusions contained in this report are those of the authors alone.
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Table 2.8 Case fatality rates of those admitted to hospital for myocardial infarction, by sex and age, Scotland 2008 and England 2010
Scotland % Men Under 75 All ages Women Under 75 All ages Number of events Men Under 75 All ages Women Under 75 All ages 118 626 657 3,716 236 651 1,255 4,014 8.2 18.7 7.4 15.1 6.2 12.0 5.3 10.6 England %
Notes: Case fatality is defined as the percentage of all MI events that were sudden deaths from AMI or admissions to hospital for AMI that had a death record within 30 days of admission, irrespective of the cause or place of death. Estimates for England are provisional, and may be updated in future publications. Source: Smolina K, Wright FL, Rayner M, Goldacre M. Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: A linked database study. BMJ 2012; 344. DOI: 10.1136/bmj.d8059. Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford (2012) Personal communication. Information Services Division Scotland (2010) Personal communication.
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Table 2.9 Case fatality rates of acute myocardial infarction, by sex and age, England 2002 to 2010
2002 % England Men Under 75 All ages Women Under 75 All ages 29.2 42.2 28.1 40.6 25.2 37.4 25.1 36.5 22.9 34.5 22.0 33.5 21.7 31.9 19.7 30.3 19.9 29.9 32,181 10,478 28.9 42.0 27.8 41.0 26.0 38.6 25.5 37.1 24.3 36.2 23.3 34.6 23.0 33.2 22.1 32.3 22.1 32.1 29,027 50,071 2003 % 2004 % 2005 % 2006 % 2007 % 2008 % 2009 % 2010 % Number of events (most recent year)
Notes: Case fatality is defined as the percentage of all MI events that were sudden deaths from AMI or admissions to hospital for AMI that had a death record within 30 days of admission, irrespective of the cause or place of death. Estimates for England are provisional, and may be updated in future publications. Source: Smolina K, Wright FL, Rayner M, Goldacre M. Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: A linked database study. BMJ 2012; 344. DOI: 10.1136/bmj.d8059. Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford (2012) Personal communication.
Figure 2.9 Case fatality rates as a percentage of all events of acute myocardial infarction, by sex and age, England 2002 to 2010
45 40 35 30 Case fatality rate (%) 25 20 15 10 5 0 2006 2008 2009 2007 2004 2005 2002 2003 2010
Men all ages
Men under 75
Women all ages
Women under 75
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Table 2.10 Case fatality rates of myocardial infarction, by Government Office Region, England 2002 to 2010
2002 % Government Office Region North East North West Yorkshire and the Humber East Midlands West Midlands East of England London South East South West 34.0 37.0 39.3 34.1 38.7 35.7 40.9 37.0 37.9 32.6 36.4 38.1 33.4 37.0 33.4 40.2 36.2 34.5 31.1 34.1 36.0 32.1 34.9 30.8 37.9 33.1 31.7 30.7 33.8 36.1 29.4 36.1 30.1 35.2 31.2 30.6 30.3 33.1 33.6 29.1 35.4 28.7 32.7 29.5 29.9 31.2 32.7 30.1 27.2 33.2 27.3 31.8 28.7 29.1 30.1 30.8 29.6 26.5 31.4 26.3 30.2 27.9 27.8 25.7 29.9 28.6 26.7 30.7 25.2 28.7 26.6 26.9 22.6 28.3 30.1 28.7 29.4 24.8 29.2 27.5 25.3 2003 % 2004 % 2005 % 2006 % 2007 % 2008 % 2009 % 2010 %
Notes: Incident cases include all mortalities and hospital admissions for myocardial infarction (ICD-10 I21-22) with no previous hospital admission for the same condition in the previous 30 days. Incident cases potentially include misdiagnoses and further investigation of earlier myocardial infarctions. Rates are age-standardised to the European Standard Population. Estimates for England are provisional, and may be updated in future publications. Source: Smolina K, Wright FL, Rayner M, Goldacre M. Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: A linked database study. BMJ 2012; 344. DOI: 10.1136/bmj.d8059. Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford (2012) Personal communication.
Figure 2.10 Case fatality rates of myocardial infarction, by Government Office Region, England 2002 and 2010
45 40 35 30 Case fatality rate (%) 25 20 15 10 5 0 North East 2002 North West 2010 Yorkshire and the Humber East Midlands West Midlands East of England London South East South West
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Table 2.11 Case fatality rates of myocardial infarction, by sex and age, England 2010
Case fatality % Age 30-54 55-64 65-74 75-84 85 <75 All ages Number of events Men 14 14 20 28 38 22 32 50,071 Women 13 18 25 36 46 20 30 32,181
Notes: Case fatality is defined as the percentage of all acute myocardial infarction (AMI) events that were sudden deaths from AMI or admissions to hospital for AMI that had a death record within 30 days of admission, irrespective of the cause or place of death. Estimates for England are provisional, and may be updated in future publications. Source: Smolina K, Wright FL, Rayner M, Goldacre M. Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: A linked database study. BMJ 2012; 344. DOI: 10.1136/bmj.d8059. Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford (2012) Personal communication.
Figure2.11 Case fatality rate as a percentage of all events of myocardial infarction, by sex and age, England 2010
50 45 40 35 Case fatality rate (%) 30 25 20 15 10 5 0 30-54 Men Women 55-64 65-74 75-84 85
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Table 2.12 Case fatality rates of those admitted to hospital for stroke, by sex and age, Scotland 2008 and England 2006
Scotland % Men Under 75 All ages Women Under 75 All ages Number of events Men Under 75 All ages Women Under 75 All ages 349 1,463 2,188 12,119 406 1,009 2,404 7,615 14.6 25.2 13.1 24.7 12.8 18.7 10.3 17.1 England %
Notes: Incident cases include all hospital admissions for stroke (ICD-10 I60-69) with no previous admission for the same condition in the previous 60 days. All mortalities from any cause are included in the numerator. Estimates for England are provisional, and may be updated in future publications. Source: Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford (2010) Personal communication. Information Services Division Scotland (2010) Personal communication.
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Table 2.13 Prevalence of CHD, stroke, myocardial infarction and angina, by sex and age, England 2006
CHD % Men 16-24 25-34 35-44 45-54 55-64 65-74 75+ All ages Women 16-24 25-34 35-44 45-54 55-64 65-74 75+ All ages 0.1 0.1 0.3 1.3 3.5 10.0 19.3 4.0 0.2 0.1 0.4 0.9 2.3 4.2 10.7 2.2 0.0 0.0 0.1 0.7 1.6 3.3 9.1 1.7 0.1 0.1 0.2 1.2 3.2 8.3 15.9 3.3 4.5 5.7 7.8 10.3 15.2 21.2 36.9 13.0 794 1,148 1,494 1,279 1,269 470 471 6,925 0.1 0.2 0.6 3.6 10.6 20.8 28.6 6.5 0.0 0.0 0.5 1.2 3.0 7.1 13.1 2.4 0.0 0.2 0.6 2.1 6.3 14.4 16.6 4.1 0.1 0.1 0.3 2.4 8.0 14.2 22.7 4.8 3.2 4.7 5.6 10.9 18.5 34.1 44.4 13.6 650 862 1,183 1,050 1,126 437 317 5,625 Stroke % Myocardial infarction % Angina % CVD % Base
Notes: Prevalence rates are weighted for non-response. Respondents were prompted to recall whether they had ever been diagnosed with each of the conditions by a doctor. Informants were classified as having any CVD condition if they reported ever having any of the following conditions confirmed by a doctor: angina, heart attack, stroke, heart murmur, or irregular heart rhythm. Source: Joint Health Surveys Unit (2008). Health Survey for England 2006: Cardiovascular disease and risk factors. The Information Centre: Leeds. The Information Centre: Leeds. Copyright 2010, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved.
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Table 2.14 Prevalence of CHD, stroke, myocardial infarction and angina, by sex and age, Scotland 2010
CHD % Men 16-24 25-34 35-44 45-54 55-64 65-74 75+ All ages Women 16-24 25-34 35-44 45-54 55-64 65-74 75+ All ages 0.0 0.5 1.0 2.6 6.9 15.1 16.8 5.2 0.0 0.1 1.4 0.8 3.3 5.7 9.3 2.5 0.0 0.4 0.2 1.1 2.8 4.9 7.5 2.1 0.0 0.3 1.0 1.8 5.6 13.9 13.5 4.4 5.1 7.3 8.1 10.1 15.3 28.2 33.4 14.0 373 565 682 762 701 574 470 4,127 0.0 0.5 0.9 4.4 11.0 22.6 31.0 7.5 0.1 0.4 1.2 1.5 5.8 8.5 12.7 3.3 0.0 0.5 0.7 2.8 7.4 13.0 19.2 4.7 0.0 0.0 0.2 3.1 7.3 18.1 20.2 5.2 5.2 4.1 8.1 12.2 23.0 37.9 49.4 16.3 274 421 478 565 555 488 331 3,112 Stroke % Myocardial infarction % Angina % CVD % Base
Notes: Prevalence rates are weighted for non-response. Respondents were prompted to recall whether they had ever been diagnosed with each of the conditions by a doctor. Participants were classified as having any CVD condition if they reported ever having any of the following conditions confirmed by a doctor: angina, heart attack, stroke, heart murmur, abnormal heart rhythm, or other heart trouble. Source: Scottish Centre for Social Research (2012). Scottish Health Survey 2010. The Scottish Government: Edinburgh.
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Table 2.15 Prevalence of any heart condition, stroke, myocardial infarction, angina and heart failure, by sex and age, Wales 2010
Having ever been diagnosed with: Myocardial infarction % Men 16-24 25-34 35-44 45-54 55-64 65-74 75+ All ages Women 16-24 25-34 35-44 45-54 55-64 65-74 75+ All ages 0 0 0 1 3 6 10 3 0 0 0 1 2 5 8 2 0 0 0 1 3 9 14 3 0 0 1 0 1 3 6 1 0 1 2 3 8 18 29 7 919 1,073 1,330 1,472 1,520 1,247 1,018 8,579 0 0 1 2 7 14 23 5 0 0 0 2 4 9 10 3 0 0 0 2 5 12 19 4 0 0 0 1 2 5 8 2 0 1 2 5 12 27 42 9 882 831 1,082 1,333 1,361 1,109 822 7,420 Stroke % Currently being treated for: Angina % Heart Failure % Any heart condition % Base
Notes: Prevalence rates are weighted for non-response. Respondents were prompted to recall whether they had ever been diagnosed with heart attack or stroke, and whether they are currently being treated for angina, heart failure or other heart conditions by a doctor. Prevalence of any heart condition includes heart failure and is hence not comparable with estimates of the prevalence of coronary heart disease it does not include high blood pressure. Source: Welsh Assembly Government (2011). Welsh Health Survey 2010. Welsh Assembly Government: Cardiff.
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Table 2.16 Prevalence of stroke, myocardial infarction and angina, by sex and age, Northern Ireland 2005/06
Stroke % Men 16-24 25-34 35-44 45-54 55-64 65-74 75+ All ages Women 16-24 25-34 35-44 45-54 55-64 65-74 75+ All ages 0 0 0 1 2 3 6 1 0 0 0 0 2 6 11 2 0 0 0 4 2 15 24 5 254 428 501 417 334 312 251 2,497 0 1 0 1 2 6 12 2 0 1 0 5 11 16 18 5 1 0 0 5 13 20 24 6 153 278 344 305 275 236 152 1,743 Myocardial infarction % Angina % Base
Notes: Prevalence rates are weighted for non-response. Respondents were prompted to recall whether they had ever been diagnosed with each of the conditions by a doctor. Source: Central Survey Unit (2007). Northern Ireland Health and Wellbeing Survey 2005/06. Northern Ireland Statistics and Research Agency: Belfast.
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Figure 2.16a Prevalence of myocardial infarction, by sex and country, United Kingdom latest available year
6
4 Prevalence (%)
0 Men England, 2006 Scotland, 2010 Wales, 2010 Northern Ireland, 2005/06 Women
78
Figure 2.16b Prevalence of stroke, by sex and country, United Kingdom latest available year
5
Prevalence (%)
79
Figure 2.16c Prevalence of angina, by sex and country, United Kingdom latest available year
8
5 Prevalence (%)
80
Table 2.17 Prevalence of angina, by sex and age, England, Scotland, Wales and Northern Ireland 2011
England % Men 0-44 45-54 55-64 65-74 75+ All ages Women 0-44 45-54 55-64 65-74 75+ All ages Number of cases Men Women 123,559 99,887 13,367 11,948 14,859 12,465 4,834 4,363 156,619 128,663 0.1 0.5 1.7 4.8 11.3 1.1 0.0 0.6 2.5 7.4 13.9 1.5 0.0 0.5 2.1 6.3 12.9 1.3 0.0 0.5 2.0 6.9 15.6 1.4 0.0 0.5 1.8 5.2 11.7 1.1 0.1 0.9 3.4 8.4 16.2 1.8 0.0 0.9 4.2 10.5 18.1 2.1 0.0 0.9 4.1 10.4 17.5 2.0 0.0 0.9 4.2 11.2 20.6 2.2 0.0 0.9 3.6 8.8 16.6 1.9 Scotland % Wales % Northern Ireland % United Kingdom %
Notes: Estimates are based on records from a sample of general practices in each of the constituent countries of the United Kingdom. Estimates for all ages are age-standardised to the European Standard Population. Calculating the total number of cases should always take account of the prevalence rate in each age group, rather than applying the all ages prevalence to national population figures. Source: General Practice Research Database (2012) Personal communication. This table is based on data from the General Practice Research Database, 2012. Copyright and database rights over the data belong to the Crown. The interpretation and conclusions contained in this report are those of the authors alone.
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Table 2.18 Prevalence of heart failure, by sex and age, England, Scotland, Wales and Northern Ireland 2011
England % Men 0-44 45-54 55-64 65-74 75+ All ages Women 0-44 45-54 55-64 65-74 75+ All ages Number of cases Men Women 75,875 84,844 7,184 7,555 8,406 9,527 2,735 3,188 94,200 105,114 0.0 0.1 0.3 1.3 11.9 0.6 0.0 0.1 0.4 2.0 11.4 0.7 0.0 0.1 0.4 1.8 12.1 0.7 0.0 0.1 0.6 2.2 13.5 0.8 0.0 0.1 0.4 1.5 11.9 0.7 0.0 0.2 0.8 2.7 13.1 0.9 0.0 0.2 1.2 3.7 12.7 1.0 0.0 0.3 1.0 3.3 12.8 0.9 0.1 0.2 1.0 3.7 15.0 1.0 0.0 0.2 0.9 2.9 13.1 0.9 Scotland % Wales % Northern Ireland % United Kingdom %
Notes: Estimates are based on records from a sample of general practices in each of the constituent countries of the United Kingdom. Estimates for all ages are age-standardised to the European Standard Population. Calculating the total number of cases should always take account of the prevalence rate in each age group, rather than applying the all ages prevalence to national population figures. Source: General Practice Research Database (2012) Personal communication. This table is based on data from the General Practice Research Database, 2012. Copyright and database rights over the data belong to the Crown. The interpretation and conclusions contained in this report are those of the authors alone.
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Table 2.19 Prevalence of coronary heart disease (CHD), stroke and hypertension, by health authority, England, Scotland, Wales and Northern Ireland 2010/11
Registered GP patients CHD Register count 2,308,733 1,877,518 124,394 298,317 221,747 169,105 203,324 198,148 192,142 148,830 126,415 195,096 228,074 20,723 5,756 8,222 16,268 14,143 22,661 55,986 14,754 27,308 20,013 855 789 18,928 1,668 128,114 30,025 5,803 17,147 22,847 12,604 15,169 24,519 75,027 17,424 13,666 18,745 13,525 11,667 Prevalence 3.5% 3.4% 4.6% 4.0% 4.1% 3.6% 3.5% 3.3% 2.2% 3.2% 2.9% 3.6% 4.4% 5.3% 4.9% 5.3% 4.3% 4.7% 4.0% 4.3% 4.6% 4.6% 3.4% 4.2% 3.5% 4.5% 6.1% 4.0% 4.3% 4.2% 4.4% 4.2% 4.1% 3.1% 4.1% 4.0% 4.1% 4.2% 4.2% 3.6% 3.7% Stroke Register count 1,151,994 944,099 58,105 140,577 105,683 82,371 103,944 100,406 93,927 80,903 67,646 110,537 109,694 9,621 2,870 3,756 8,110 6,298 10,580 26,784 7,623 12,047 10,489 355 351 10,134 676 65,203 14,539 3,267 8,808 12,101 6,159 8,546 11,783 32,998 7,811 6,258 8,008 5,780 5,141 Prevalence 1.8% 1.7% 2.2% 1.9% 1.9% 1.8% 1.8% 1.7% 1.1% 1.8% 1.6% 2.0% 2.1% 2.5% 2.5% 2.4% 2.2% 2.1% 1.8% 2.0% 2.4% 2.0% 1.8% 1.7% 1.5% 2.4% 2.5% 2.1% 2.1% 2.4% 2.3% 2.2% 2.0% 1.7% 2.0% 1.8% 1.8% 1.9% 1.8% 1.6% 1.6% Hypertension Register count 8,890,858 7,460,497 410,357 1,030,582 756,106 652,882 845,535 834,662 970,554 632,487 543,580 783,752 705,994 59,329 16,380 24,009 53,841 41,739 74,117 165,839 48,358 80,551 68,478 3,292 3,473 61,136 5,452 486,533 111,496 23,274 63,318 81,003 50,723 62,294 94,425 237,834 52,049 42,986 59,163 44,947 38,689 Prevalence 13.6% 13.5% 15.3% 14.0% 13.9% 14.1% 14.6% 13.9% 11.0% 13.8% 12.5% 14.3% 13.5% 15.3% 14.1% 15.5% 14.3% 13.8% 12.9% 12.6% 15.0% 13.6% 11.6% 16.1% 15.3% 14.6% 19.9% 15.4% 15.8% 16.8% 16.2% 15.0% 16.7% 12.6% 15.9% 12.6% 12.3% 13.3% 13.3% 12.1% 12.1%
United Kingdom England North East North West Yorkshire and the Humber East Midlands West Midlands East of England London South East South Central South West Scotland Ayrshire & Arran Borders Dumfries & Galloway Fife Forth Valley Grampian Greater Glasgow & Clyde Highland Lanarkshire Lothian Orkney Shetland Tayside Western Isles Wales Betsi Cadwaladr ULHB Powys Teaching LHB Hywel Dda LHB ABM ULHB Cwm Taf LHB Cardiff & Vale ULHB Aneurin Bevan LHB Northern Ireland Belfast Southern Eastern Northern Southern Western
65,437,967 55,169,643 2,678,976 7,381,814 5,456,644 4,636,678 5,801,090 5,986,835 8,845,268 4,582,266 4,333,806 5,466,266 5,216,925 387,577 116,285 155,370 375,671 302,146 573,533 1,313,117 322,350 591,826 589,109 20,502 22,769 419,217 27,453 3,168,721 704,259 138,580 390,645 541,356 303,942 494,659 595,280 1,882,678 423,863 323,465 445,172 370,927 319,251
Notes: England - Copyright Health and Social Care Information Centre 2009. Stroke refers to stroke and transient ischaemic attack. Prevalence (unadjusted) = (number on disease register / registered GP patients ) * 100%. Prevalence estimates for Shetland and Orkney are relatively unstable, due to their being based on a smaller number of patients. Source: England - Information Centre QOF achievement data 2010/11. Wales - StatsWales. QOF 20010/11 achievement data. Scotland - ISD Scotland. QOF achievement data 2010/11. Northern Ireland - Department of Health, Social Services and Public Safety. QOF achievement data at health and social services board level.
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Table 2.20 Prevalence of cardiovascular disease, by sex and age, Great Britain 1988 to 2010
All ages % Men 1988 1989 1994 1995 1996 1998 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Women 1988 1989 1994 1995 1996 1998 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 7.7 7.7 9.2 8.7 9.5 9.9 10.4 10.2 11.9 10.9 11.0 10.8 11.5 9.7 9.4 9.5 10.1 1.7 2.2 1.7 1.3 1.5 1.3 1.8 1.5 1.9 2.2 1.7 2.0 2.3 1.8 1.2 1.7 2.1 10.8 11.5 10.6 9.7 12.4 10.6 11.7 11.5 12.9 11.8 13.2 12.3 12.8 11.0 9.9 9.8 10.6 22.8 22.0 23.9 19.7 22.4 26.8 26.2 25.2 29.1 29.7 26.6 26.0 29.0 23.9 23.0 26.2 22.3 26.5 26.8 25.1 29.2 25.4 29.9 30.6 32.2 37.9 30.3 31.9 31.3 33.3 27.7 32.5 27.5 31.7 7.3 6.9 9.3 9.3 9.9 11.3 10.7 11.0 11.9 11.3 11.1 11.4 11.5 10.9 11.1 11.4 11.7 1.7 1.2 1.6 1.2 1.4 1.9 1.8 2.2 1.7 1.7 1.4 1.5 2.3 1.0 1.4 1.6 1.5 14.3 13.3 13.8 12.9 14.1 15.5 13.7 15.0 15.2 14.7 14.6 16.7 12.8 14.7 15.6 14.9 14.6 24.7 25.9 24.6 27.2 26.8 28.1 29.0 31.3 33.0 34.5 29.5 28.8 29.0 32.0 31.2 32.3 33.9 22.3 22.1 23.6 23.8 24.9 31.0 30.8 33.3 39.8 31.7 37.3 32.9 33.3 33.8 31.1 33.7 35.5 16-44 % 45-64 % 65-74 % 75+ %
Notes: From 2000 data are weighted for non-response. See source for details. Source: Office for National Statistics (2011). General Lifestyle Survey 2010. Results published online at http://www.ons.gov.uk/ons/rel/ghs/general-lifestyle-survey/2010/index.html (Accessed May 2010).
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Figure 2.20 Prevalence of cardiovascular disease (CVD), by age, Great Britain 1988 to 2010
45 40 35 30 Prevalence (%) 25 20 15 10 5 0 2006 2008 2009 2004 2000 2005 2003 2002 2007 1998 1997 2001 1990 1994 1996 1999 1988 1991 1992 1993 1989 1995 2010
1644
4564
6574
75+
85
3. Treatment
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3. Treatment
This chapter reports on different methods of treatment for cardiovascular disease (CVD), with a focus on treatments for coronary heart disease (CHD). The chapter includes tables and figures on the number of prescriptions, operations and hospital episodes for CVD in the UK, with temporal trends and comparisons with other countries in Europe where possible. The chapter also includes a discussion of the impact of the National Service Framework for Coronary Heart Disease 1, which was introduced in 2000 and covered different aspects of treatment for CHD within the NHS over a ten year period finishing in 2010. An assessment of staffing levels and rehabilitation for CHD is also provided.
Prescriptions The rapid increase in the number of prescriptions for the treatment and prevention of CVD began in the late 1980s. In 2011, around 292 million prescriptions were issued for CVD in England, nearly six times as many as issued in 1986, and an increase of 2% from the number of prescriptions in 2010 (Table 3.1). Total number of prescriptions issued for CVD in the UK was around 348 million (Table 3.2). Since 1990, the number of prescriptions for antiplatelet drugs has increased steadily, and there are now over 38 million prescriptions for antiplatelet drugs in England every year. The increase in the number of prescriptions of lipid lowering drugs was slow until the late 1990s, but since then has been very rapid. The number of prescriptions for lipid lowering drugs is more than fifteen times higher than a decade ago (Table 3.1 and Figure 3.1). In 2011 antihypertensive drugs were the most prescribed drugs for CVD in England, Scotland and Wales. In Northern Ireland it was lipid lowering drugs followed by the antihypertensive drugs (Table 3.2). The cost of prescriptions for hypertension and heart failure therapy decreased by approximately 64 million between 2010 and 2011, to just over 330 million 2. The cost of prescriptions for cardiovascular diseases may not increase at the same rate as the increase in the number of prescriptions, as when commonly used drugs come out of patent they can be replaced by cheaper generic drugs (Figure 3.1). Operations The total number of operations carried out to treat CHD is increasing. The number of percutaneous coronary interventions (PCIs) carried out in the UK in 2010 was more than three times higher than a decade earlier; over 80,000 procedures are now carried out annually in the UK. But the amount of coronary artery bypass graft (CABG) surgery reached a plateau in the late 1990s, driven by more widespread use of less invasive procedures (e.g. stents). Currently around 25,000 CABG procedures are carried out in the UK each year (Table 3.3 and Figure 3.3). Rates of CABG and PCI vary substantially across the UK. In the most recent atlas of coronary revascularisation rates for men and women by local authority in England in 2002 showed a greater than six fold difference between the lowest and highest rates 3. More recently, rates of operations for CHD have been shown to vary greatly around England for both men and women, with higher operation rates found in urban and metropolitan areas, and in rural areas in the North and South West of England 4. Inpatient hospital episodes Overall, there were around 405,000 inpatient episodes of CHD in National Health Service hospitals in 2010/11 in England, and a further 50,000 in Scotland and 24,000 in Wales. These represent 3.4% of all inpatient episodes in men and 1.4% in women in England (4.8% and 2.3% for men and women respectively in Scotland). The number of inpatient episodes of CHD has increased by 7% in the last ten years 5 (Table 3.4 and Figures 3.4a, 3.4b, 3.4c and 3.4d). Medical risk factors for CHD, such as diabetes and obesity, also result in a sizeable burden to the National Health Service. In 2010/11 there were around 38,000 inpatient episodes of diabetes, and over 12,000 of obesity in England (Table 3.4).
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Staffing levels In 2002, a report on the provision of services for patients with heart disease in the UK claimed there was a shortage of all types of health care professionals involved in cardiovascular care 6. However, since then the numbers of consultant cardiologists and cardiothoracic surgeons have increased considerably. In 2011, there were 947 cardiologists and 306 cardiothoracic surgeons working in England 7. In the same time period, there were 165 and 62 in Scotland, 136 and 38 in Wales and 47 and 7 in Northern Ireland. The total number of cardiologists (full time equivalence) currently working in the UK is around 1,295 (which equates to around 20 per million). This level of staffing is around 80% higher than in 2002 8. Rehabilitation The National Audit of Cardiac Rehabilitation monitors access to cardiac rehabilitation around the UK (except Scotland). Its most recent report (2011) 9 found that in 2009/10 only 42% of heart attack and revascularisation patients started a cardiac rehabilitation programme. The audit team also found large geographical inequalities in access to cardiac rehabilitation for example, the percentage of myocardial infarction patients that started a rehabilitation programme ranged from 30% to 59% in different Strategic Health Authorities in England. In Scotland percentage of completing cardiac rehabilitation programmed ranged from 36% to 79% in different NHS Boards 10. International differences Country-level rates of hospitalisation for CVD are dependent upon a number of factors including prevalence of disease, service provision and primary care referrals practice. Therefore, international comparisons of hospitalisation rates for CVD should be made with caution. Rates of hospitalisations for CVD vary considerably across Europe. For example, the hospitalisation rate in Belarus is four times higher than in Portugal. In general, high hospitalisation rates for CVD, CHD and stroke are found in Eastern European and Scandinavian countries (Tables 3.5 to 3.7). Within Europe, there is an East-West divide in temporal trends for hospitalisation for CVD. Rates in some Eastern European and former Soviet countries have increased rapidly since 1995, whereas rates in Western European countries have remained relatively stable. For example, the rate of hospitalisations for CHD in Ukraine has nearly trebled since 1995, whereas the United Kingdom rate has changed little over this time period (Tables 3.5 to 3.7, Figures 3.6 and 3.7).
National Service Framework for Coronary Heart Disease The National Service Framework (NSF) outlined a series of priorities, milestones and goals to be achieved to improve service quality, tackle variations in care and reduce the number of deaths from CHD over the ten-year period 2000-2010. It is clear that there have been some impressive successes in implementing the programme outlined in the NSF. For example, three immediate priorities were achieved quickly: the introduction of specialist smoking cessation clinics by health authorities to help 150,000 people quit smoking; the setting up of 50 rapid-access chest pain clinics to assess people with new symptoms for angina within two weeks of referral; and the reduction of call-to-needle times for thrombolysis for heart attacks, by improving ambulance response times and increasing the proportion of accident and emergency (A&E) departments able to provide thrombolysis. By 2010/11, over 700,000 people in England attended NHS smoking cessation services, and of these, 49% reported that they were not smoking four weeks after their quit date (Table 3.8) 11. By June 2001, there were 150 rapidaccess chest pain clinics open across England 12. By 2004/05, only the South East Coast had missed the target of 75% of category A (immediately life threatening) calls responded to within eight minutes 13. This is compared to only 3 out of 32 ambulance services achieving this target in 2000/01. From 2008/09, the measurement for response time was changed, but across England 74% of emergency and urgent calls were responded to in less than eight minutes. The Scottish Ambulance Service reported that they responded to 72% of emergency calls within eight minutes in 2010/11 14 (Table 3.9). Further targets that were achieved by the NSF regarded treatment for CHD once patients arrived at hospital. These included targets to increase to 75% the proportion of heart attack patients receiving thrombolysis within 30 minutes of arriving at hospital; to improve the use of effective medicines after heart attack so that 80 to 90% of people discharged from hospital following a heart attack are prescribed aspirin, beta-blockers and statins; and to increase the total number of revascularisation procedures by 3,000. As discussed earlier, the number of revascularisation procedures carried out in the UK is still increasing in 2008 there were nearly 45,000 more revascularisation procedures in the UK than in 2000. The Myocardial Ischaemia National Audit Project (MINAP) has monitored the achievement of the other two targets. MINAP data show that by April 2002, 59% of eligible heart attack patients were receiving thrombolysis within 30 minutes of arriving in hospital. As the number of patients having primary angioplasty has increased, the number having thrombolytic treatment, either before or on arrival at hospital, has fallen. By 2010/11, the level was 75% in England and 62% in Wales. MINAP data further show that in 2010/11, at least 95% of people discharged from hospital following a heart attack in England were prescribed secondary prevention medicine (Table 3.10) 15.
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The NSF also outlined the importance of cardiac rehabilitation. It set an overall goal that in every hospital over 85% of people discharged with a primary diagnosis of heart attack or after coronary revascularisation should be offered cardiac rehabilitation. However, as discussed earlier, the rate of CHD patients actually starting cardiac rehabilitation programmes is still much lower than this level (42% in 2009/10) 9. The Department of Health have monitored the implementation of the NSF for CHD, and periodically report on its findings. The most recent report in 2009 highlighted improvements in waiting time for CABGs: in April 2002, there were 7,558 people waiting for a CABG and 4,364 of them had been waiting three months or more; by December 2008, this had fallen to 1,670 people waiting and only six people had been waiting longer than three months 16. However, the review acknowledged that many things have changed since 2000 and identified several areas to be focussed on, such as preventing vascular disease and not just treating it, removing inequalities of access, and ensuring that those with chronic vascular conditions who require long-term and end-of-life care get the same level and quality of services that those with acute conditions are currently receiving.
1. 2. 3.
Department of Health (2000). National Service Framework for Coronary Heart Disease. The Stationery Office: London. Office for National Statistics (2008). Prescription cost analysis. The Information Centre: London, and previous editions. Otreba P, Rayner M, Hill A, Goldacre M (2003) An atlas of coronary heart disease mortality, hospital admissions and coronary revascularisations in South East England. SEPHO: Oxford. This publication contains maps of CHD mortality, hospital admissions and coronary revascularisations by local authority across England as well as the South East Region. See www.heartstats.org/chd_atlas Scarborough P, Allender S, Peto V, Rayner M (2008). Regional and social differences in Coronary Heart Disease 2008. British Heart Foundation: London. This publication contains maps of mortality, morbidity and treatment rates for coronary heart disease, and local estimates of the prevalence of behavioural risk factors for CHD. See www.heartstats.org/publications. In 2000/2001, the number of inpatient episodes for CHD was 378,532 in National Health Service hospitals in England. See Table 3.5 in Petersen S, Peto V and Rayner M (2003) Coronary heart disease statistics. British Heart Foundation: London. Hall R, More R, Camm J et al (2002). Fifth report on the provision of services for patients with heart disease. Heart; 88 (Suppl III): iii1-iii59. Office for National Statistics (2012). Medical and Dental Workforce Census 2011. The Information Centre: Leeds. Data from NHS workforce statistics (2011/12) and national statistical agencies. National Audit of Cardiac Rehabilitation (2011). Annual Statistical Report 2011. British Heart Foundation: London.
4.
5.
6.
7. 8. 9.
10. Cardiac Rehabilitation in Scotland (2011). Information Services Division. Edinburgh. 11. Four week self-reported quit rates only give an indication of the true short-term quit rates achieved by smoking cessation services. In 2003/04, carbon monoxide (CO) validation was offered to clients of smoking cessation services as a tool to aid smoking cessation. Around 70% of those who reported having successfully quit smoking at the 4-week follow-up had the level of carbon monoxide in their bloodstream measured. In 88% of cases this test confirmed they were not smoking at 4-weeks. Longer term success rates are currently unknown. 12. Department of Health Heart Team, personal communication. 13. Department of Health Statistical Bulletin (2005) Ambulance services, England: 2004-2005. Department of Health: London. 14. Working for you, Scottish Ambulance Service Annual Report and Accounts 2010/2011. NHS Scotland: Edinburgh. (accessed August 2012). 15. For more results from the MINAP project, including hospital level data, see Royal College of Physicians (2011) How the NHS Manage Heart Attacks. Tenth Public Report of the Myocardial Infarction National Audit Project. Royal College of Physicians: London. Also available at www.rcplondon.ac.uk/pubs. 16. Department of Health (2009). The Coronary Heart Disease National service framework report. Building on excellence, maintaining progress. Progress report for 2008. Department of Health: London.
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Table 3.1 Prescriptions used in the prevention and treatment of cardiovascular disease, England 1981 to 2011
Prescriptions (thousands) Digoxin and other positive inotropic drugs (2.1) Diuretics (2.2) Anti-arrhythmic drugs (2.3) Beta-adrenoreceptor blocking drugs (2.4) Antihypertensive and heart failure drugs (2.5) Nitrates, calcium blockers & other antianginal drugs (2.6) Sympathomimetics (2.7) Anticoagulants and protamine (2.8) Antiplatelet drugs (2.9) Anti-fibrinolytic drugs and haemostatics (2.11) Lipid-lowering drugs (2.12) Local sclerosants (2.13) All prescriptions for disease of the circulatory system 295 247 1,066 3,138 1981 1986 1991 1996 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
4,243 20,678 232 9,827
3,722 21,996 334 12,525
3,822 22,195 532 14,282
3,871 23,106 840 14,375
3,983 27,738 1,214 18,321
4,031 30,203 1,292 20,439
4,029 32,185 1,338 22,439
4,043 34,432 1,343 24,336
4,088 36,546 1,325 26,361
4,103 37,619 1,292 27,460
4,126 37,582 1,265 27,378
4,141 37,355 1,247 26,810
4,149 37,536 1,226 27,634
4,119 37,511 1,188 28,529
4,088 37,687 1,174 29,686
4,006 37,563 1,156 30,924
4,912
4,424
6,431
12,125
21,075
25,047
29,591
33,788
38,580
42,865
47,742
53,634
57,823
60,838
63,571
65,449
5,156 15 629 281
10,314 6 900 1,058
16,718 19 1,356 3,619
21,971 7 2,609 9,002
25,394 3 4,152 16,552 267 10,331 1
26,814 2 4,609 18,891 282 13,523 1
27,994 2 4,975 21,601 289 17,604 0
29,156 3 5,389 24,428 300 22,655 0
30,715 4 5,871 27,356 310 29,444 0
32,309 4 6,294 30,218 311 35,568 0
34,707 5 6,790 32,779 327 42,098 0
37,214 6 7,309 35,382 352 47,412 0
39,100 8 7,991 38,124 358 52,190 0
40,575 12 8,546 39,107 363 56,452 0
42,043 16 9,157 38,182 373 59,550 0
43,086 17 9,773 38,351 392 61,649 0
46,267
55,526
70,041
91,044
129,030
145,134
162,046
179,872
200,598
218,043
234,798
250,862
266,138
277,244
285,530
292,370
Notes: The data up to 1990 are not consistent with data from 1991 onwards. Figures up to 1990 are based on fees and on a sample of 1 in 200 prescriptions dispensed by community pharmacists and appliance contractors only. Figures from 1991 are based on items and cover all prescriptions dispensed by community pharmacists, appliance contractors, dispensing doctors and prescriptions submitted by prescribing doctors for items personally administered. British National Formulary (BNF) codes in parentheses. Source: Office for National Statistics (2012). Prescription cost analysis 2011. The Information Centre: Leeds, and previous editions.
90
Figure 3.1 Prescriptions used in the prevention and treatment of CVD, selected BNF drug groups, England 1981 to 2011
70
60
Number of prescriptions (000s)
50
40
30
20
10
0 2006 2008 2009 2007 2010 2004 2000 2005 1981 1982 2002 2003 1983 1984 1985 1986 1987 1988 1990 1993 1994 1995 1996 1998 2001 1991 1992 1997 1999 1989 2011
Anti-arrhythmic drugs
Antiplatelet drugs
Antihypertensive and heart failure drugs
Lipid lowering drugs
91
Table 3.2 Prescriptions used in the prevention and treatment of cardiovascular disease, UK latest available year
Prescriptions (thousands) Digoxin and other positive inotropic drugs (2.1) Diuretics (2.2) Anti-arrhythmic drugs (2.3) Beta-adrenoreceptor blocking drugs (2.4) Antihypertensive and heart failure drugs (2.5) Nitrates, calcium blockers & other antianginal drugs (2.6) Sympathomimetics (2.7) Anticoagulants and protamine (2.8) Antiplatelet drugs (2.9) Antifibrinolytic drugs & haemostatics (2.11) Lipid-lowering drugs (2.12) Local sclerosants (2.13) All prescriptions for disease of the cardiovascular system England 2011 4,006 37,563 1,156 30,924 65,449 43,086 17 9,773 38,351 392 61,649 0 292,370 Wales 2011 284 2,960 64 2,322 4,920 3,314 1 808 2,904 33 4,788 0 22,399 Scotland 2011/12 276 3,382 71 2,957 5,045 3,699 1 819 3,506 44 4,861 0 24,660 Northern Ireland 2011 93 1,002 32 1,059 1,640 1,154 0 274 1,223 15 1,838 0 8,330 UK 4,659 44,907 1,323 37,262 77,054 51,253 19 11,674 45,984 484 73,136 0 347,759
Notes: Numbers are rounded to nearest 000. Figures are based on items and cover all prescriptions dispensed by community pharmacists, appliance contractors, dispensing doctors and prescriptions submitted by prescribing doctors for items personally administered. British National Formulary (BNF) codes in parentheses. Source: Office for National Statistics (2012). Prescription cost analysis 2011. The Information Centre: Leeds. Welsh Government (2012). Prescription Cost Analysis 2011. Health Statistics and Analysis Unit:Cardiff. ISD Scotland (2012). Prescription Cost Analysis 2011/12. NHS National Services: Edinburgh. HSC (2012). Prescription Cost Analysis 2011. Business Services Organisation: Belfast.
92
Table 3.3 Number of CABGs and PCIs, United Kingdom 1977 to 2010
Coronary artery bypass surgery (CABG) 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988* 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2,297 2,653 2,918 4,057 5,130 6,008 8,332 9,433 10,667 10,767 11,521 11,113 12,648 14,431 15,659 19,241 21,031 22,056 22,475 22,160 25,639 25,083 24,733 25,127 24,663 25,277 25,461 25,160 23,412 23,623 25,372 22,846 19,766 17,822 9,933 11,575 12,937 14,624 17,344 20,511 22,902 24,899 28,133 33,256 38,992 44,913 53,261 62,780 70,142 73,692 77,373 80,331 83,130 87,676 Percutaneous coronary interventions (PCI)
Notes: Data are not available for PCIs until after 1990. * One centre did not make a return this year. Operations performed within the private sector are not included. Source: British Cardiovascular Intervention Society (2009). Personal communication. British Cardiovascular Intervention Society (2012). BCIS Audit returns. Personal communication.
93
Figure 3.3 Number of coronary artery bypass operations and percutaneous coronary interventions per year, United Kingdom 1980 to 2010
90,000 80,000 70,000 Number of procedures per year 60,000 50,000 40,000 30,000 20,000 10,000 0 2006 2008 2009 2007 2004 2000 2005 1980 1977 1981 1982 2002 2003 1984 1990 1994 1996 1998 1983 1985 1986 1987 1988 1991 1992 1993 1995 1997 2001 1989 1999 2010 1979 1978
Coronary artery bypass surgery (CABG)
Percutaneous coronary interventions (PCI)
94
Table 3.4 Inpatient episodes by main diagnosis in National Health Service hospitals, by sex, England, Scotland, Wales and Northern Ireland 2010/11
England Men All diagnoses All diseases of the circulatory system (I00-I99) Coronary heart disease (I20-I25) Angina pectoris (I20) Acute myocardial infarction (I21) Other coronary heart disease Heart failure (I50) Stroke (I60-I69) Diabetes (E10-E14) Obesity (E66) All cancer (C00-D48) Colo-rectal cancer (C18-C21) Lung cancer (C33-C34) Breast cancer (C50) Bladder cancer (C67) All diseases of the nervous system (G00-G99) All diseases of the respiratory system (J00-J99) All diseases of the digestive system (K00-K93) All diseases of the genitourinary system (N00-N99) Injury and poisoning (S00-T98) All other diagnoses 7,628,685 767,889 263,538 60,496 55,566 147,476 60,223 96,364 19,742 3,180 850,394 88,894 57,536 948 65,549 178,326 Women 9,641,197 603,920 141,558 43,692 36,501 61,365 56,811 101,971 18,545 9,099 889,510 63,908 44,148 180,151 21,207 207,224 Scotland Men 668,172 83,249 32,378 5,457 15,133 11,788 6,168 10,936 3,851 154 89,474 11,747 8,980 130 3,624 15,123 Women 745,613 65,620 17,809 3,979 9,253 4,577 5,567 11,675 3,542 263 104,956 9,280 8,626 23,577 1,483 18,356 Wales Men 388,768 44,492 15,621 3,883 3,575 8,163 4,430 6,045 2,668 24 31,704 3,116 2,571 14 3,030 8,239 Women 497,554 36,410 8,679 2,834 2,347 3,498 4,170 6,426 2,065 58 29,654 2,067 2,040 3,486 1,141 10,369 Northern Ireland Men 302,301 26,019 9,903 2,343 1,783 5,777 2,037 3,453 2,431 10 28,607 3,993 2,669 33 1,991 4,146 Women 330,859 20,265 4,732 1,245 1,087 2,400 2,160 3,586 1,987 13 31,151 2,672 1,702 6,898 604 5,159
590,963
576,234
57,089
60,768
39,473
39,078
20,681
20,728
985,122
1,031,740
89,932
97,048
51,962
54,608
35,087
37,824
441,529 584,203 3,207,337
656,723 580,201 5,068,001
36,112 60,239 232,949
54,708 57,667 282,685
23,954 32,018 154,234
36,632 31,478 257,202
75,416 19,086 90,818
65,111 17,289 131,332
Notes: Finished consultant episodes; ordinary admissions and day cases combined. Pregnancy cases are not included. ICD-10 codes in parentheses. Source: Department of Health (2012) Hospital Episode Statistics 2010/11. www.hesonline.nhs.uk (accessed May 2012). Information Services Division Scotland (2012) Main diagnosis discharges from hospital 2010/11. www.isdscotland.org (accessed May 2012). NHS Wales Informatics Service (2011) The Patient Episode Database for Wales - 2010/11. www.infoandstats.wales.nhs.uk (accessed May 2012). Hospital Information Branch(2012) Northern Ireland Episode Based Acute Inpatient and Day Case Activity Data 2010/11.Personal communication.
95
Figure 3.4a Inpatient episodes by main diagnosis in men for National Health Service hospitals, England 2010/11
A B C D E
Figure 3.4b Inpatient episodes by main diagnosis in women for National Health Service hospitals, England 2010/11
AB C D E
F J
F G J G I H
A. B. C. D. E. F. G. H. I. J.
Coronary heart disease (3%) Stroke (1%) Other cardiovascular disease (5%) Nervous system disease (2%) Respiratory disease (8%) Cancer (11%) Digestive system disease (13%) Genitourinary disease (6%) Injury and poisoning (8%) All other causes (42%)
A. B. C. D. E. F. G. H. I. J.
96
Figure 3.4c Inpatient episodes by main diagnosis in men for National Health Service hospitals, Scotland 2010/11
A B C D
Figure 3.4d Inpatient episodes by main diagnosis in women for National Health Service hospitals, Scotland 2010/11
A B C D E
E J
F F
I H
G G I H
A. B. C. D. E. F. G. H. I. J.
A. B. C. D. E. F. G. H. I. J.
97
Table 3.5 Age-standardised cardiovascular disease (CVD) hospital discharge rates per 100,000, Europe 1980 to 2009
1980 Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan TFYR Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan European Region EU 1,920 1,979 1,217 2,021 2,191 2,119 2,601 2,792 270 759 390 531 939 653 1,184 896 821 2,568 533 1,267 909 1,405 2,612 1,422 959 2,226 2,396 1,286 537 1,391 691 1,424 775 2,796 2,534 1,560 1,059 2,996 1,316 1,784 1,626 1,914 1,727 1,737 2,226 1,344 1,530 1,814 1,338 1,059 1,414 1,249 1,583 2,194 2,052 944 1,580 2,024 2,255 1,125 1,315 2,422 2,763 1,455 2,443 1,685 1,333 2,639 1,158 1,898 1,978 1,217 2,423 2,628 1,754 2,128 1,597 1,257 2,445 2,687 1,935 1,440 2,047 2,349 1,207 903 2,598 3,201 1,191 1,404 1,593 1,635 507 2,955 2,010 3,171 2,292 2,338 3,293 607 964 1,451 905 1,790 1,136 690 1,779 1,265 809 1,774 1,232 549 3,051 2,201 2,664 3,858 1,869 1,760 818 3,261 2,543 3,239 3,785 2,307 454 3,267 2,309 4,239 1,863 1,420 1,911 2,582 1,314 1,041 3,144 4,102 2,612 666 1,400 1,403 2,349 2,835 1,850 813 3,514 2,559 3,243 3,121 2,283 649 3,310 2,708 4,495 1,830 1,268 1,638 2,363 1,805 1,130 3,636 4,154 2,236 727 1,636 1,558 2,467 2,556 1,206 2,023 2,589 3,414 1,812 2,679 1,851 1,339 2,467 1,680 771 1,556 1,146 1,225 3,462 1,353 1,394 2,430 2,397 3,024 1,947 757 3,368 2,538 3,360 3,033 2,302 762 3,323 2,797 4,376 1,545 1,241 1,600 2,330 1,856 1,257 3,816 4,047 2,249 751 1,710 1,572 2,495 2,645 1,194 2,100 3,159 3,479 1,823 2,688 1,960 1,323 2,455 1,719 879 1,430 1,047 1,249 3,586 1,321 1,444 2,458 2,420 1,932 2,463 1,940 1,323 2,441 1,735 918 1,443 1,183 1,368 3,677 1,304 1,552 2,453 2,378 1,180 1,426 3,781 1,311 1,558 2,494 2,436 1,522 3,744 1,305 1,586 2,498 1,775 925 933 2,094 2,684 1,918 1,315 2,160 2,697 1,976 3,861 1,480 1,202 1,502 2,248 1,817 1,385 3,900 4,059 2,172 656 1,670 1,580 2,449 2,550 1,332 2,153 2,826 942 1,654 1,626 2,452 3,085 1,388 2,300 3,057 2,327 3,178 2,368 1,183 1,677 1,181 1,482 2,179 1,899 1,326 3,893 4,226 3,190 4,283 1,970 1,163 3,863 3,180 1,926 844 3,254 2,469 3,372 2,913 2,268 837 3,392 2,273 975 3,463 971 3,331 1,904 670 3,151 2,423 3,494 3,168 2,501 3,327 3,712 1,892 1,092 1,236 1,225 3,004 1,481 762 3,320 595 3,444 2,235 1985 1990 1995 417 2000 540 586 639 3,630 472 4,577 2,356 2005 623 701 931 3,746 572 5,165 2,233 2006 668 677 972 3,769 616 5,374 2,204 2007 719 683 1,035 3,804 641 5,599 2,168 2008 705 753 1,142 3,777 672 5,750 653 5,786 2009 785 726 1,224
Notes: Blank cells indicate no data were available. Age standardised for European population Source: WHO Europe (2010) Health for All Database (HFA-DB) http://data.euro.who.int/hfadb/ (Accessed June 2012).
98
Table 3.6 Age-standardised coronary heart disease (CHD) hospital discharge rates per 100,000, Europe 1980 to 2009
1980 Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan TFYR Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan European Region EU 609 575 321 643 652 614 719 728 38 141 56 99 174 321 144 269 665 122 480 206 56 1,197 523 300 738 707 309 102 313 164 349 202 868 1,089 347 278 959 888 508 689 665 332 397 541 500 543 342 612 890 598 225 562 637 936 277 419 752 1,103 373 955 366 363 905 324 849 321 1,094 1,283 834 493 522 365 1,163 1,327 790 477 938 520 436 156 1,166 1,526 296 412 521 677 181 947 722 961 700 936 1,153 223 181 460 139 524 295 293 545 334 339 553 309 222 1,223 684 990 1,369 542 495 332 1,041 790 1,117 1,160 503 194 1,060 777 1,113 724 457 823 600 419 322 1,263 1,415 819 184 421 523 876 721 503 279 983 823 998 923 513 333 977 936 876 704 422 619 582 606 385 1,381 1,376 738 271 541 539 952 774 276 547 473 1,313 490 884 411 338 786 502 217 666 365 34 1,646 488 443 795 664 854 486 194 905 766 1,090 865 519 404 959 970 857 576 418 577 570 533 364 1,456 1,311 689 238 555 529 981 778 254 588 492 1,330 507 836 433 328 766 498 249 605 454 28 1,712 471 472 802 655 570 737 417 317 745 484 264 551 534 27 1,761 458 588 801 632 804 631 524 19 1,825 444 24 1,809 421 448 803 498 265 266 629 810 397 302 644 780 411 791 571 392 516 550 547 394 1,453 1,304 606 188 521 527 972 742 328 592 364 288 509 526 952 884 339 656 367 659 374 899 351 565 375 501 529 684 497 1,472 1,297 1,189 1,312 721 354 808 932 470 257 851 731 1,002 791 504 399 938 497 483 916 463 1,017 469 198 776 684 999 771 695 900 1,273 490 334 437 521 391 499 318 587 201 1,635 689 282 748 154 2,212 736 1985 1990 1995 121 2000 157 2005 187 120 382 982 175 2,569 678 2006 188 149 411 994 179 2,641 653 2007 204 150 434 990 186 2,720 632 2008 196 179 469 954 214 2,713 230 2,864 2009 250 157 505
Notes: Blank cells indicate no data were available. Source: WHO Europe. Health for All Database (HFA-DB) http://data.euro.who.int/hfadb/ (Accessed June 2012).
99
Figure 3.6 Age-standardised coronary heart disease (CHD) hospital discharge rates per 100,000, selected countries 1980 to 2009
2000 1800 1600 Hospital discharges per 100,000 1400 1200 1000
D. B.
C.
800 600 400

E. A.
200 0 2006 2004 2000 2008 2009 2005 2002 2003 2007 1980 1981 1982 1983 1984 1985 1986 1987 1988 1990 1991 1992 1993 1994 1995 1996 1997 1998 2001 1999 1989
A. United Kingdom
B. Ukraine
C. Latvia
D. Greece
E. Spain
100
Table 3.7 Age-standardised stroke hospital discharge rates per 100,000, Europe 1970 to 2009
1970 Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan TFYR Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan European Region EU 299 304 112 333 342 244 358 486 27 121 50 71 109 31 199 106 82 467 38 218 148 132 540 204 79 380 367 219 89 268 107 249 112 613 491 255 176 617 370 181 230 293 130 159 191 181 175 163 193 382 232 287 270 280 458 336 271 328 595 338 452 230 213 446 91 282 107 383 408 203 394 176 145 445 512 244 234 253 436 169 124 542 671 117 190 230 256 274 192 54 487 330 598 430 380 681 116 131 134 119 268 233 131 293 297 143 323 281 89 558 394 497 820 426 411 140 619 452 502 658 222 74 462 404 832 237 250 259 489 210 153 638 780 233 79 169 184 320 592 409 120 615 384 619 561 228 98 497 448 1,276 207 171 247 475 351 174 795 839 167 54 197 224 342 345 327 475 523 760 431 518 228 223 417 207 56 243 152 145 770 212 116 440 393 616 437 126 601 373 613 564 227 102 506 464 1,217 180 169 246 470 355 188 838 826 165 71 183 229 345 355 308 518 669 769 420 515 235 225 410 218 65 247 96 153 798 210 117 442 399 410 458 226 223 397 211 66 261 100 183 828 207 116 438 389 100 192 859 213 127 442 392 209 862 223 120 443 220 64 69 419 483 218 223 459 462 232 1,051 149 165 237 457 362 229 852 816 168 58 192 226 331 344 305 540 629 68 203 229 331 388 310 543 580 608 587 309 107 206 166 235 446 377 236 838 874 692 859 405 168 1,053 615 426 157 572 364 639 550 223 132 513 229 142 526 149 622 411 120 543 356 705 550 358 714 613 410 101 128 194 194 113 132 427 53 569 362 130 671 45 896 390 1975 1980 1985 1990 1995 45 2000 80 2005 94 117 172 577 52 1,063 368 2006 108 106 162 570 62 1,092 363 2007 124 107 177 559 65 1,143 358 2008 130 84 187 549 71 1,154 73 1,163 2009 150 94 195
Notes: Blank cells indicate no data were available Source: WHO Europe. Health for All Database (HFA-DB) http://data.euro.who.int/hfadb/ (Accessed June 2012).
101
Figure 3.7 Age-standardised stroke hospital discharge rates per 100,000, Europe 1980 to 2009
1000 900
B.
800 Hospital discharges per 100,000 700 600 500

D.
C.
400 300
E.
200 100 0 2006 2004 2000 2008 2009 2005 2003 2002 2007 1994 1996 1998 1980 1981 1982 1992 1993 1995 1997 2001 1984 1990 1999 1983 1985 1986 1987 1988 1989 1991
A.
A. United Kingdom
B. Ukraine
C. Latvia
D. Greece
E. Spain
102
Table 3.8 Outcome at 4 weeks in people using National Health Service smoking cessation services, England, Scotland and Northern Ireland 1999/00 to 2010/11
1999/00 England Total number setting a quit date % Who had successfully quit at 4 week follow-up (self report) Scotland Total number setting a quit date % Who had successfully quit at 4 week follow-up (self report) Northern Ireland Total number setting a quit date % Who had successfully quit at 4 week Follow-up (self report) 7,369 8,702 13,795 21,476 23,383 34,386 44,019 50,121 79,672 14,600 132,500 227,335 234,858 361,224 529,567 602,820 600,410 680,289 671,259 787,527 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2010/11
39%
49%
53%
53%
57%
56%
55%
53%
52%
50%
49%
38%
38%
39%
51%
47%
52%
51%
51%
52%
Notes: A client is counted as having successfully quit smoking at the 4 week follow-up if he/she has not smoked at all since two weeks after the quit date. Scottish data are based on calendar years. Source: Health and Social Care Information Centre (2011) Statistics on NHS stop smoking services in England, April 2010 to March 2011. Information Centre: Leeds and previous editions. Galbraith L, Hecht G (2011) NHS smoking cessation service statistics (Scotland) 1st January to 31st December 2010. The Scottish Public Health Observatory: Edinburgh, and previous editions. Northern Ireland Statistics & Research Agency (2011) Statistics on smoking cessation services in Northern Ireland: 2010/11. Department of Health, Social Services and Public Safety: Belfast.
103
Table 3.9 Responses to emergency calls within eight minutes by ambulance service, England 2004/05 to 2010/11 and Scotland 2010/11
Emergency calls 2004/05 % Ambulance service North East North West Yorkshire East Midlands West Midlands East of England London South East Coast South Central Great Western South Western Isle of Wight England Scotland 77.3 76.7 75.1 75.8 79.4 76.3 76.6 74.8 76.2 72.7 75.7 77.2 76.2 75.2 74.3 72.7 75.1 77.9 76.6 75.1 76.0 76.0 74.0 75.9 75.7 75.3 76.3 72.7 72.4 75.9 77.2 75.2 75.2 75.1 73.8 72.8 74.1 78.0 74.6 78.5 75.6 73.5 79.5 80.9 75.0 78.9 77.2 75.1 72.2 78.9 81.7 77.1 75.7 74.3 69.4 76.0 75.4 74.6 75.5 75.2 72.6 68.4 78.0 77.0 74.3 75.8 73.6 73.7 72.4 76.8 74.6 75.1 76.0 77.5 74.3 76.9 77.3 74.9 72.0 2005/06 % 2006/07 % Emergency and urgent calls 2007/08 % 2008/09 % 2010/11 %
Notes: From 2007/08 urgent calls are included (previous years relate to emergency calls only). From 2008/09 the starting point for response time measurement was changed comparisons with earlier years should be treated with caution. Response to life-threatening Category A emergencies across Scotland within 8 minutes Source: Office for National Statistics(2011) Ambulance services, England:2010-11. Leeds: Information Centre. Working for you,Scottish Ambulance Service Annual Report and Accounts 2010/2011. NHS Scotland: Edinburgh.
104
Table 3.10 Thrombolytic treatment, use of aspirins, beta blockers and statins after a heart attack, England and Wales 2004/05 to 20010/11
2004/05 % 2005/06 % 2006/07 % 2007/08 % 2008/09 % 2009/10 % 2010/11 %
Percentage of patients having thrombolytic treatment within 30 mins of arrival at hospital Target England National Average Wales National Average 75 84 70 75 83 74 75 84 70 75 84 67 75 83 73 75 79 67 75 75 62
Percentage of patients having thrombolytic treatment within 60 mins of calling for help England Target National Average Wales Target National Average 28 30 41 49 48 70 55 70 53 58 54 68 58 68 64 68 71 68 72 68 69 68 68
Aspirin %
Beta blockers %
Statins %
ACE inhibitors %
Clopidogrel/ Thienopyridine inhibitor %
Percentage of patients discharged on secondary prevention medication 2010/1 Target England National Average Wales National Average Belfast Average 80 99 98 99 80 96 95 99 80 97 95 99 n/a 94 91 97 n/a 95 92 98
Notes: Data are from the MINAP project, based at the Royal College of Physicians. For more details of the project see www.rcplondon.ac.uk/index.asp No national targets for ACE inhibitors and Clopidogrel. Source: Royal College of Physicians (2011) Myocardial Infarction National Audit Project. How the NHS manages heart attacks. Tenth public report 2011. UCL: London, and previous editions.
105
4. Behavioural risk factors
106
4. Behavioural risk factors

This chapter reports on the prevalence of behavioural risk factors for coronary heart disease (CHD), including sections on smoking, poor diet, physical inactivity and alcohol consumption. Patterns in the prevalence of each of these risk factors by age, sex, socio-economic status, geographic region and ethnicity are explored. Prevalence rates in the United Kingdom are compared against rates found in other countries. Temporal trends in the prevalence of these risk factors are also reported.
Smoking Smoking increases the risk of CHD. The long-term risk of smoking to individuals has been demonstrated by a 50year cohort study of British doctors. This study found that CHD mortality was around 60% higher in smokers (and 80% higher in heavy smokers) compared to non-smokers. After observing smokers and non-smokers over a 50 year period, the study concluded that about half of all regular smokers will eventually be killed by their habit 1. In Great Britain, 20% of adults smoke cigarettes. The younger age groups tend to have a higher prevalence, with men aged 25 to 34 and women aged 20 to 24 having the highest prevalence of smoking. The lowest prevalence is found in those aged over 60 in both sexes. In Northern Ireland, smoking prevalence is at 24%, with the highest rates being found in those aged 20 to 34 in men and 20 to 24 in women. Smoking has been declining since the 1970s in both Great Britain and since the 1980s in Northern Ireland. All countries of the United Kingdom now have a ban on smoking in enclosed public places, whilst England, Wales and Northern Ireland also have a ban on the sale of cigarettes in vending machines. It is hoped that this will lead to reductions in the prevalence rate of smoking amongst young people (Tables 4.1 and 4.2, Figure 4.1). There is little variation in smoking rates by region of England, however rates are marginally higher in the North compared to the South. Scotland and Wales both have the highest rates at 25%, although prevalence in Northern Ireland is 24%, higher than England with 20% (Table 4.3). Smoking is socially patterned, with the prevalence lower in the professional groups compared to the routine and manual groups. In Great Britain in 2008, 28% of those in the routine and manual group smoked, compared to 20% in the intermediate group and 13% of those in the managerial and professional group. Similar results are found for both sexes in Great Britain. While there is an overall gradient of this kind in Northern Ireland, the trend across the social groups is not as smooth. The gradient in men is slightly steeper compared to women, with 9% of professional men and 4% of professional women smoking compared to 44% of unskilled men and 33% of semi-skilled women (Table 4.4, Figures 4.4a and 4.4b). Smoking rates vary noticeably between ethnic groups in the UK. In 2004, 40% of Bangladeshi men smoked, compared to 21% of Black African and Chinese men. With the exception of Black Caribbean women, the prevalence of smoking among the ethnic minority women was low, with only 2% of Bangladeshi women and 10% of Black African women smoking. For all minority ethnic groups the prevalence of men smoking was 20% or over, for women this only occurred in the Irish and Black Caribbean ethnic groups. Chewing tobacco is more common in the Bangladeshi community and 16% of Bangladeshi women consume tobacco in this way 2 (Table 4.5). In 2010, 4% of boys and 6% of girls in England aged 11 to 15 regularly smoked cigarettes. The latest data from Wales, Scotland and Northern Ireland all show a higher prevalence of smoking in girls than in boys. Since the early 1980s, there has been a decline in smoking amongst young people in England, Scotland and Northern Ireland. In Wales the prevalence has remained the same in boys and increased in girls (Table 4.6). Data from the World Health Organizations (WHO) Global Burden of Disease study show that smoking prevalence in men in the UK is well below the average for the European region (26% compared to 45%). For women the prevalence is comparable. The most recent data from the WHO show that smoking prevalence for men ranges from 70% in the Russian Federation to 9% in Ethiopia. In women the prevalence ranges from 0.2% in Algeria to 54% in Nauru (Table 4.7). Poor diet A poor diet increases the risk of chronic diseases, particularly CVD and cancer. Diet affects CVD in a variety of ways. An energy imbalance, where more energy is taken in than expended can result in weight gain and obesity. High saturated fat raises cholesterol levels, high salt intake can raise blood pressure, and low intakes of fibre, fruit and vegetables can lead to a greater susceptibility to CVD.
107
The National Food Survey, and more recently the Family Food Survey, allows us to examine trends in diet over time in Great Britain. Overall intake of calories, fat and saturated fat has decreased since the 1970s. This trend is accompanied by a decrease in sugar and salt intake, and an increase in fibre and fruit and vegetable intake (Table 4.8). This change in pattern may in part be due to a change in the type of foods purchased. Since the 1940s purchase of lard has dramatically reduced whilst the amount of butter purchased has also dropped, with more reduced fat spreads being purchased. Similarly, the purchase of whole milk has gradually been replaced with skimmed milks, reducing total fat and saturated fat content of the diet (Table 4.9, Figures 4.9a, 4.9b and 4.9c). The latest National Diet and Nutrition Survey provides an estimate of the quality of the diet for adults in Great Britain. The results suggest that in 2008-10, the percentage of food energy obtained from fat was within dietary recommendations; however targets for percentage of food energy coming from saturated fat and non-milk extrinsic sugars (NMES) were not being met. NMES include the sugar released from fruit when it is blended or juiced, table sugar, the sugar in products such as honey and sugars that are added to foods, as well as some of the sugars in canned, stewed, dried or preserved fruits. Average intake of fibre is also too low (at 14g per day compared to a recommendation of 18g per day), and that less than one third of both men and women currently consume the recommended five portions of fruit and vegetables a day (Table 4.10). The best estimates of salt intake levels are provided by analysis of urine samples. In 2006, urinary analyses were conducted for samples of the adult population in all countries of Great Britain, although more recent data were collected for the UK (2008), Scotland (2009) and England (2011). Results suggest that average salt intake in all countries was above the target of 6g per day. Average consumption in men was between 9g per day in Wales (2006) and England (2011) and 10g per day in Scotland (2009). Consumption levels in women were lower but still over the recommended levels (Table 4.11). Consumption of fat, saturated fat, and non-milk extrinsic sugars is fairly similar around the UK. There is minimal variation of fibre and fruit and vegetable consumption. Calorie (kcal) consumption does vary considerably, with people in the North and London consuming the least amount of calories. People in the South West consume the most. Although differences between UK countries are small, people in Wales consume the most calories, the most fat and saturated fat, as well as the most sugars. They also purchase more fruit and vegetables than people in other UK countries (Table 4.12).
The Family Food Survey provides consumption by income quintile. A gradient can be observed in the consumption of fat, saturated fat, total sugars and nonmilk extrinsic sugars, with those in the lower income groups consuming more of these than those on a higher income. An opposite gradient is found with fruit and vegetables purchased, with those with a higher income buying more (Table 4.13 and Figure 4.13). Differences in consumption by ethnic group are also apparent. In 2008, the White group had the highest intake of saturated fat, both absolutely and as a percentage of total energy (15%) they also consumed more calories per day than other ethnic groups. The lowest intake of saturated fat as a percentage of total energy was in the Black and Black British group, at 11%. Salt consumption also varied considerably, with Asian and Asian British consuming 3.5 grams and the White group consuming 3 grams more at 6.5g per day 3 (Table 4.14). In 2010, the Health Survey for England estimated that 19% of boys and 20% of girls aged 5 to 15, were consuming 5 or more portions of fruit and vegetables a day the recommended daily amount. This is compared to 11% for both groups in 2001 (Table 4.15). Data from the WHO for 2007 show that the availability of fruit and vegetables was generally higher in Southern European countries, as compared to Northern, Western, Central and Eastern European countries. The proportion of energy available from fat varied widely, ranging from 16% in Azerbaijan to 42% in France and Spain. At 38% the proportion of energy available from fat in the UK was higher than the European average of 36% (Table 4.16). Physical inactivity People who are physically active are at lower risk of CHD. To produce the maximum benefit, exercise needs to be regular and aerobic. This should involve the use of the major large muscle groups steadily and rhythmically, so the heart rate and breathing increase significantly. Guidelines issued by the four Chief Medical Officers (CMOs) of England, Scotland, Wales and Northern Ireland in 2011, emphasise for the first time the importance of physical activity for people of all ages. The guidelines bring different aspects of physical activity together including a life course approach, the flexibility to combine moderate and vigorous intensity activities and reduce sedentary behaviour 4. The guidelines also highlight the importance of minimising the amount of time spent being sedentary. The new CMOs guidelines on physical activity were published in July 2011. Currently available data were collected in reference to the previous guidelines published in 2004. These guidelines recommended 30 minutes of physical activity on at least five days a week for adults 5 and at least one hour of moderate intensity activity a day for children aged 5 to 18 years 6. Data presented in this publication, therefore, correspond to the 2004 guidelines rather than those from 2011.
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The percentage of individuals of both sexes meeting physical activity recommendations in England increased between 1997 and 2008. Small increases have also been found in Scotland between 1998 and 2010. These figures seem to have remained stable in Wales whereas a new survey in Northern Ireland suggests large increases between 2001 and 2010, although as comparing between surveys can be problematic these findings should be viewed with caution. Despite these increases, physical activity levels in the UK still remain relatively low. Men in Scotland exercise the most, with 45% exercising above the recommended levels. However in Wales the percentage meeting the recommended levels is 36%. The percentage of women meeting the recommended levels is lower in all UK countries, at 33% in Scotland and 23% in Wales. There is also a considerable difference by age, with those aged 65 consistently showing the lowest percentage of those achieving the recommended. The highest levels tend to be found in those aged under 45 (Tables 4.17 and 4.18). The 2008 Health Survey for England had a focus on physical activity 7. Physical activity levels are normally self-reported, however for this report a sub-sample was selected to use accelerometers to objectively measure their physical activity levels. Based on the accelerometry data, only 6% of men and 4% women met the governments recommended levels of physical activity in comparison to the self-reported levels of 39% for men and 29% for women, suggesting that physical activity levels are often over-reported. Accelerometers measure frequency, intensity and duration of physical activity, but are not waterproof and may not accurately record activities such as cycling or rowing. People were asked to wear the accelerometers while awake for seven consecutive days, but to take them off when swimming or showering. Due to issues of consent, eligibility, compliance and faults with the devices only 49% of men and 46% of women from the 4,507 adults selected to wear accelerometers provided sufficient data to be included in the analyses of daily average wear. Of the 1,707 children aged 4 to 15 selected 43% of boys and 47% of girls provided sufficient data6. Despite its limitations, selfreport is the most commonly used method of assessment and is therefore still reported on in this chapter. There is some variation in those meeting the recommended levels by region of England, although it is not marked. In men, the lowest percentage is found in the North East (33%) and the highest in South West (44%). For women, the lowest is in the West Midlands (25%) and the highest is in the South East Coast (34%) (Table 4.19). The Health Survey for England 2008 shows a substantial difference in physical activity levels by equivalised household income quintile. There were a higher percentage of men and women meeting the recommended levels in the highest income quintiles compared to the lowest. The gradient is stronger in men with 42% compared to 31%, but 34% compared to 26% in women (Table 4.20).
The 2004 Health Survey for England had a focus on the health of ethnic minorities, it is the most recent to do so. Compared with the general population in 2004, Indian, Pakistani, Bangladeshi and Chinese men and women were less likely to meet physical activity recommendations. Of the men, Bangladeshi and Pakistani men had the lowest prevalence of meeting the recommendations (26% and 28%). This pattern was also true of the women from these groups, at 11% and 14% respectively. Irish men and Black Caribbean women had the highest prevalence of meeting the recommendations (Table 4.21). Self-reported levels of physical activity in children vary by country of the UK. In Scotland for children aged 2 to 15, 75% of boys and 72% of girls reported meeting the recommended levels of activity. For the same age group in England however, only 32% of boys and 24% of girls did. While the percentage of boys meeting the recommendations shows a varying pattern by age in both England and Scotland, for girls in these countries there was a notable decrease after age 10. Results between countries are not directly comparable, however, due to the differences in data collection (Table 4.22). European levels of exercising or playing sport (defined as exercising at least five times a week) range from 3% in Bulgaria to 23% in Ireland. The UK is among the higher levels in Europe (14%) and is above the EU average of 9% (Table 4.23 and Figure 4.23). Differences are also found between countries in the levels of exercise outside of sport, ranging from the highest prevalence of regular exercise in Latvia (44%) to Italy (7%). The UK is again amongst the higher levels with 37%, higher than the EU average of 27% (Table 4.24, Figure 4.24). Alcohol consumption While moderate alcohol consumption (one or two drinks a day) does not increase the risk of CVD, at high levels of intake particularly in binges the risk of CVD is increased. The World Health Report 2002 estimated that 2% of CHD and almost 5% of stroke in men in developed countries was due to alcohol. However, the impact of alcohol consumption in women in developed countries was estimated to be positive if no alcohol were consumed, there would have been a 3% increase in CHD and a 16% increase in stroke 8. The most recent Government advice is that regular consumption of between three and four units a day for men, and between two and three units a day for women will not lead to significant health risk 9. Consuming over these levels is not advised. The benchmark for heavy drinking is set at more than eight units in one day for a man and more than six units in one day for a woman. In Great Britain in 2010 more than a third of men (36%) and over a quarter of women (28%) regularly exceeded the Governments recommended level of alcohol intake. Nineteen percent of men and 13% of women exceeded the Government definition of heavy drinking in both instances the highest rate of alcohol consumption was found in the 25 to 44 age group (Table 4.25, Figure 4.25).
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Since 1998 the General Household Survey has measured the prevalence of heavy drinking in Great Britain. Consistently over this time period, 16 to 24 year olds were the most likely group to drink heavily, and men were more likely than women to drink heavily. However, the prevalence of heavy drinking in 16 to 24 year olds has decreased over the last ten years and now men and women aged 22 to 64 are more likely to drink than the younger age group (Table 4.26, Figure 4.26). The prevalence of drinking alcohol in people aged under 16 also seems to be in decline from a peak in the mid 1990s. In England, alcohol consumption in 11 to 15 year old boys fell from 27% in 1996 to only 13% in 2010, and from 26% to 13% in girls of the same age. A similar pattern is found in Scotland, where prevalence of alcohol consumption in 15 year old boys fell from 48% to 35% between 1996 and 2010, and from 46% to 34% in girls of the same age. Alcohol consumption levels in girls and boys of the same age seem to be higher in England than in Scotland (Tables 4.27 and 4.28). Within Great Britain, there is considerable geographic variation in the prevalence of heavy drinking. For both men and women, the highest prevalence rates are found in the North of England, with 24% of men in the North West regularly drinking more than eight units on the heaviest drinking day in 2010, compared to only 15% in the East and West Midlands. For women, the lowest prevalence rate of heavy drinking (more than six units) was found in the West Midlands (8%) and the highest rate was found in the North West (18%). Between countries, Scotland had the highest prevalence of heavy drinking for both men and women (Table 4.29, Figures 4.29a and 4.29b). The socioeconomic gradient in exceeding drinking recommendations and heavy drinking in Great Britain is contrary to patterns in other behavioural risk factors. In 2010, for both men and women, the highest rate of both heavy drinking and exceeding recommendations was found in the managerial and professional social class although gradients across socio-economic classification were greater for women than men. Sixteen percent of women in the managerial and professional social class exceeded six units on their heaviest drinking day compared to only 10% of women in the routine and manual social class. This gradient was even steeper for exceeding recommendations in alcohol consumption (Table 4.30, Figure 4.30). The amount of alcohol consumed on a regular basis varies dramatically by ethnic group. Drinking any alcohol at all is rare in the Pakistani and Bangladeshi ethnic groups, and abstention from alcohol is far more common in the Indian, Black and Chinese ethnic groups than in the general population. In England in 2004, a quarter of men (25%) and 14% of women regularly drink heavily levels are much lower for the Black Caribbean, Black African, Indian, Pakistani, Bangladeshi and Chinese ethnic groups. Only the Irish ethnic group had a higher prevalence rate for heavy drinking (Table 4.31).
In 2009, more people in the United Kingdom reported drinking heavily (34%) than the average level for the 27 member states of the European Union (29%). The highest reported rate was in Ireland (44%). In general, countries in Eastern Europe had lower reported rates than in the rest of Europe (e.g. Latvia 11%, Poland 19%) (Table 4.32).
1. Doll R, Peto R, Boreham J, Sutherland I (2004) Mortality in relation to smoking: 50 years observations on male British doctors. BMJ; 328: 1519-27. 2. Department of Health (2005) Health Survey for England 2004. The Health of Minority Ethnic Groups - headline tables. NHS Health and Social Care Information Centre. 3. This is likely to be an underestimate of salt consumption, as it does not include salt added during cooking or at the table. 4. Department of Health, Physical Activity, Health Improvement and Protection (2011). Start active, stay active: a report on physical activity from the four home countries Chief Medical Officers: London. 5. Department of Health (2004). At least five a week: evidence on the impact of physical activity and its relationship to health. Department of Health: London. 6. Department of Health (2005) Choosing Activity: a physical activity action plan. Department of Health: London. 7. Department of Health (2010) Health Survey for England 2008. The Stationery Office: London. 8. World Health Organization (2002). The World Health Report 2002. Reducing Risks, Promoting Healthy Life. World Health Organization: Geneva. 9. Department of Health (1995) Sensible drinking. The report of an inter-departmental working group. Department of Health: London. See also www.nhs.uk/LiveWell/Alcohol (accessed June 2010).
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Table 4.1 Cigarette smoking in adults, by sex and age, Great Britain 1972 to 2010
1972 % Men 16-19 20-24 25-34 35-49 50-59 60+ All ages Unweighted base Women 16-19 20-24 25-34 35-49 50-59 60+ All ages Unweighted base Total 16-19 20-24 25-34 35-49 50-59 60+ All ages Unweighted base 41 51 52 51 50 34 46 22,494 40 48 51 52 51 34 45 21,332 37 46 46 47 47 31 42 23,442 34 44 45 45 45 30 40 22,636 32 42 45 44 45 29 39 22,554 30 40 38 39 41 27 35 19,840 31 38 38 37 39 26 34 18,205 30 39 36 36 35 25 33 19,178 28 37 36 36 33 23 32 18,795 30 38 35 34 29 21 30 17,551 27 38 34 31 29 20 28 18,181 27 39 32 30 27 17 27 16,750 39 48 49 48 47 25 41 12,143 38 44 46 49 48 26 41 11,480 34 45 43 45 46 24 38 12,554 33 43 42 43 42 24 37 12,156 32 40 44 43 44 24 37 12,100 30 40 37 38 40 23 33 10,641 32 36 36 36 39 23 32 9,788 30 38 35 34 35 22 31 10,304 28 37 35 35 34 21 30 10,122 32 39 34 33 29 20 29 9,445 25 37 34 30 29 19 28 9,764 27 38 30 28 26 17 26 9,108 43 55 56 55 54 47 52 10,351 42 52 56 55 53 44 51 9,852 39 47 48 50 49 40 46 10,888 35 45 48 48 48 38 45 10,480 32 44 47 45 47 36 42 10,454 31 41 40 40 42 33 38 9,199 29 40 40 39 39 30 36 8,417 30 41 37 37 35 29 35 8,874 28 37 37 37 33 26 33 8,673 28 38 36 34 28 24 31 8,106 29 39 34 32 28 21 29 8,417 28 40 34 31 27 18 28 7,642 1974 % 1976 % 1978 % 1980 % 1982 % 1984 % 1986 % 1988 % 1990 % 1992 % 1994 %
Notes: From 2000 data are weighted for non-response. Pre-2000 data are unweighted. The effect of weighting on smoking data appears slight: it increased the overall prevalence of smoking in 2000 by one percentage point, from 26% to 27%. Source: Office for National Statistics (2012) General Lifestyle Survey 2010. Results published online at http://www.ons.gov.uk/ons/rel/ghs/general-lifestylesurvey/2010/index.html (accessed May 2012).
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1996 %
1998 %
2000 %
2001 %
2002 %
2003 %
2004 %
2005 %
2006 %
2007 %
2008 %
2009 %
2010 %
26 43 38 30 28 18 29 7,172
30 42 37 32 27 16 28 6,579
30 35 39 31 27 16 29 6,593
25 40 38 31 26 16 28 7,055
22 37 36 29 27 17 27 6,837
27 38 38 32 26 16 28 8,097
23 36 35 31 26 15 26 6,868
23 34 34 29 25 14 25 10,038
20 33 33 26 23 13 23 7,677
22 32 29 25 22 13 22 7,240
18 29 30 24 23 13 22 6,700
24 24 27 26 22 15 22 6,160
20 25 28 25 21 13 21 6,080
32 36 34 30 26 19 28 8,501
31 39 33 28 27 16 26 7,830
28 35 32 27 28 15 25 7,496
31 35 31 28 25 17 26 8,299
29 38 33 27 24 14 25 7,951
25 34 31 28 23 14 24 9,327
25 29 28 28 22 14 23 8,029
26 30 29 26 23 13 23 11,627
20 29 26 25 22 12 21 9,005
20 30 23 23 21 12 20 8,380
26 31 25 23 20 12 21 7,930
24 28 24 23 20 13 20 7,290
17 29 25 23 20 13 20 7,210
29 39 36 30 27 18 28 15,673
31 40 35 30 27 16 27 14,409
29 35 35 29 27 16 27 14,089
28 37 34 29 26 17 27 15,354
25 38 34 28 26 15 26 14,788
26 36 34 30 25 15 26 17,424
24 32 31 29 24 14 25 14,897
24 32 31 27 24 14 24 21,665
20 31 30 25 22 12 22 16,682
21 31 26 24 21 12 21 15,620
22 30 27 24 22 13 21 14,630
24 26 25 25 21 14 21 13,450
19 27 26 24 20 13 20 13,290
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Figure 4.1 Prevalence of smoking in adults, by sex, Great Britain 1972 to 2010
60
50
40 Prevalence (%)
30
20
10
0 2006 2008 2009 2007 1972 2004 2000 2005 1980 2003 1982 2002 1984 1990 1998 1986 1988 1992 2001 1994 1996 2010 1974 1976 1978
Men
Women
113
Table 4.2 Prevalence of cigarette smoking in adults, by sex and age, Northern Ireland 1983 to 2009-10
1983 1990-91 1992-93 1994-95 1996-97 1998-99 2000-01 2002-03 2004-05 2006-07 2007-08 2008-09 2009-10
% Men 16-19 20-24 25-34 35-49 50-59 60+ All ages Base Women 16-19 20-24 25-34 35-49 50-59 60+ All ages Base Total 16-19 20-24 25-34 35-49 50-59 60+ All ages Base 25 42 42 39 36 22 33 5,575 19 39 41 33 32 16 29 3,077 31 46 42 45 41 30 39 2,498
24 39 40 38 34 24 33 2,629
24 40 34 34 32 23 31 2,475
20 37 34 32 30 22 29 2,323
23 39 39 34 33 21 31 2,074
15 36 37 30 29 20 28 1,916
23 26 30 33 26 16 26 1,811
33 32 32 26 27 18 27 2,454
19 32 37 33 29 16 27 1,710
13 37 38 29 28 13 25 1,500
18 20 33 32 25 12 23 1,465
17 52 38 27 25 16 26 1,296
[11] 36 38 26 24 15 24 1,491
27 31 40 37 31 21 31 3,216
24 32 33 36 27 20 29 3,097
27 35 35 32 25 17 27 3,059
23 30 37 32 24 17 27 2,727
24 39 37 35 28 17 29 2,654
27 34 34 32 26 17 28 2,591
28 35 33 29 28 13 26 2,722
19 38 34 30 25 13 25 2,328
31 33 30 30 27 15 26 2,175
[12] 35 29 28 24 13 23 1,938
13 34 28 27 26 13 23 1,855
27 41 31 28 24 13 24 2,088
26 34 40 37 32 22 32 5,845
24 35 33 35 30 21 30 5,572
24 36 35 32 27 19 28 5,382
23 34 37 33 28 19 29 4,801
20 38 37 33 28 18 29 4,570
26 31 33 32 26 17 27 4,402
31 33 32 27 27 16 26 5,176
19 35 35 31 27 15 26 4,038
24 35 33 30 28 14 25 3,675
15 29 31 30 24 13 23 3,403
15 40 32 27 26 14 24 3,151
21 39 34 27 24 14 24 3,579
Notes: Where the base is >50 percentages are shown in square brackets. Source: Northern Ireland Statistics and Research Agency (2011). Continuous Household Survey 2009/10. NISRA: Belfast.
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Table 4.3 Prevalence of cigarette smoking in adults, by sex and region, United Kingdom 2010
Men % England North East North West Yorkshire and the Humber East Midlands West Midlands East of England London South East South West Wales Scotland Northern Ireland Base England North East North West Yorkshire and the Humber East Midlands West Midlands East of England London South East South West Wales Scotland Northern Ireland 5,130 250 750 610 470 570 650 510 800 510 390 590 1,491 6,140 340 870 740 570 680 740 600 950 650 390 720 2,088 11,270 600 1,620 1,350 1,040 1,260 1,380 1,110 1,760 1,170 740 1,270 3,579 20 17 23 24 15 21 20 19 21 18 24 25 24 Women % 19 25 22 22 17 21 17 16 18 17 25 24 24 Total % 20 21 22 23 16 21 19 17 19 17 25 25 24
Notes: Data are for adults aged 16 and over. Source: Office for National Statistics (2011). General Lifestyle Survey 2010. Results published online at http://www.ons.gov.uk/ons/rel/ghs/general-lifestylesurvey/2010/index.html (Accessed May 2010). Northern Ireland Statistics and Research Agency (2011). Continuous Household Survey 2009/10. NISRA: Belfast,
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Table 4.4 Prevalence of cigarette smoking in adults, by sex and socioeconomic status, Great Britain and Northern Ireland 2010
Men % Great Britain Managerial and professional Intermediate Routine and manual Total Northern Ireland Professional Employer, manager Intermediate non-manual Junior non manual Skilled manual Semi-skilled manual Unskilled manual No SEG, ref etc,armed forces Total Bases Great Britain Managerial and professional Intermediate Routine and manual Total Northern Ireland Professional Employer, manager Intermediate non-manual Junior non manual Skilled manual Semi-skilled manual Unskilled manual No SEG, ref etc,armed forces Total 108 192 214 140 499 163 82 93 1,491 54 121 419 535 166 473 128 192 2,088 162 313 633 675 665 636 210 285 3,579 2,670 1,040 2,150 6,060 2,940 1,340 2,580 7,160 5,600 3,870 3,240 13,220 9 16 23 16 26 36 44 20 24 4 13 15 24 25 33 31 23 24 7 15 18 23 26 34 36 22 24 14 20 29 21 12 20 28 20 13 20 28 20 Women % Total %
Notes: Adults aged 16 and over. Great Britain: Respondents whose household reference person was a full time student, had an inadequately described occupation, had never worked or was long-term unemployed are not shown as separate categories but are included in the total. Socio-economic classification is based on the current or last job of the household reference person. Northern Ireland: SEG refers to socio-economic group. Source: Office for National Statistics (2011). General Lifestyle Survey 2010. Results published online at http://www.ons.gov.uk/ons/rel/ghs/general-lifestylesurvey/2010/index.html (Accessed May 2010). Northern Ireland Statistics and Research Agency (2011). Continuous Household Survey 2009/10. NISRA: Belfast.
116
Figure 4.4a Smoking prevalence, by sex and socioeconomic group, Great Britain 2010
35
30
25
Prevalence (%)
20
15
10
0 Managerial and professional Men Women Intermediate Routine and manual
117
Figure 4.4b Smoking prevalence, by sex and socioeconomic group, Northern Ireland 2010
50 45 40 35 30 25 20 15 10 5 0 A. Men Women B. C. D. E. F. G. H.
Prevalence (%)
A. Professional B. Employer, manager C. Intermediate non-manual D. Junior non manual E. Skilled manual F. Semi-skilled manual G. Unskilled manual H. No SEG, ref etc, armed forces
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Table 4.5 Cigarette smoking in adults, by sex, age and ethnic group, England 2004
Men All ages % Black Caribbean Black African Indian Pakistani Bangladeshi Chinese Irish General population Bases Black Caribbean Black African Indian Pakistani Bangladeshi Chinese Irish General population 403 379 547 423 396 345 496 2,855 114 172 199 213 198 170 114 721 165 169 230 145 149 117 194 973 124 38 118 65 49 58 188 1,161 637 457 630 497 453 372 653 3,805 186 224 237 268 287 145 147 895 289 189 274 164 117 176 275 1,374 162 44 119 65 49 51 231 1,536 25 21 20 29 40 21 30 24 16-34 % 27 21 18 28 35 25 46 32 35-54 % 34 20 22 34 49 21 26 26 55+ % 12 25 19 18 29 9 25 14 All ages % 24 10 5 5 2 8 26 23 Women 16-34 % 44 15 8 5 1 12 35 28 35-54 % 21 6 4 7 4 5 26 26 3 4 21 15 55+ % 5 2 3
Notes: General population refers to the whole population of England, regardless of ethnicity. Blank cells indicate too few respondents for accurate estimate. Source: Joint Health Surveys Unit (2005) Health Survey for England 2004. The Health of Minority Ethnic Groups. The Information Centre: Leeds. Copyright 2010, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved.
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Table 4.6 Regular cigarette smoking in young people aged 11 to 15, by sex, England, Scotland, Wales and Northern Ireland 1982 to 2010
1982 1983 1984 1986 1988 1990 1992 1994 1996 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
% Boys England Wales Scotland Northern Ireland Girls England Wales Scotland Northern Ireland 14 11 15 11
13
7 9
7 8
9 8 11 12
9 10 10
10 8 11
11 12 14
9 10 11
9 10 10 11
9 8 11
7 9 9
16 14
10 13
8 5
7 7
13
12 12
9 11
11 12 12 13
10 13 13
13 13 13
15 16 14
12 17 13
10
12 16 16 14
11
11 14 16
11
10 13 16
10
10
17 12
14 9
11 10
10
9 6
13
Notes: In Scotland, rates are for children aged 12-15 up to 1999, and aged 13-15 from 2000. From 2000 onwards, Northern Ireland data is taken from the Young Persons Behaviour & Attitudes Survey (school based survey of pupils in Years 8 to 12). Regular smokers are those pupils that report smoking cigarettes everyday or at least once a week. Sources: Department of Health (2011) Smoking, drinking and drug use among young people in England in 2010. The Information Centre: Leeds. Copyright 2010, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved. National Assembly for Wales, Statistics for Wales: personal communication. National Centre for Social Research and the National Foundation for Educational Research (2001). Smoking, drinking & drug use among young people in Scotland in 2000. The Stationery Office: Edinburgh. Office for National Statistics (2011) Scottish schools adolescent lifestyle and substance use survey (SALSUS) national report. Smoking, drinking and drug use among 13 and 15 year olds in Scotland in 2010. NHS Scotland: Edinburgh. Department of Health and Social Security Northern Ireland (1991) Smoking and Drinking Amongst 11-15 year olds in Northern Ireland in 1990. DHSS NI: Belfast Northern Ireland Statistics and Research Agency (2002) Young Persons Behaviour and Attitudes Survey. Personal communication NISRA 2010.
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Table 4.7 Current tobacco use, by sex, all available countries the World 2009
WHO member states Men % African Region Benin Burkina Faso Cameroon Cape Verde Chad Comoros Congo Cte dIvoire DR of Congo Eritrea Ethiopia Gabon Gambia Ghana Guinea Kenya Liberia Malawi Mali Mauritania Mauritius Mozambique Namibia Niger Nigeria Sao Tome and Principe Senegal Seychelles Sierra Leone South Africa Swaziland Uganda Tanzania Zambia Zimbabwe Region of the Americas Argentina Barbados Belize 17 15 18 14 14 22 24 10 17 10 10 8 19 31 11 25 26 14 26 28 29 31 18 30 9 10 9 16 24 39 24 16 16 21 24 30 26 32 13 23 4 2 4 2 2 9 <1 3 2 <1 5 8 8 2 3 3 4 4 16 22 1 3 Women % 3 1 8 2 3 3 9 <1 4 2 2 <1 3 3 3 2 1
121
WHO member states
Men %
Women % 18 13 17 33 8 4 13 4 6 3
Bolivia Brazil Canada Chile Costa Rica Cuba Dominican Republic Guatemala Guyana Honduras Mexico Paraguay Peru Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Trinidad and Tobago United States of America Uruguay South-East Asia Region Bangladesh India Indonesia Maldives Myanmar Nepal Sri Lanka Thailand Western Pacific Region Australia Brunei Darussalam Cambodia China Cook Islands Fiji Japan Kiribati Laos Malaysia Marshall Islands Micronesia Mongolia
42 22 24 38 24 11 17 22 27
24 30
8 14 9
12 28 18 27 33 31 33 46 26 61 43 40 36 27 45 51 22 32 42 51 43 18 42 71 51 50 36 30 48
2 12 6 11 25 22 4 2 4 5 11 8 29 <1 3 4 19 4 3 2 31 3 12 43 4 2 7 18 6
122
WHO member states
Men %
Women % 50 24 9 31 10 7 23 6 19 13 20 8 2 22 19 32 2 45
Nauru New Zealand Palau Papua New Guinea Philippines Republic of Korea Samoa Singapore Solomon Islands Tonga Tuvalu Vanuatu Viet Nam European Region Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Malta Netherlands Norway Poland
49 27 37 58 47 49 58 35 46 44 51 43 48 41 60 38 51 47 41 49 30 47 43 30 46 28 36 57 33 63 43 27 29 33 40 45 50 50 30 31 31 36
9 22 36 31 28 23 22 27 6 25 41 33 21 13 19 9 2 22 22 21 26 28 25
123
WHO member states
Men %
Women % 16 5 24 24 27 19 22 27 21 15 13 23 3 5 8 <1 2 4 6 4 31 <1 2 <1 6 1 2
Portugal Republic of Moldova Romania Russian Federation Serbia Slovakia Slovenia Spain Switzerland Turkey Ukraine United Kingdom Uzbekistan Eastern Mediterranean Region Bahrain Egypt Iran Iraq Jordan Kuwait Lebanon Libya Morocco Oman Pakistan Saudi Arabia Sudan Syrian Arab Republic Tunisia United Arab Emirates Yemen Global
32 43 46 59 38 39 30 36 31 47 50 25 22 30 34 40 26 31 47 35 46 47 33 12 34 24 24 42 58 19 35 36
5 2 11 8
Notes: Tobacco smoking includes cigarettes, cigars, pipes or any other smoked tobacco products. Current smoking includes both daily and non-daily or occasional smoking. Smoking prevalence data are sourced from surveys conducted in countries in different years. To obtain smoking prevalence estimates for 2006, trend information is used either to project into the future for countries with data older than 2006 or to backtrack for countries with data later than 2006. This is achieved by incorporating trend information from all available surveys for each country. For countries without historical data, trend information from the respective sub-region in which they fall is used. Prevalence is age-standardised to the WHO standard population. Source: World Health Organization. Global Health Observatory http://apps.who.int/ghodata/# (Accessed August 2012). World Health Organization (2012) World Health Statistics 2012. Geneva: Switzerland.
124
Table 4.8 Consumption of total fat, saturated fat, salt, sugar, fibre and fruit and vegetables in adults aged 16 and over, Great Britain 1975 to 2010
1975 1980 1985 1990 1995 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Consumption per person per day, total diet (i.e. including alcohol) Energy (kcal) Energy (kJ) Fat (g) Fat (% total energy) Saturated fat (g) Saturated fat (% total energy) Total sugars (g) Non-milk extrinsic sugars (g) Non-milk extrinsic sugars (% total energy) Non-starch polysaccharide fibre (g) Sodium (g) Salt (g) Purchase per person per week Fruit and vegetables (excluding potatoes) (g) 1,818 2,059 2,018 2,164 2,254 2,381 2,248 2,306 2,269 2,274 2,448 2,454 2,421 2,317 2,246 2,240 2,489 10.4 112 40.4 53.4 19.3 2,439 10.3 112 41.3 49.1 18.1 2,208 9.3 102 41.6 43.0 17.5 2.8 7.0 2,058 8.6 94 40.9 37.2 16.3 2.7 6.8 2,143 9.0 89 37.4 35.5 14.9 129 87 15.2 12.8 2.8 7.0 2,152 9.0 86 36.1 34.6 14.5 131 88 15.3 13.9 2.9 7.3 2,089 8.8 86 36.9 33.9 14.6 122 81 14.5 13.3 2.9 7.2 2,099 8.8 85 36.6 33.7 14.4 124 82 14.7 13.5 2.8 7.0 2,077 8.7 85 36.7 33.6 14.6 124 82 14.7 13.1 2.7 6.9 2,048 8.6 83 36.7 32.9 14.5 123 80 14.7 13.2 2.7 6.8 2,082 8.8 85 36.7 33.4 14.4 123 79 14.2 13.8 2.7 6.9 2,074 8.7 85 36.9 33.4 14.5 121 77 13.9 13.8 2.6 6.5 2,052 8.6 84 37.7 32.6 14.7 119 76 14.2 13.4 2.5 6.2 2,028 8.5 83 37.9 32.3 14.7 117 76 14.4 13.3 2.5 6.1 2,054 8.6 84 37.9 32.5 14.6 119 77 14.5 13.5 2.5 6.3 2,035 8.5 84 38.0 31.6 14.3 116 76 14.3 13.5 2.5 6.3
Notes: Data pre-1996 are unadjusted National Food Survey data. 2001/02 data onwards are Expenditure and Food Survey data. 1996 to 2000 data are adjusted estimates from the National Food Survey. Because of the discontinuity between datasets, these trends need to be interpreted with caution. Consumption assumed from purchase data, and applies to food consumed in the household only. Source: Department for Environment, Food and Rural Affairs (2011). DEFRA: York and previous editions. Department for Environment, Food and Rural Affairs (2003). National Food Survey 2000. The Stationery Office: London and previous editions.
125
Table 4.9 Consumption of selected foods in adults aged 16 and over, United Kingdom 1942 to 2010
1942 Litres per person per week Liquid wholemilk Skimmed milks Yoghurt Total milk and cream Number per person per week Eggs Grams per person per week Natural cheese Processed cheese Total cheese Oranges and other citrus fruits Apples and pears Bananas Total fresh fruit Fruit juice (ml) Other fruit Total fruit Fresh green vegetables Other fresh vegetables Total fresh vegetables (excludes potatoes) All processed vegetables (includes frozen & canned) Fresh potatoes Bread Flour Cakes, buns and pastries Biscuits (includes crispbreads) Breakfast cereals Total cereals (excludes breads) Bread and cereal products Sugar Preserves Tea Coffee Total beverages Fresh white fish Fresh fatty fish Shell fish Takeaway fish Total fish and fish products Salt Butter Margarine Low fat spreads Reduced fat spreads Lard Total fats Beef and veal Mutton and lamb Pork Bacon and ham Poultry Sausages Total meat and meat products Soft drinks, low calorie (ml) Soft drinks, not low calorie (ml) Total soft drinks (ml) Chocolate bars Confectionery 113 746 50 245 230 150 11 112 56 329 228 154 9 128 10 114 846 58 339 248 188 57 175 50 103 1,017 63 339 221 149 80 177 143 106 1,121 57 324 208 128 118 145 170 100 1,160 56 118 129 112 187 74 23 593 2,310 238 140 197 438 450 888 136 1,877 1,718 181 197 101 72 93 201 37 409 7 97 513 392 433 825 214 1,759 1,637 206 190 104 40 678 2,315 287 179 61 6 77 89 16 3 29 188 75 11 86 124 230 96 522 14 162 698 430 427 857 260 1,588 1,289 192 179 161 51 711 2,000 503 91 79 11 101 67 9 3 24 166 26 161 104 92 10 102 142 234 85 543 17 163 723 372 394 766 382 1,470 1,080 161 161 163 78 711 1,791 480 73 73 16 102 50 6 1 29 152 28 170 81 103 6 110 153 260 91 608 97 152 857 366 466 832 554 1,176 949 169 153 205 94 655 1,604 392 63 62 20 99 32 7 3 20 137 32 106 115 105 9 113 136 249 130 624 225 113 962 287 475 762 638 1,008 859 95 146 199 121 692 1,551 211 52 46 19 84 24 8 5 15 147 15 42 96 27 20 25 265 134 82 84 115 204 74 999 97 12 109 137 235 214 765 332 92 1,189 246 506 752 671 727 782 69 187 189 135 846 1,628 130 37 36 16 70 15 11 6 7 144 9 37 22 22 50 7 193 113 54 68 109 235 66 1,014 516 1,184 1,699 113 151 104 12 116 151 226 225 856 350 86 1,292 235 567 802 567 587 701 60 168 165 135 865 1,566 94 35 33 17 57 19 18 12 10 167 11 38 20 16 39 4 183 120 53 52 112 260 64 1,046 442 1,276 1,718 84 123 103 13 116 145 229 226 855 366 92 1,313 221 566 787 609 565 692 54 165 165 135 861 1,553 92 34 30 16 55 20 18 13 10 170 8 40 18 13 43 4 184 128 54 55 111 255 65 1,042 534 1,273 1,807 84 123 106 12 119 148 223 230 855 340 86 1,281 224 566 790 594 537 677 54 159 163 130 858 1,535 92 33 30 17 56 17 18 14 10 165 9 41 19 12 41 3 181 126 55 54 109 251 65 1,029 508 1,178 1,686 88 129 99 12 111 131 205 219 790 325 84 1,199 203 557 760 599 535 659 63 153 170 130 858 1,517 93 34 30 17 55 16 15 13 9 161 9 40 22 11 40 3 184 111 45 55 108 250 62 998 490 1,192 1,682 88 131 105 11 116 123 204 205 762 302 79 1143 201 552 753 597 514 656 58 158 169 133 875 1531 90 35 29 18 54 15 16 14 9 158 9 39 24 12 36 3 181 112 46 54 111 246 65 999 469 1209 1,678 90 134 107 11 118 119 199 204 755 296 82 1133 192 565 757 592 501 634 58 153 162 133 871 1,505 90 36 28 20 56 15 16 13 8 151 11 40 23 11 39 3 183 114 44 53 113 242 66 1,016 579 1,139 1,718 89 131 1.4 3.5 4.6 4.7 3.4 2.0 1.6 1.6 2.0 2.0 2.0 2.0 2 2.14 2.94 2.92 2.89 1.98 2.72 2.75 2.63 2.37 0.02 0.06 2.68 1.24 0.73 0.11 2.23 0.68 1.16 0.16 2.16 0.48 1.17 0.20 2.03 0.49 1.14 0.20 2.02 0.43 1.15 0.20 2.00 0.42 1.15 0.20 2.00 0.42 1.16 0.2 1.9 0.35 1.16 0.2 1.90 1950 1960 1970 1980 1990 2000 2005 2006 2007 2008 2009 2010
Notes: Figures differ from actual food and drink consumption for a number of reasons e.g. food may be discarded during food preparation (e.g. vegetable peelings), food may be left on the plate at the end of a meal or food may become inedible before it can be consumed and is therefore thrown away. Data for 1942 to 1970 from non-adjusted National Food Survey (GB only). Data for 1975 to 1995 from adjusted National Food Survey (GB only). Data for 1996 to 2000 from adjusted National Food Survey (UK). Data for 2005 onwards from Expenditure and Food Survey (UK). Because of the discontinuity between datasets, these trends need to be interpreted with caution. Source: Department for Environment, Food and Rural Affairs (2011) Family Food in 2010. DEFRA: York and previous editions. Department for Environment, Food and Rural Affairs (2003). National Food Survey 2000. The Stationery Office: London and previous editions.
126
Figure 4.9a Consumption of fats in adults aged 16 and over, United Kingdom 1942 to 2010
400
350
Consumption per person per week (g)
300
250
200
150
100
50
0 1950 1955 1960 1965 1970 1942 1945 1975 1980 1985 1990 2005 1995 2000 2010 2010
Total fats
Low and reduced fat spreads
Butter
Margarine
Figure 4.9b Consumption of milk and milk products in adults aged 16 and over, United Kingdom 1942 to 2010
3.5
3.0 Consumption per person per week (litres)
2.5
2.0
1.5
1.0
0.5
0.0 1950 1955 1960 1965 1970 1975 1990 2000 2005 1980 1942 1945 1985 1995
Total milk and cream
Skimmed milks
Liquid wholemilk
127
Figure 4.9c Consumption of fresh fruit and vegetables in adults aged 16 and over, United Kingdom 1942 to 2010
1000 900 800 Consumption per person per week (g) 700 600 500 400 300 200 100 0 1950 1955 1960 1965 1970 1942 1945 1975 1980 1985 1990 2005 1995 2000 2010
Total fresh vegetables (excludes potatoes)
Total fresh fruit
Fruit juice
128
Table 4.10 Quality of diet, by sex, United Kingdom 2008-2010

Men Percentage of food energy, total fat Percentage of food energy, saturated fat Percentage of food energy, trans fatty acids Percentage of food energy, non-milk extrinsic sugars Mean grams per day of non-starch polysaccharide (fibre) Mean daily number of portions of fruit and vegetables consumed % eating recommended 5 or more portions a day Base 35.2 12.9 0.8 12.9 14.9 4.2 32 346 Women 34.4 12.6 0.8 12.2 12.8 4.1 29 461 Total 34.8 12.8 0.8 12.6 13.9 4.2 30 807 Target <35% <11% <2% <11% >18.0g > 5 portions
Notes: Adults aged 19 to 64. Data are weighted for non-response. Target refers to the dietary reference values set by the Department of Health, which are the current recommendations for consumption levels in the UK. Source: Bates B, Lennox A, Bates C, Swan G. The National Diet and Nutrition Survey: Headline results from year 1 and 2 (combined) of the rolling programme (2008/09 - 2009/10). Department of Health and Food Standards Agency: London.
129
Table 4.11 Consumption of salt in adults aged 16 and over, United Kingdon 2008, Wales 2006, Scotland 2009 and England 2011
Men 19-24 UK, 2008 Mean salt consumption (g/day) % exceeding recommended daily consumption Base Wales, 2006 Mean salt consumption (g/day) % exceeding recommended daily consumption Base Scotland, 2009 Mean salt consumption (g/day) % exceeding recommended daily consumption Base 9.3 88 46 10.1 93 70 9.7 88 123 Men 19-34 England, 2011 Mean salt consumption (g/day) % exceeding recommended daily consumption Base 9.5 21 43 10.0 11 84 8.2 28 123 9.3 20 250 7.1 32 43 6.8 48 101 6.6 46 153 6.8 42 297 35-49 50-63 All ages 19-34 10.6 86 104 10.0 89 342 9.0 95 44 7.2 64 71 7.9 71 126 Women 35-49 50-63 All ages 7.4 69 121 7.8 72 361 12.4 89 6 9.4 83 19 9.0 80 64 8.6 81 66 9.4 82 155 6.3 56 6 7.8 64 38 6.8 60 89 6.4 48 119 6.8 57 252 10.7 86 9 10.2 87 37 9.5 81 111 9.3 80 137 9.7 82 294 10.0 79 7 8.1 72 54 7.4 62 157 7.0 61 180 7.7 65 398 25-34 35-49 50-64 All ages 19-24 25-34 Women 35-49 50-64 All ages
Notes: The recommended daily consumption of salt for both men and women is 6g per day or less. The 2006 estimates should be viewed with caution due to poor survey response rates. Salt consumption based on 24 hour urine collection. Source; National Centre for Social Research (2008) An assessment of dietary sodium levels among adults (aged 19-64) in the general population, based on analysis of dietary sodium samples. Food Standards Agency: London. National Centre for Social Research (2007) An assessment of dietary sodium levels among adults (aged 19-64) in the general population in Wales, based on analysis of dietary sodium in 24-hour urine samples. NatCen: London. Scottish Centre for Social Research (2011) A survey of 24 hour urinary sodium excretion in a representative sample of the Scottish population as a measure of salt intake. ScotCen: Edinburgh. National Centre for Social Research (2012) National Diet and Nutrition Survey - Assessment of dietary sodium in adults (aged 19 to 64 years) in England, 2011. NatCen: London.
130
Table 4.12 Consumption of total fat, saturated fat, salt, sugar, fibre and fruit and vegetables, by Government Office Region 2008/10
East of England West Midlands East Midlands Yorkshire and The Humber
South West
North West
South East
Consumption per person per day, total diet (i.e. including alcohol) Energy (kcal) Fat (g) Fat (% total energy) Saturated fat (g) Saturated fat (% total energy) Total sugars (g) Non-milk extrinsic sugars (g) Non-milk extrinsic sugars (% total energy) Non-starch polysaccharide fibre (g) Sodium (g) Salt (g) 1,978 80 37.3 31.0 14.7 113 74 1,988 82 38.1 31.4 14.6 113 73 1,990 82 38.0 31.7 14.7 115 74 2,094 85 37.7 32.9 14.5 123 80 2,052 84 37.7 31.7 14.2 117 78 2,086 86 37.9 33.2 14.7 123 80 1,877 78 38.2 27.9 13.7 103 64 2,037 85 38.3 32.8 14.9 120 77 2,165 90 38.3 35.1 15.0 127 82 2,012 83 38.0 31.8 14.6 117.0 75 2,121 87 37.9 33.9 14.7 128 84 2,098 85 37.3 33.3 14.7 124 82 2,049 82 36.9 32.4 14.5 115 74
14.3
12.6 2.48 6.2
Purchase per person per week Fruit and vegetables (excluding potatoes) (g) Base 1,950 1,977 2,100 2,364 2,068 2,443 2,526 2,429 2,525 2,287 2,382 2,141 1,877
730
Notes: Adults aged 16 and over. Consumption is assumed from purchase data, and applies to food consumed in the household only. Data are weighted for non-response. Base is number of households. Source: Department for Environment, Food and Rural Affairs (2011) Family Food in 2010. DEFRA: York and previous editions.
North East
Northern Ireland
Scotland
England
London
Wales
14.2
14.4
14.7
14.5
14.7
13.1
14.6
14.6
14.4
15.1
15.0
13.9
12.6 2.47 6.2
13.1 2.48 6.2
14.0 2.55 6.4
13.5 2.48 6.2
13.9 2.55 6.4
12.9 2.04 5.1
13.6 2.52 6.3
14.5 2.65 6.6
13.3 2.44 6.1
14.0 2.63 6.6
13.3 2.65 6.6
13.3 2.60 6.5
1,771
1,460
1,211
1,467
1,546
1,413
2,186
1,516
13,300
798
1,512
1,323
131
Table 4.13 Consumption of total fat, saturated fat, salt, sugar, fibre and fruit and vegetables, by income quintile, United Kingdom 2007/09
Quintile 1 (lowest income) Consumption per person per day, total diet (i.e. including alcohol) Energy (kcal) Fat (g) Fat (% total energy) Saturated fat (g) Saturated fat (% total energy) Total sugars (g) Non-milk extrinsic sugars (g) Non-milk extrinsic sugars (% total energy) Non-starch polysaccharide fibre (g) Sodium (g) Salt (g) Purchase per person per week Fruit and vegetables (excluding potatoes) (g) 2,167 2,237 2,240 2,296 2,556 2,174 91 38.2 35.3 14.9 129 84 14.7 13.8 2.62 6.6 2,124 88 38.2 34.2 14.8 126 83 14.9 13.4 2.48 6.2 2,066 85 38.1 32.7 14.6 120 78 14.5 13.3 2.52 6.3 2,027 82 37.6 31.9 14.5 116 75 14.3 13.4 2.49 6.2 1,934 78 37.5 30.4 14.6 110 69 13.8 13.4 2.40 6.0 Quintile 5 (highest income)
Quintile 2
Quintile 3
Quintile 4
Notes: Adults aged 16 and over. Consumption is assumed from purchase data, and applies to food consumed in the household only. Source: Department for Environment, Food and Rural Affairs (2011) Family Food in 2010. DEFRA: York and previous editions.
Figure 4.13 Consumption of fruit and vegetables in adults, by income quintile, UK 2007/09
3000
2500 Consumption per person per day (g)
2000
1500
1000
500
0 Quintile 1 (lowest income) Quintile 2 Quintile 3 Quintile 4 Quintile 5 (highest income)
132
Table 4.14 Consumption of total fat, saturated fat, salt, sugar, fibre and fruit and vegetables in adults, by ethnic group, United Kingdom 2006/08
Asian & Asian British Consumption per person per day, total diet (i.e. including alcohol) Energy (kcal) Fat (g) Fat (% total energy) Saturated fat (g) Saturated fat (% total energy) Total sugars (g) Non-milk extrinsic sugars (g) Non-milk extrinsic sugars (% total energy) Non-starch polysaccharide fibre (g) Sodium (g) Salt (g) Purchase per person per week Fruit and vegetables (excluding potatoes) (g) 2,348 2,143 2,535 1,987 2,462 1,975 78 36.0 25.7 11.8 99 60 11.4 13.2 1.41 3.5 1,641 64 35.6 19.9 11.0 97 65 15.1 10.4 1.51 3.8 1,676 70 37.8 23.6 12.8 91 55 12.5 11.4 1.60 4.0 1,524 62 36.9 22.8 13.7 91 60 14.9 10.2 1.75 4.4 2,075 85 38.0 33.6 15.0 121 78 14.5 13.6 2.61 6.5 Black & Black British Chinese & Other Mixed White
Notes: Adults aged 16 and over. Consumption is assumed from purchase data, and applies to food consumed in the household only. Source: Department for Environment, Food and Rural Affairs (2011) Family Food in 2010. DEFRA: York and previous editions.
133
Table 4.15 Consumption of fruit and vegetables in children aged 5 to 15, by sex and age, England 2001 to 2010
Age (Years) 5 Boys % consuming 5 or more portions per day 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Base 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Girls % consuming 5 or more portions per day 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Base 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 147 301 123 39 95 217 214 212 120 164 125 296 112 48 102 229 218 203 114 169 146 298 118 44 93 263 219 227 110 166 154 300 118 66 75 241 226 223 117 163 146 300 126 35 89 233 232 227 114 158 160 281 128 52 97 224 236 239 116 155 149 310 122 45 108 247 226 226 126 176 128 304 128 57 99 221 225 224 120 166 132 296 128 53 81 234 249 245 123 179 131 280 127 56 94 210 255 260 132 181 142 270 112 56 95 217 241 228 119 167 1,560 3,236 1,342 552 1,027 2,536 2,541 2,514 1,312 1,844 8.3 11.4 13.1 10.0 23.6 19.0 18.7 13.7 28.2 23.9 7.9 8.6 11.4 9.0 16.4 19.0 20.1 12.4 20.1 15.0 7.1 13.0 5.8 2.0 10.3 20.0 24.9 18.8 11.9 18.3 12.2 10.6 13.7 17.9 20.8 19.0 20.8 22.6 22.0 20.8 9.0 9.5 5.5 9.0 17.1 24.0 19.2 25.1 19.2 19.4 11.6 11.1 5.6 18.9 12.4 20.0 23.4 22.0 29.2 18.7 14.2 13.1 12.3 6.0 17.3 21.0 24.5 16.0 24.6 20.7 12.8 12.9 15.7 18.8 23.2 23.0 20.6 23.6 25.2 18.1 11.8 11.4 11.6 19.0 14.8 20.0 21.1 25.3 20.3 25.3 9.1 15.3 18.9 6.3 9.8 25.0 21.3 20.8 19.3 21.8 13.4 14.4 15.0 11.7 18.8 27.0 20.7 21.1 19.5 19.4 10.7 11.9 11.7 12.2 16.8 22.0 21.4 20.3 21.8 20.2 139 287 105 56 89 253 222 224 118 176 137 304 130 63 83 208 235 233 128 190 128 336 122 52 89 247 221 215 105 161 138 317 119 61 102 182 257 235 111 168 143 296 110 63 115 265 222 235 131 165 127 331 128 61 84 244 244 248 125 166 143 322 110 43 97 222 240 239 128 180 144 299 128 61 96 231 235 237 139 171 144 290 117 59 87 231 266 258 116 191 124 309 116 52 86 239 281 275 144 194 131 275 116 50 80 214 246 242 122 172 1,498 3,367 1,301 621 1,010 2,536 2,670 2,640 1,367 1,934 9.2 11.7 9.3 8.9 17.7 23.0 21.0 18.0 22.1 21.0 11.3 9.5 4.2 9.6 18.4 20.0 25.1 19.5 22.7 21.3 8.6 9.8 10.8 7.9 18.3 20.0 17.1 17.7 21.5 20.1 8.4 9.7 5.7 7.1 13.6 17.0 21.7 18.7 24.1 15.3 10.9 9.3 10.8 14.4 22.6 18.0 26.0 18.4 14.8 15.4 12.7 10.1 14.4 10.2 21.2 18.0 18.3 18.1 20.5 25.7 11.6 12.1 9.9 13.0 6.7 15.0 18.9 21.7 15.7 18.5 7.0 14.7 10.2 19.7 20.3 20.0 19.4 17.3 18.8 17.6 13.3 11.6 8.8 18.5 21.9 21.0 23.3 18.9 21.7 16.0 14.5 14.5 10.8 7.6 16.3 16.0 18.2 21.2 25.0 16.2 18.1 14.3 11.2 22.8 13.5 19.0 19.2 15.4 24.0 26.0 11.4 11.5 9.6 12.7 17.4 19.0 20.7 18.7 20.9 19.3 6 7 8 9 10 11 12 13 14 15 Total
Notes: Data are weighted for child selection, but not for non-response. Comparisons over time should be made with caution, due to the relatively low sample size in 2004. Source: Joint Health Surveys Unit (2012) Health Survey for England 2010. Updating of trend tables. The Information Centre: Leeds. Copyright 2010, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved.
134
Table 4.16 Total energy available from fat and availability of fruit and vegetables, by country, Europe 2007
% energy from fat Albania Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia 28.8 24.9 39.4 15.5 33.5 40.0 20.5 30.9 33.1 39.0 35.9 35.8 25.4 36.0 41.8 20.8 36.5 36.7 39.2 39.1 34.6 37.0 39.0 27.6 20.1 35.9 fruit and veg per person per year (kg) 299 394 251 222 205 201 289 132 193 269 144 209 174 172 214 102 182 404 195 222 219 317 295 190 178 168 Europe average EU average 35.9 37.3 240 225 Lithuania Luxembourg FYR Macedonia Malta Netherlands Norway Poland Portugal Republic of Moldova Romania Russia Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan Turkey Turkmenistan Ukraine United Kingdom Uzbekistan % energy from fat 27.2 38.9 36.2 28.9 37.3 35.3 29.7 35.4 21.1 27.9 25.1 39.5 34.2 33.8 42.1 35.6 40.3 26.4 27.1 22.7 26.2 37.7 24.1 fruit and veg per person per year (kg) 187 276 256 318 239 220 180 287 108 209 184 211 154 197 243 205 169 127 333 173 153 218 226
Notes: Data for these countries are for 2007. Fruit and vegetables do not include potatoes. Amount available refers to fruit and vegetables produced nationally, plus imports, minus exports. Source: World Health Organization (2012). European Health for All statistical database. http://data.euro.who.int/hfadb/
135
Table 4.17 Percentage of adults meeting physical activity recommendations in adults, by sex and country, England, Scotland, Wales and Northern Ireland 1997 to 2010
1997 Meeting government recommendations Men England Wales Scotland Northern Ireland Women England Wales Scotland Northern Ireland Bases Men England Wales Scotland Northern Ireland Women England Wales Scotland Northern Ireland 888 2,722 4,671 8,705 7,611 8,812 4,034 2,498 3,436 8,598 7,300 7,499 7,678 7,194 3,615 8,606 4,238 8,579 4,122 3,934 1,968 3,882 7,182 7,177 7,486 3,269 1,747 3,256 7,437 6,845 6,691 7,614 6,418 7,314 6,119 2,837 7,412 3,278 7,420 3,112 29 26 21 21 24 22 32 28 25 23 28 25 23 31 22 33 23 32 24 33 35 40 30 32 34 36 36 42 33 37 36 40 38 36 42 38 45 36 43 37 45 44 % 1998 % 2001 % 2003 % 2004 % 2005 % 2006 % 2007 % 2008 % 2009 % 2010 %
Notes: Data are for adults aged 16 and over in England, Wales and Scotland. Source: Joint Health Surveys Unit (2010). Health Survey for England 2008: Physical activity and fitness. The Information Centre: Leeds. Copyright 2010, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved. Scottish Health Executive (2011). The Scottish Health Survey 2010: Results. The Scottish Executive: Edinburgh. Welsh Government(2011). Welsh Health Survey 2010. Welsh Assembly: Cardiff. Northern Ireland Statistics and Research Agency (2007). Northern Ireland Health and Social Wellbeing Survey 2005/06. Includes data from previous years. The Department of Health, Social Services and Public Safety (2011). First results from the 2010/11 Health Survey Northern Ireland. Public Health Information & Research Branch: Belfast.
136
Table 4.18 Self-reported physical activity levels in adults, by sex and age, England 2008, Scotland 2010, Wales 2010 and Northern Ireland 2010/11
All adults Summary physical activity level England Men Meeting recommendations Some activity Low activity Base Women Meeting recommendations Some activity Low activity Base Scotland Men Meeting recommendations Some activity Low activity Base Women Meeting recommendations Some activity Low activity Base Wales Men Meeting recommendations Some activity Low activity Base Women Meeting recommendations Some activity Low activity Base Northern Ireland Men Meeting recommendations Below recommendations Base Women Meeting recommendations Below recommendations Base 35 65 2,395 36 64 218 44 56 391 41 59 449 36 64 443 33 67 353 28 72 305 15 85 236 44 56 1,675 53 47 133 46 54 228 49 51 246 44 56 303 38 62 293 33 67 293 27 73 179 24 33 36 8,579 28 40 23 919 27 41 24 1,073 28 38 25 1,330 28 34 32 1,472 25 34 35 1,520 19 27 48 1,247 7 15 76 1,018 37 26 31 7,420 48 26 17 882 43 29 19 831 42 29 24 1,082 41 24 28 1,333 31 26 37 1,361 26 24 45 1,109 14 17 65 822 33 33 33 4,122 37 39 25 373 42 36 22 564 45 35 19 682 40 36 24 761 30 33 36 699 17 31 52 573 7 17 76 470 45 26 29 3,112 66 22 12 274 61 24 15 420 51 29 20 478 48 25 27 566 34 29 36 555 22 29 50 488 10 20 70 331 29 34 38 7,660 35 33 32 1,088 36 39 25 1,212 34 39 28 1,428 32 35 33 1,230 28 34 37 1,119 17 30 53 798 6 16 78 785 39 31 30 7,305 53 30 16 1,133 49 32 19 1,210 44 33 23 1,411 41 34 25 1,204 32 31 37 1,084 20 33 47 724 9 23 68 538 % 1624 % 2534 % 3544 % 4554 % 5564 % 6574 % 75+ %
Notes: Meets recommendations: 30 minutes or more of moderate or vigorous activity on at least 5 days a week; Some activity: 30 minutes or more of moderate or vigorous activity on 1 to 4 days a week; Low activity: lower levels of activity. All data are self-reported. Source: Joint Health Surveys Unit (2010). Health Survey for England 2008: Physical activity and fitness. The Information Centre: Leeds. Copyright 2010, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved. Scottish Health Executive (2011). The Scottish Health Survey 2010: Results. The Scottish Executive: Edinburgh. Welsh Government(2011). Welsh Health Survey 2010. Welsh Assembly: Cardiff. Northern Ireland Statistics and Research Agency (2007). Northern Ireland Health and Social Wellbeing Survey 2005/06. Includes data from previous years. The Department of Health, Social Services and Public Safety (2011). First results from the 2010/11 Health Survey Northern Ireland. Public Health Information & Research Branch: Belfast.
137
Table 4.19 Self-reported age-standardised physical activity levels in adults, by sex and strategic health authority, England 2008
Strategic Health Authority
North East North West Yorkshire & the Humber East Midlands West Midlands East of England London South East Coast South Central South West
% Men Meets recommendations Some activity Low activity Women Meets recommendations Some activity Low activity Base Men Women 429 523 26 32 41 33 33 34
39 30 31
40 29 31
38 35 27
38 33 29
38 31 30
38 29 33
38 35 27
41 33 26
44 30 26
29 34 37
26 34 40
27 33 39
25 32 43
27 37 35
29 31 40
34 35 31
30 32 38
32 33 35
965 1,193
714 906
637 795
676 877
820 939
755 927
532 674
527 620
682 863
Notes: Meets recommendations: 30 minutes or more of moderate or vigorous activity on at least 5 days a week; Some activity: 30 minutes or more of moderate or vigorous activity on 1 to 4 days a week; Low activity: lower levels of activity. Episodes of activity less than 30 minutes have been excluded. Data are age-standardised to the mid-year 2007 population estimates for England; see source for details of method. All data are self-reported. Source: Joint Health Surveys Unit (2010). Health Survey for England 2008: Physical activity and fitness. The Information Centre: Leeds. Copyright 2010, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved.
138
Table 4.20 Self-reported age-standardised physical activity levels in adults, by sex and quintile of equivalised household income, England 2008
Highest % Men Meets recommendations Some activity Low activity Women Meets recommendations Some activity Low activity Base Men Women 1,329 1,313 1,180 1,285 1,041 1,310 1,046 1,397 854 1,274 34 37 28 28 38 35 28 34 38 27 32 41 26 29 45 42 35 23 41 37 23 42 29 29 39 28 33 31 23 46 Second % Third % Fourth % Lowest %
Notes: Meets recommendations: 30 minutes or more of moderate or vigorous activity on at least 5 days a week; Some activity: 30 minutes or more of moderate or vigorous activity on 1 to 4 days a week; Low activity: lower levels of activity. Episodes of activity less than 30 minutes have been excluded. All data are self-reported. Source: Joint Health Surveys Unit (2010). Health Survey for England 2008: Physical activity and fitness. The Information Centre: Leeds. Copyright 2010, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved.
Figure 4.20 Self-reported age-standardised physical activity levels in adults, by sex and quintile of equivalised household income, England 2008
45 40 35 30 Percentage 25 20 15 10 5 0 Highest Men Women Second Third Fourth Lowest
139
Table 4.21 Self-reported physical activity in adults, by sex and ethnic group, England 2004
General population % Men High Medium Low Base Women High Medium Low Base 25 36 39 3,818 31 30 39 648 29 28 43 467 23 32 45 634 14 34 52 508 11 21 68 477 17 36 47 375 29 38 33 656 37 31 32 2,873 37 29 34 409 35 30 35 386 30 26 44 549 28 21 51 429 26 23 51 408 30 32 38 348 39 28 33 497 Black Caribbean % Black African % Indian % Pakistani % Bangladeshi % Chinese % Irish %
Notes: High = 30 minutes or more physical activity on at least 5 days a week (recommended level). Medium = 30 minutes or more on 1 to 4 days a week. Low = lower level of activity. Adults aged 16 and over. Data are weighted for-non-response. General population refers to the whole population of England, regardless of ethnicity. Source: Joint Health Surveys Unit (2005). Health Survey for England 2004: The Information Centre: Leeds. Copyright 2005, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved.
140
Table 4.22 Self-reported physical activity levels in children, by sex and age, England 2008 and Scotland 2010
All children % England Boys Meeting recommendations Some activity Low activity Base Girls Meeting recommendations Some activity Low activity Base 24 47 29 3,545 All children % Scotland Boys Meeting recommendations Base Girls Meeting recommendations Base 72 694 70 174 73 143 84 132 74 100 62 145 75 811 70 188 75 190 85 170 69 104 75 159 35 38 27 246 33 42 24 268 2-4 % 28 49 23 229 31 43 26 225 5-7 % 28 44 27 236 28 50 22 254 8-10 % 23 55 23 231 25 49 26 248 11-12 % 27 44 29 296 16 55 29 291 13-15 % 19 50 31 240 20 46 34 259 12 47 41 278 15 40 45 244 32 44 24 3,493 43 30 27 253 32 39 25 240 28 41 30 247 32 43 25 239 34 41 25 249 36 47 18 235 32 45 23 236 33 46 22 243 31 49 20 255 29 50 21 254 29 46 25 260 27 52 21 286 32 43 24 267 32 42 26 229 2 % 3 % 4 % 5 % 6 % 7 % 8 % 9 % 10 % 11 % 12 % 13 % 14 % 15 %
Notes: Meets recommendations: 60 minutes or more on all 7 days of the week; Some activity: 30 to 59 minutes on all 7 days of the week; Low activity: lower levels of activity. All data are self-reported. Results between countries are not directly comparable due to the differences in data collection. Source: Joint Health Surveys Unit (2010). Health Survey for England 2008: Physical activity and fitness. The Information Centre: Leeds. Copyright 2010, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved. Scottish Health Executive (2011). The Scottish Health Survey 2010: Results. The Scottish Executive: Edinburgh.
141
Table 4.23 Self-reported frequency of exercising or playing sport in adults, EU countries 2009
Never % Austria Belgium Bulgaria Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom EU 59 28 58 46 37 18 41 7 34 31 67 53 26 55 44 44 32 38 28 49 55 49 35 22 42 6 32 39 Seldom % 33 22 28 13 35 18 25 21 18 20 15 24 15 16 29 20 17 14 16 24 11 28 35 26 19 22 22 21 With some regularity % 33 34 10 25 23 49 27 55 35 40 15 18 35 26 19 22 39 31 51 19 24 13 25 39 27 50 32 31 Regularly % 5 16 3 16 5 15 7 17 13 9 3 5 23 3 8 14 12 17 5 6 9 8 5 13 12 22 14 9 Dont know % 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 2 1 2 0 0 0 0 0 0
Notes: All adults aged 15 and above. Regularly means the respondent exercises at least 5 times a week. With some regularity means 3 to 4 or 1 to 2 times a week. Seldom means 1 to 3 times a month or less often. Adults aged 15 and over. Source: European Commission (2010). Sport and Physical Activity: Special Eurobarometer 334 / Wave 72.3 TNS Opinion & Social. http://ec.europa.eu/sport/news/ eu-physical-activity-guidelines_en.htm (Accessed December 2011).
Percentage
142
10
15
20
25
0 Bulgaria Greece Italy Austria Czech Republic Hungary Slovakia Netherlands Poland Estonia Latvia Romania Germany Portugal EU Luxembourg Spain France Slovenia Lithuania United Kingdom Denmark Belgium Cyprus Finland Malta Sweden Ireland
Figure 4.23 Self-reported frequency of regularly exercising or playing sport in adults, EU countries 2009
143
Table 4.24 Self-reported frequency of engaging in physical activity outside sport in adults, EU countries 2009
Never % Austria Belgium Bulgaria Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom EU 5 19 3 32 13 4 8 4 10 6 27 10 12 33 9 14 7 24 5 17 36 27 8 5 10 2 12 14 Seldom % 26 24 27 17 35 11 15 18 15 16 25 18 13 30 14 19 16 13 11 19 15 26 25 15 19 14 15 20 With some regularity % 54 36 40 31 35 42 37 49 42 50 33 31 41 30 32 26 40 30 41 34 31 24 40 41 38 44 36 38 Regularly % 15 21 25 20 17 43 40 29 33 28 15 41 33 7 44 39 37 32 43 26 17 19 27 39 33 40 37 27 Dont know % 0 0 5 0 0 0 0 0 0 0 0 0 1 0 1 0 0 1 0 4 1 4 0 0 0 0 0 1
Notes: All adults aged 15 and above. Regularly means the respondent exercises at least 5 times a week. With some regularity means 3 to 4 or 1 to 2 times a week. Seldom means 1 to 3 times a month or less often. Adults aged 15 and over. Source: European Commission (2010). Sport and Physical Activity: Special Eurobarometer 334 / Wave 72.3 TNS Opinion & Social. http://ec.europa.eu/public_ opinion/archives/ebs/ebs_334_en.pdf (Accessed December 2011).
Percentage
144
10
15
20
25
30
35
40
45
50
0 Italy Austria Greece Czech Republic Portugal Romania Cyprus Belgium Bulgaria Poland Slovakia EU Germany Finland Malta France Ireland Spain Luxembourg United Kingdom Lithuania Slovenia Estonia Sweden Hungary Denmark Netherlands Latvia
Figure 4.24 Self-reported frequency of engaging in physical activity outside sport in adults, EU countries 2009
145
Table 4.25 Alcohol consumption in adults, by sex and age, Great Britain 2010
All ages % Men Number of days of drinking last week None 5 or more Maximum daily amount Exceeded recommended amount (4 units +) Heavy drinking (8 units +) Unweighted base Women Number of days of drinking last week None 5 or more Maximum daily amount Exceeded recommended amount (3 units +) Heavy drinking (6 units +) Base 28 13 7,200 31 17 630 35 19 2,090 32 11 2,510 11 2 1,970 47 10 54 2 44 7 40 13 57 14 36 19 6,070 34 24 560 41 25 1,620 40 20 2,170 22 7 1,710 33 17 51 5 31 12 27 20 35 26 16-24 % 25-44 % 45-64 % 65+ %
Notes: Alcohol consumption levels are based on the number of units of alcohol consumed on the heaviest day during the previous week, the maximum daily amount. Source: Office for National Statistics (2011). General Lifestyle Survey 2010. Results published online at http://www.ons.gov.uk/ons/rel/ghs/general-lifestylesurvey/2010/index.html (Accessed May 2010).
146
Figure 4.25 Percentage of adults exceeding daily benchmarks for alcohol consumption, by sex and age, Great Britain 2010
45 40 35 30 Percentage 25 20 15 10 5 0 16-24 25-44 45-64 65+ 16-24 25-44 45-64 65+ Exceeding recommended daily benchmark Men Women Exceeding benchmark for heavy drinking
Note: Recommended daily benchmark is 4 units for men and 3 units for women. Benchmark for heavy drinking is 8 units for men and 6 units for women.
147
Table 4.26 Heavy drinking and drinking over recommended levels in adults, by sex and age, Great Britain 1998 to 2010
1998 Maximum daily alcohol consumption Men Exceeded recommended amount (4 units +) 16-24 25-44 45-64 65+ All ages Heavy drinking (8 units +) 16-24 25-44 45-64 65+ All ages Unweighted base Women Exceeded recommended amount (3 units +) 16-24 25-44 45-64 65+ All ages Heavy drinking (6 units +) 16-24 25-44 45-64 65+ All ages Unweighted base 24 11 5 1 8 7,821 27 13 5 1 10 7,491 27 14 5 1 10 8,299 28 13 5 1 10 7,942 26 13 5 1 9 9,304 24 13 6 1 9 8,012 27 20 12 2 15 11,617 25 21 12 2 15 9,013 24 22 13 3 15 8,380 24 20 13 2 14 7,950 24 19 11 2 13 7,290 17 19 11 2 13 7,200 42 28 17 4 21 42 31 19 4 23 40 31 19 5 23 42 31 19 5 23 40 30 20 4 23 39 28 20 5 22 41 42 37 12 34 39 40 35 14 33 40 43 36 14 34 36 37 32 10 29 37 36 32 11 29 31 35 32 11 28 39 29 17 4 22 6,561 37 27 17 5 21 6,598 37 30 17 5 22 7,054 35 28 18 5 21 6,828 37 30 20 6 23 8,087 32 31 18 7 22 6,862 32 30 22 6 19 10,028 30 31 21 7 23 7,674 32 31 24 8 24 7,230 30 27 21 7 21 6,720 24 27 21 5 20 6,160 24 25 20 7 19 6,070 52 48 37 16 39 50 45 38 16 39 50 49 37 18 40 49 46 38 16 38 51 47 41 19 40 47 48 37 20 39 46 48 42 21 40 42 48 42 21 40 44 48 44 23 41 42 42 41 21 37 36 44 41 20 37 34 41 40 22 36 % 2000 % 2001 % 2002 % 2003 % 2004 % 2005 % 2006 % 2007 % 2008 % 2009 % 2010 %
Notes: Alcohol consumption levels are based on the number of units of alcohol consumed on the heaviest day during the previous week. Methods for estimating the number of units of alcohol consumed were updated in 2006. Estimates since 2006 are not directly comparable with estimates from before 2006. Source: Office for National Statistics (2011). General Lifestyle Survey 2010. Results published online at http://www.ons.gov.uk/ons/rel/ghs/general-lifestylesurvey/2010/index.html (Accessed May 2010).
148
Figure 4.26 Heavy drinking and drinking over recommended levels in young adults aged 16-24, Great Britain 1998 to 2010
60
50
40 Percentage
30
20
10
0 2006 2008 2009 2007 2004 2000 2005 2003 2002 1998 2001 1999 2010
Men exceeding recommended levels Men heavy drinking
Women exceeding recommended levels Women heavy drinking
Note: Estimates in 2006 to 2010 are not directly comparable with pre-2006 estimates due to changes in the methods used to estimate the number of units consumed.
149
Table 4.27 Alcohol consumption in children, by sex and age, England 1988 to 2010
1988 % Boys 11 Years 12 Years 13 Years 14 Years 15 Years All ages Girls 11 Years 12 Years 13 Years 14 Years 15 Years All ages Bases Boys 11 Years 12 Years 13 Years 14 Years 15 Years All ages Girls 11 Years 12 Years 13 Years 14 Years 15 Years All ages 225 312 296 311 374 1,518 289 277 290 298 302 1,459 304 354 333 298 317 1,614 231 304 326 309 341 1,511 266 272 277 285 291 1,391 291 365 383 657 666 2,362 564 681 696 691 764 3,396 798 978 935 946 1,012 4,669 820 923 941 917 1,024 4,625 636 829 826 767 978 4,036 612 759 718 746 845 3,680 534 696 673 705 859 3,468 227 279 312 306 348 1,473 309 340 312 300 358 1,623 284 335 351 310 366 1,652 266 307 304 306 326 1,509 269 296 275 297 295 1,432 285 336 293 597 745 2,256 612 740 737 750 796 3,635 866 1,003 1,035 950 1,107 4,961 861 1,024 1,007 977 1,078 4,947 600 818 765 805 869 3,857 621 769 756 756 896 3,798 537 725 702 691 886 3,541 4 7 11 19 36 17 4 6 19 32 39 20 5 7 11 25 40 17 4 9 16 26 48 22 6 9 22 35 55 26 2 6 14 29 40 18 5 9 19 31 45 23 4 9 21 34 45 23 3 9 19 33 46 23 2 7 15 30 41 20 2 4 13 25 37 17 1 3 9 16 30 13 7 12 20 25 45 24 8 9 17 32 42 22 8 13 15 32 49 24 8 10 22 34 52 26 7 12 27 37 50 27 4 14 16 28 48 23 5 11 18 34 51 25 7 12 20 34 49 25 5 11 17 32 44 23 5 8 16 29 40 21 3 6 15 24 38 18 2 3 9 15 29 13 1990 % 1992 % 1994 % 1996 % 1998 % 2000 % 2002 % 2004 % 2006 % 2008 % 2010 %
Notes: Sample is drawn from children in years 7-11 in secondary schools in England. For 2008, the sample was drawn from 268 secondary schools including schools from both the maintained and non-maintained education sectors. Percentages refer to individuals who reported drinking alcohol at some point in the previous week. Source: National Centre for Social Research (2011) Smoking, drinking and drug use among young people in England in 2010. The Information Centre: Leeds, and previous editions. Copyright 2011, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved.
150
Table 4.28 Alcohol consumption in children, by sex and age, Scotland 1990 to 2010
1990 % Boys 13 Years 15 Years Girls 13 Years 15 Years Bases Boys 13 Years 15 Years Girls 13 Years 15 Years 324 219 343 216 348 252 309 175 389 402 555 391 1,481 2,424 1,730 1,745 5,805 5,439 2,665 2,320 9,085 8,718 301 251 380 218 358 250 303 220 369 424 621 424 1,429 2,489 1,787 1,668 5,790 5,622 2,604 2,269 9,715 9,469 10 25 12 28 13 35 18 46 15 35 20 37 23 46 20 46 15 37 12 31 14 34 10 30 14 35 18 37 21 48 19 39 19 42 23 47 20 40 13 35 11 31 15 35 1992 % 1994 % 1996 % 1998 % 2000 % 2002 % 2004 % 2006 % 2008 % 2010 %
Notes: Sample is drawn from children in years S2 and S4 in secondary schools in Scotland. For 2008, the sample was drawn from 377 secondary schools including schools from both the maintained and non-maintained education sectors. Percentages refer to individuals who reported drinking alcohol at some point in the previous week. Source: Office for National Statistics (2011) Scottish schools adolescent lifestyle and substance use survey (SALSUS) national report. Smoking, drinking and drug use among 13 and 15 year olds in Scotland in 2010. NHS Scotland: Edinburgh.
151
Table 4.29 Heavy drinking and drinking over recommended levels in adults, by sex and country or region, Great Britain 2010
Exceeded recommended amount (4 units +) Maximum daily amount Men North East North West Yorkshire and the Humber East Midlands West Midlands East of England London South East South West England Wales Scotland Great Britain 38 41 38 33 27 33 33 39 34 35 36 40 36 Exceeded recommended amount (3 units +) Maximum daily amount Women North East North West Yorkshire and the Humber East Midlands West Midlands East of England London South East South West England Wales Scotland Great Britain 30 35 30 25 21 28 23 31 28 28 28 31 28 12 18 14 10 8 13 11 13 11 12 12 14 13 340 870 740 570 680 730 600 950 650 6,130 390 680 7,200 % 21 24 22 15 15 16 19 19 18 19 19 23 19 Heavy drinking (6 units +) % 250 750 610 470 570 650 510 800 510 5,120 350 590 6,070 Base % Heavy drinking (8 units +) % Base
Notes: Alcohol consumption levels are based on the number of units of alcohol consumed on the heaviest day during the previous week, the maximum daily amount. Data are weighted for non-response. Estimates are for adults aged 16 and over. Source: Office for National Statistics (2011). General Lifestyle Survey 2010. Results published online at http://www.ons.gov.uk/ons/rel/ghs/general-lifestylesurvey/2010/index.html (Accessed May 2010).
152
Figure 4.29a Heavy drinking by country or region, men, 2010, Great Britain
Heavy drinking (8 units +) on heaviest drinking day in previous week. 22% or more 19% to 21% 16% to 18% 15% or less
153
Figure 4.29b Heavy drinking by country or region, women, 2010, Great Britain
Heavy drinking (6 units +) on heaviest drinking day in previous week. 17% or more 14% to 16% 11% to 13% 10% or less
154
Table 4.30 Alcohol consumption in adults, by sex and socioeconomic classification, Great Britain 2010
Exceeded recommended amount (4 units +) Maximum daily amount Men Managerial and professional Large employers and higher managerial Higher professional Lower managerial and professional Intermediate Intermediate Small employers and own account Routine and manual Lower supervisory and technical Semi routine Routine Total 40 48 39 38 36 36 37 32 34 31 30 36 Exceeded recommended amount (3 units +) Maximum daily amount Women Managerial and professional Large employers and higher managerial Higher professional Lower managerial and professional Intermediate Intermediate Small employers and own account Routine and manual Lower supervisory and technical Semi routine Routine Total 35 42 39 33 28 25 32 22 27 21 18 28 16 19 18 14 13 12 14 10 13 9 8 13 2,940 460 560 1,920 1,340 720 620 2,580 730 1,080 770 7,020 % 21 26 19 20 20 19 21 18 19 19 15 19 Heavy drinking (6 units +) % 2,670 440 600 1,630 1,030 420 610 2,140 760 690 690 5,940 Base % Heavy drinking (8 units +) % Base
Notes: Alcohol consumption levels are based on the number of units of alcohol consumed on the heaviest drinking day during the previous week, the maximum daily amount. Data are weighted for non-response. Estimates are for adults aged 16 and over. Source: Office for National Statistics (2011). General Lifestyle Survey 2010. Results published online at http://www.ons.gov.uk/ons/rel/ghs/general-lifestylesurvey/2010/index.html (Accessed May 2010).
155
Figure 4.30 Heavy drinking and drinking over recommended levels in adults, by sex and socioeconomic classification, Great Britain 2010
45 40 35 30 Percentage 25 20 15 10 5 0 Managerial and professional Intermediate Routine and manual Managerial and professional Intermediate Routine and manual
Drinking over recommended levels (3 / 4 units +) on heaviest drinking day in previous week Men Women
Heavy drinking (6 / 8 units +) on heaviest drinking day in previous week
156
Table 4.31 Alcohol consumption, by sex and ethnic group, England 2004
General population Alcohol consumed on the heaviest drinking day Men None Under 2 units Up to 4 units More than 4, up to 8 units More than 8 units % Exceeding 4 units Base Women None Under 2 units Up to 3 units More than 3, up to 6 units More than 6 units % Exceeding 3 units Base 39 18 70 16 14 30 3,745 53 17 81 12 6 18 618 74 11 92 5 2 7 446 79 8 92 4 4 8 618 97 1 98 0 1 1 495 99 0 99 0 0 1 448 68 15 88 8 4 12 364 33 18 64 20 16 36 642 24 13 55 20 25 45 2,829 40 12 72 16 12 28 397 62 8 83 10 7 17 369 53 11 77 13 9 22 531 93 1 96 1 3 4 416 99 0 99 0 0 1 395 52 14 81 9 10 19 337 20 10 44 25 32 56 490 % Black Caribbean % Black African % Indian % Pakistani % Bangladeshi % Chinese % Irish %
Notes: Data are weighted for non-response. Estimates are for adults aged 16 and over. General population refers to the whole population of England, regardless of minority ethnic group. Source: Joint Health Surveys Unit (2005) Health Survey for England 2004. The Information Centre: Leeds. Copyright 2005, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved.
157
Table 4.32 Frequency of heavy drinking in adults, by country, European Union 2009
% Austria Belgium Bulgaria Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom EU 36 28 18 26 24 22 18 22 20 36 34 24 44 30 11 18 14 26 23 19 28 39 17 18 34 13 34 29
Notes: Survey conducted in October 2009. Individuals were interviewed in their home using their native language. Approximately 1,000 interviews were conducted in each member state, with the exception of Germany (2,000), United Kingdom (1,300) and Luxembourg (600). Percentage refer to individuals who reported drinking 5 or more drinks on one occasion at least once a week in the last 12 months. Source: TNS Opinion & Social (2010) Eurobarometer 72.3 EU citizens attitudes towards alcohol. European Commission: Brussels.
Percentage
158
10
15
20
25
30
35
40
45
50
0 Latvia Sweden Luxembourg Slovakia Bulgaria Estonia Lithuania Slovenia Poland France Denmark Finland Netherlands Czech Republic Hungary Cyprus Malta Belgium Portugal European Union Italy Greece Spain United Kingdom Austria Germany Romania Ireland
Figure 4.32 Percentage of individuals reporting heavy drinking at least once a week in the last 12 months in adults, by country, European Union 2009
159
5. Medical risk factors
160
5. Medical risk factors

This chapter reports on the prevalence of medical risk factors for coronary heart disease (CHD), including sections on blood pressure, blood cholesterol, overweight and obesity, and diabetes. Patterns in the prevalence of each of these risk factors by age, sex, socioeconomic status, geographic region and ethnicity are explored. Prevalence rates in the UK are compared against rates found in other countries. Where possible, temporal trends in the prevalence of these risk factors are reported.
Blood Pressure Risk of CHD is directly related to higher levels of both systolic and diastolic blood pressure. Meta-analysis of prospective data on over one million adults has shown that for adults aged 40 to 69 years, each 20mmHg increase in usual systolic blood pressure, or 10mmHg increase in usual diastolic blood pressure, doubles the risk of death from CHD 1. At older ages the increase in risk of death from CHD is smaller, around 50% increase for every 20mmHg increase in usual systolic or 10mmHg increase in diastolic blood pressure in adults aged 80 to 89 years. Both drug treatment and lifestyle changes particularly weight loss, increase in physical activity, and a reduction in salt and alcohol intake can effectively lower blood pressure. The World Health Report 2002 estimates that around 11% of all disease burden in developed countries is caused by raised blood pressure, and that over 50% of CHD and almost 75% of stroke in developed countries is due to systolic blood pressure levels in excess of 115mmHg 2. In 2004, the INTERHEART study estimated that 22% of heart attacks in Western Europe and 25% of heart attacks in Central and Eastern Europe were due to a history of high blood pressure, and that those with a history of hypertension were at just under twice the risk of a heart attack compared to those with no history of hypertension 3. The 2006 National Institute of Health and Clinical Excellence (NICE) guidelines recommended persistent high blood pressure of 160/100 mmHg (or 140/90 mmHg with higher CVD risk) as the threshold for offering drug treatments, and that optimal blood pressure treatment targets are 140/90 mmHg 4 (Table 5.1). Rates of hypertension have dropped slightly in England since 1998, for both men and women at all ages. The largest decreases have occurred at older ages. For example, 73% of women aged 65 to 74 had hypertension in 1998 compared to 63% in 2010 (Table 5.2 and Figure 5.2). In the 2010 Health Survey for England, 31% of men and 29% of women had hypertension (defined here as a systolic blood pressure of 140mmHg or over, or a diastolic blood pressure of 90mmHg or over) or were being treated for hypertension. Of those who were treated, 41% of men and 42% of women remained hypertensive (Table 5.3). The prevalence of hypertension increases with age in both sexes. For example, only 3% of women aged 16 to 24 are hypertensive, compared to 47% aged 55 to 64 and 63% aged 65 to 74 (Table 5.3 and Figure 5.3). Data from the Scottish Health Survey suggest that the prevalence of high blood pressure is similar in England and Scotland. In 2010, 32% of English men and 29% of English women were hypertensive compared to 35% of Scottish men and 30% of Scottish women 5 (Table 5.4). Data from Wales and Northern Ireland are not comparable with those for England and Scotland, as they are not based on direct blood pressure measurements. The Welsh Health Survey 2010 showed that 20% of men and women reported being treated for raised blood pressure (Table 5.5). For men in England, the lowest levels of hypertension are found in the West Midlands (27%), and the highest levels are found in the East Midlands and Yorkshire and the Humber (36%). For women, the lowest levels are found in London, South East, South Central and South West (25%) and the highest levels are found in the North East (33%) (Table 5.6). The prevalence of hypertension in men does not seem to vary by income quintile. In 2006, the prevalence was around 30% for each quintile. This is not the case for women where the prevalence of high blood pressure in the lowest income quintile is about 50% higher than in the highest income quintile (Table 5.7).
161
Data from the Health Survey for England show that in 2004 the proportion of Bangladeshi men with high blood pressure was half that of the general population; in Pakistani and Chinese men the proportion was two thirds that of the general population. Pakistani and Chinese women were half as likely to have high blood pressure compared to women in the general population. The prevalence of untreated hypertension was lower among Pakistani, Bangladeshi and Chinese men and Indian, Pakistani, Bangladeshi and Chinese women than in the general population 6 (Table 5.8). In 2008, the WHO Global Health Observatory published that in the WHO-Europe region the prevalence of hypertension ranged from 33% in Israel to 48% in Armenia. The prevalence in the UK was 37% (Table 5.9). Blood Cholesterol Risk of CHD is directly related to blood cholesterol levels. Blood cholesterol levels can be reduced by drugs, physical activity and by dietary changes, in particular a reduction in the consumption of saturated fat. Research from the World Health Organization highlights the importance of raised blood cholesterol as a risk factor for CHD. The World Health Report 2002 estimates that around 8% of all disease burden in developed countries is caused by raised blood cholesterol, and that over 60% of CHD and around 40% of ischaemic stroke in developed countries is due to total blood cholesterol levels in excess of 3.8mmol/l 2. More recently the INTERHEART case-control study estimated that 45% of heart attacks in Western Europe and 35% of heart attacks in Central and Eastern Europe are due to abnormal blood lipids, and that those with abnormal lipids are at over three times the risk of a heart attack compared to those with normal lipids 3. Different guidelines give slightly different advice for managing high levels of blood cholesterol (hyperlipidaemia) 7,8. A joint publication by a series of UK cardiovascular societies in 2005 suggests that a threshold of 4.0mmol/l should be used to monitor treatment in individuals with CVD or at high risk of CVD. However, the National Institute of Health and Clinical Excellence recommends retaining the threshold of 5.0mmol/l for tracking levels of raised cholesterol, since many individuals will be unable to sustain a cholesterol level lower than 4.0mmol/l (Table 5.10). High-density lipoprotein cholesterol (HDL-cholesterol) is the fraction of cholesterol that removes cholesterol (via the liver) from the blood. Low levels of HDL-cholesterol are associated with an increased risk of CHD and a worse prognosis after a heart attack. Guidelines on HDLcholesterol generally recommend treatment for those with concentrations below 1.0mmol/l (Table 5.10).
The mean blood cholesterol level for men aged 16 and over in England in 2008 was 5.2mmol/l and for women 5.4mmol/l. Around 58% of men and 61% women had blood cholesterol levels of 5.0mmol/l and above 9. In Scotland, the mean blood cholesterol level in 2008 was 5.2mmol/l for men and 5.3mmol/l for women, and the proportion of people with levels of 5.0mmol/l and above continues to reduce with 57% of men and 58% of women aged 16 to 64 10 (Table 5.11 and Figure 5.11). The prevalence of raised cholesterol increases with age in both men and women until the mid 50s. In 2008, the proportion of men with cholesterol levels of 5.0mmol/l or above was 25% in those aged 16 to 24 compared to around 76% in those aged 45 to 54. The proportion of women aged 16 to 24 with cholesterol levels of 5.0mmol/l or above was 36% compared to 83% in those aged 55 to 64, and slightly lower in those over 65 years (Table 5.11 and Figure 5.11). The mean HDL-cholesterol level for those aged 16 and over in England in 2008 for women was 1.6mmol/l, and 1.3mmol/l for men 9. Overall, about 7% of men and 2% of women had HDL-cholesterol levels of less than 1.0mmol/l in England. In 2008, about 18% of men and 6% of women had HDL-cholesterol levels of less than 1.0mmol/l in Scotland 11 (Table 5.12). The prevalence of low HDL-cholesterol showed less agerelated variation, with no clear pattern. Rates of low HDLcholesterol are much higher in men than women over five times higher overall. The greatest difference being in the 65-74 group in which the rate of low HDL-cholesterol was 1.1% for women and 8.8% for men (Table 5.12). In both England and Scotland, the prevalence of raised total cholesterol fell between 1994 and 2008 for both men and women. In England, the prevalence of raised total cholesterol in men decreased in all age groups between 2003 and 2008 with the largest decrease in the 75 and over group which experienced a 24% drop. Similarly for women, the over 75 group also experienced the biggest reduction (16%). The prevalence of raised total cholesterol in women deceased for all age groups except for the 16 to 24 group which was slightly higher than in 2003. In older age groups (55 and older in men and 65 and older in women) the prevalence of raised total cholesterol has fallen steadily over the past decade (Table 5.11) 10. In 2008, the proportion of people with total cholesterol levels of 5mmol/l and over ranged between 52% and 64% for different regions of England for men, and between 56% and 68% for women. London had the lowest prevalence of raised cholesterol for men (52%) and North East had the lowest for women (56%). South Central had the highest prevalence in men (64%) but the East Midlands had the highest prevalence for women (68%) (Table 5.13).
162
Total blood cholesterol levels show little socioeconomic variation in either sex. However, low HDL-cholesterol levels vary with income; those with higher incomes are less likely to have levels of HDL-cholesterol below 1.0mmol/l (Tables 5.14). In 2004, the prevalence of blood cholesterol levels of 5.0mmol/l and above, was lower in all ethnic minority groups than the general population, with the exception of the Irish ethnic group. The highest rates of HDL-cholesterol below 1.0mmol/l for both sexes were found in the Indian, Pakistani and Bangladeshi communities. One fifth of Bangladeshi and Pakistani men had HDL-cholesterol levels of less than 1.0mmol/l compared to 6% of men in the general population. In contrast, Black African men and Black Caribbean women and Chinese women had a relatively low prevalence of low HDL-cholesterol (Table 5.15). Overweight and Obesity Overweight and obesity increase the risk of CHD. As well as being an independent risk factor, obesity is also a major risk factor for high blood pressure, raised blood cholesterol, diabetes and impaired glucose tolerance 12. The adverse effects of excess weight are more pronounced when fat is concentrated in the abdomen. This is known as central or abdominal obesity and is assessed using the waist to hip ratio or waist circumference 13. The World Health Report 2002 estimated that over 7% of all disease burden in developed countries was caused by raised body mass index (BMI), and that around a third of CHD and ischaemic stroke and almost 60% of hypertensive disease in developed countries was due to overweight 2. The INTERHEART case-control study estimated that 63% of heart attacks in Western Europe and 28% of heart attacks in Central and Eastern Europe were due to abdominal obesity (a high waist to hip ratio), and those with abdominal obesity were at over twice the risk of a heart attack compared to those without 3. This study also found that abdominal obesity was a much more significant risk factor for heart attack than BMI. In 2004, an obesity target for children in England was introduced by the Department of Health to halt the year-on-year rise in obesity in children under 11 by 2010. A more general aim to address the increasing rates of obesity in the population was also put forward. In Scotland a target was set to reduce the rate of increase in the proportion of children with their Body Mass Index outside a healthy range by 2018 and in Northern Ireland a target was to halt the rise in obesity in the general population by March 2010. There are currently no targets for overweight and obesity in Wales (Table 5.16).
In England in 2010, around 42% of men and 32% of women were overweight (a BMI of 25-30 kg/m2), and an additional 27% of men and 26% of women were obese (a BMI of more than 30 kg/m2). Central obesity was also common among adults in England. In 2008, data show that around 34% of men and 46% of women had central obesity (Tables 5.17 and 5.18). Generally overweight and obesity increases with age. In 2010, about 35% of men and 32% of women aged 16 to 24 were overweight or obese compared to 81% of men and 74% of women aged 65 to 74 (Table 5.17 and Figure 5.17). The prevalence of central obesity also generally increased with age, especially in men. About 13% of men and 18% of women aged 16 to 24 had central obesity compared to 49% of men and 64% of women aged 65 to 74 (Table 5.18). The classification of overweight and obesity in children and adolescents is more problematic than in adults. Constant changes in body composition during growth mean that the relationship between BMI and adiposity during childhood is age-dependent, and further complicated by race and gender. There is no clear agreement on the best way to define overweight and obesity in children. The International Obesity Taskforce (IOTF) has developed an international classification based on age and sex-specific BMI cut-off points. UK data is sometimes reported using the National BMI percentile classification where children are classified as overweight or obese using the 85th and 95th percentiles as cut points. These two methods of classification result in different estimates of childhood overweight and obesity 14. The National BMI classification has been used in the 2010 Health Survey for England. This survey found just less than a third of boys (31%) and girls (29%) in England aged 2 to 15 years were either overweight or obese 15 (Table 5.19). The National Child Measurement Programme found that 22% of reception class (ages 4 to 5 years) and 33% of year 6 (ages 10 to 11 years) children were either overweight or obese (Tables 5.20). Overweight and obesity has been increasing rapidly. In England, the percentage of men aged 16 and over who are obese rose from 14% in 1994 to 26% in 2010, and for women who are obese, from 17% in 1994 to 26% in 2010. The increase in obesity was particularly marked among men aged 45 to 74, approximately doubling between 1994 and 2008 (Table 5.21 and Figure 5.21).
163
The high levels of overweight and obesity among children are likely to exacerbate the trend towards overweight and obesity in the adult population, since compared to non-obese children, obese children have a high risk of becoming overweight adults 16. Between 1995 and 2010 the prevalence of obesity among English boys increased from 11% to 17% and from 12% to 15% among English girls, and overweight (including obesity) increased from 24% to 31% in boys and 25% to 29% in girls over the same time period. Less data are available for trends in overweight (including obesity) in Scotland, but estimates suggest a similar increase in the prevalence of overweight in boys from 28% in 1998 to 36% in 2008 and decreased to 31% in 2010 . Over the same time period the prevalence of overweight in girls in both England and Scotland has remained reasonably stable (Table 5.22 and Figure 5.22). In England in 2010, about two thirds of men were overweight or obese with very little variation by Government Office Region. The highest prevalence was found in the West Midlands (72%) and the lowest in London (64%). For women, the prevalence of overweight and obesity was lower than for men, with the highest prevalence in East and East Midlands (63%) and the lowest in South East (50%). Recent evidence suggests that rates of obesity among women are rising faster in the North than the South of England. This pattern is not observed in men, where rates appear to be rising uniformly across England 17 (Table 5.23). Among women, obesity rates vary considerably by household income. In 2010, 34% of women from the lowest quintile of household income were obese compared to 17% in the highest quintile. Much less variation was found in men (Table 5.24). In both men and women, the prevalence of central obesity was higher among households with lower income. In 2010, 36% of men and 53% of women from the lowest quintile of household income had a raised waist circumference compared to 33% of men and 36% of women in the highest quintile. Much less variation was found in men (Table 5.25). Levels of general and abdominal obesity vary with ethnicity in both men and women in England. Because individuals from different ethnic groups tend to store fat in different places of the body and therefore have different body shapes, it is useful to compare measurements generated by the different techniques when considering ethnic differences in obesity. Using the Body Mass Index (BMI) method, in 2004 the prevalence of obesity in men was substantially lower in the South Asian community, and also in Chinese men than in the general population. Using this definition as few as 6% of Chinese and Bangladeshi men were defined as obese, compared to 23% of men in the general population aged 16 and over. Similarly, the prevalence of obesity in Bangladeshi and Chinese women was lower than the general population when measured by BMI, although the difference was not as substantial. However, this difference is entirely removed when the Waist-to-Hip
Ratio (WHR) method is used using this technique the prevalence of obesity in Bangladeshi men is similar to that of men in the general population (around one in three men), and the prevalence of obesity in Bangladeshi women is higher than that of women in the general population. Ethnic differences in obesity measured using Waist Circumference (WC) are similar to those found using the WHR method, with a few exceptions. For example, using WHR the prevalence of obesity in Indian men (38%) is more than double the prevalence in Black African men (16%) however, the prevalence of obesity in these ethnic groups using the WC method is very similar (around one in five men in both ethnic groups) (Table 5.26 and Figures 5.26a and 5.26b). Data from the WHO Global Infobase 18 suggest that the prevalence of adult overweight and obesity in the UK is among the highest in Europe. In 2006, the International Obesity Taskforce collated data on overweight and obesity in children worldwide. Caution should be used in interpreting these data as the studies used different age groups and different definitions of overweight and obesity. For boys, the countries with overweight (including obesity) levels of 30% or more were Cyprus (30.2%), Malta (31%), Spain (32.9%) and Italy (35.9%). For girls, Italy reported more than 35% as overweight or obese (Table 5.27). Diabetes There are two categories of diabetes: type 1 and type 2 19. Diabetes substantially increases the risk of CHD. Men with non-insulin dependent (Type 2) diabetes have a two to fourfold greater annual risk of CHD, with an even higher (three to fivefold) risk in women with Type 2 diabetes 20. The INTERHEART case-control study estimated that 15% of heart attacks in Western Europe are due to diagnosed diabetes, and that people with diagnosed diabetes are at three times the risk of a heart attack compared to those without 21. The prevalence of diabetes increases with age and is higher in men than in women. The prevalence of diabetes in men is around 6% and in women is around 5%, although these rates vary around the UK. The prevalence of diabetes is highest in Wales, where 7% of men and 6% of women have been diagnosed with the disease. Most diagnosed cases of diabetes are type 2 diabetes around 90% of diagnosed diabetes in England were type 2 in 2006 (Tables 5.28, 5.29, 5.30 and 5.31). Not all diabetes is diagnosed. The Health Survey for England in 2003 measured blood glucose levels of all respondents aged over 35 and found that 3.1% of men and 1.5% of women had undiagnosed diabetes 21.
164
The prevalence of diabetes has been measured sporadically since the early 1990s in a number of national health surveys in England, Wales, Scotland and Northern Ireland. Comparing the results of these surveys suggests that prevalence of diabetes has been increasing since the early 1990s and is still on the increase. In England, male and female prevalence rates have more than doubled since 1991. In Scotland prevalence of diabetes increased between 2003 and 2008 by 40% for men and just under 20% for women (Table 5.32, Figure 5.32). There is substantial geographic variation in the prevalence of diabetes in the UK. As mentioned earlier, prevalence in Wales is higher than in Scotland, England and Northern Ireland. Within England, both male and female prevalence rates are generally lower in the South of England, with the exception of London. Female prevalence rates in Yorkshire and the Humber (5.4%) are more than double rates in the South West (2.6%) (Table 5.33). For women, the prevalence of diabetes appears to be socially patterned. In 2009 the Health Survey for England showed that the prevalence of diabetes in women in the lowest quintile of income (6.3%) was far higher than for women in the highest quintile of income (1.2%). The pattern was not as clear for men (Table 5.34). The prevalence of diabetes varies dramatically by ethnic group within the UK. In 2004, the prevalence of diabetes among some ethnic minority groups in England was much higher than in the general population. In Black Caribbean and Indian men, the prevalence of diagnosed diabetes was more than twice that found in the general population, in contrast the prevalence in Chinese and Irish men were lower than the general population. The prevalence for Black Caribbean and Pakistani women was two and a half times that of the general population. In contrast, the prevalence of diabetes in Black African and Irish women was substantially lower than in the general population (Table 5.35, Figure 5.35). There is some variation in the prevalence of diabetes by country in Europe. In 2009, European Health for All Database found that national diabetes prevalence rates range from less than 1% to 4.8%. There does not appear to be a consistent geographic pattern to these prevalence rates (Table 5.36).
1. Prospective Studies Collaboration (2002) Age-specific relevance of usual blood pressure to vascular mortality: a meta analysis of individual data for one million adults in 61 prospective studies. The Lancet; 360: 1903-1913. 2. World Health Organization (2002) The World Health Report 2002. Reducing Risks, Promoting Healthy Life. World Health Organization: Geneva. 3. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigo J, Lisheng A, on behalf of the INTERHEART Study Investigators (2004) Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART Study): case-control study. The Lancet; 364: 937-952.
4. National Institute for Health and Clinical Excellence (2006) Hypertension: Management of hypertension in adults in primary care. NICE: London. 5. The Scottish Health Survey (SHS) uses the same methods as the Health Survey for England. 6. See Table 7.3, page 32 in The Health of Minority Ethnic Groups headline tables (2005) Health Survey for England 2004. NHS Health and Social Care Information Centre. 7. Institute for Health and Clinical Excellence (2008) Lipid modification. NICE: London. 8. Department of Health (2000) National Service Framework for Coronary Heart Disease. DH: London. 9. Joint Health Surveys Unit (2009) Health Survey for England 2008. Physical activity and fitness. The Information Centre: Leeds. 10. The reporting trends in raised cholesterol levels in England are complicated due to different weighting of results in the 2003 and later surveys. 11. Scottish Executive (2010) The Scottish Health Survey 2008. Personal communication. 12. World Health Organization (2000) Obesity preventing and managing the global epidemic. Report of a WHO Consultation on Obesity. World Health Organization: Geneva. 13. Central obesity is commonly defined as a waist-hip ratio of 0.95 and over in men and 0.85 and over in women. Raised waist circumference is defined as a waist measurement greater than 102cm for men and greater than 88cm for women. 14. For details of the International classification system see Department of Health (2003) Health Survey for England 2002. The Stationery Office: London. Because of differences in definition and measurement, direct comparison of adult (Table 11.2) and childhood (Table 11.6) tables in this chapter is inappropriate. 15. Overweight and obesity estimates derived using the alternative National BMI percentiles classification showed no marked sex differences whereas the International classification may under-estimate obesity prevalence among boys. 16. Serdula M, Ivery D, Coates R, Freedman D, Williamson D and Byers T (1993) Do obese children become obese adults? A review of the literature. Prev Med 22:167-177. 17. Scarborough P, Allender S (2008). The North South gap in overweight and obesity in England. British Journal of Nutrition, 100; 677-684. 18. World Health Organization (2012) Global Infobase. Available at https://apps.who.int/infobase/ accessed July 2012. 19. See glossary for definition. 20. Garcia MJ, McNamara PM, Gordon T, Kannell WB (1974). Morbidity and mortality in the Framingham population. Sixteen year follow up. Diabetes; 23: 105-111. 21. Joint Health Surveys Unit (2004) Health Survey for England 2003. The Stationery Office: London.
165
Table 5.1 Blood pressure recommendations and hypertension definition for the United Kingdom
Recommendations Systolic blood pressure general population Systolic blood pressure diabetes or chronic renal failure sufferers Diastolic blood pressure general population Diastolic blood pressure diabetes or chronic renal failure sufferers Hypertension Definition Systolic blood pressure greater than or equal to 140mmHg, and / or diastolic blood pressure greater than or equal to 90mmHg Sustained levels of systolic blood pressure greater than or equal to 160mmHg, and / or diastolic blood pressure greater than or equal to 100mmHg No greater than 140mmHg No greater than 130mmHg No greater than 85mmHg No greater than 80mmHg
Threshold for drug treatment
Sources: Williams B, Poulter NR, Brown MJ et al (2004). Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society 2004-BHS IV. Journal of Human Hypertension. 18; 139-185. National Institute for Health and Clinical Excellence (2006). Hypertension: Management of hypertension in adults in primary care. NICE: London.
166
Table 5.2 Prevalence of high blood pressure, by sex and age, England 1998 to 2010
1998 % Men All ages 16-24 25-34 35-44 45-54 55-64 65-74 75 and over Base All ages 16-24 25-34 35-44 45-54 55-64 65-74 75 and over Women All ages 16-24 25-34 35-44 45-54 55-64 65-74 75 and over Base All ages 16-24 25-34 35-44 45-54 55-64 65-74 75 and over 6,483 692 1,142 1,190 1,164 896 751 648 3,046 268 516 621 562 419 366 294 5,813 582 896 1,144 1,056 866 716 553 2,668 1,145 380 554 440 408 324 274 5,075 479 715 994 837 889 617 544 2,392 216 325 429 453 431 298 240 4,838 411 602 965 810 870 638 542 2,090 262 326 387 330 318 235 230 4,507 604 661 827 742 689 496 488 1,454 194 219 272 230 220 161 159 2,200 286 328 412 391 323 245 215 33 4 7 13 31 52 73 78 33 4 6 10 31 52 75 81 35 5 7 12 34 54 74 79 34 4 6 12 33 52 70 79 32 2 5 10 24 47 68 77 29 1 4 10 23 42 62 73 31 1 3 10 26 42 66 73 29 1 6 12 26 43 61 74 29 2 5 13 25 41 62 73 27 1 5 12 25 41 60 64 29 3 4 10 26 47 63 79 5,401 594 984 981 981 766 665 430 2,552 260 424 510 429 378 323 228 4,840 516 711 917 877 786 660 373 2,161 947 308 445 348 335 287 184 4,108 370 557 806 699 736 577 363 1,916 185 243 312 351 367 264 194 3,924 335 473 715 663 739 592 407 2,021 285 329 380 340 316 218 154 4,350 657 697 827 697 672 462 338 1,365 208 209 255 230 204 149 110 2,139 341 369 404 380 296 214 135 41 16 21 26 42 60 70 73 40 12 21 27 41 54 70 65 41 20 18 23 41 58 68 70 37 14 17 24 36 53 62 71 38 11 13 21 37 53 65 67 39 9 17 26 33 53 64 69 39 10 18 18 35 51 63 68 31 8 13 15 33 50 63 62 32 7 13 18 33 52 62 68 32 6 15 17 33 53 58 73 31 5 6 25 37 51 65 79 2000 % 2001 % 2002 % 2003 % 2005 % 2006 % 2007 % 2008 % 2009 % 2010 %
Notes: Informants were classified as having high blood pressure if their systolic blood pressure was 140mmHg or over or their diastolic blood pressure was 90mmHg or over, or they were taking medicine prescribed for blood pressure. All data are presented unweighted for analysis of trends. The measurement of blood pressure in the Health Survey for England series changed in 2003. Source: Joint Health Surveys Unit (2011) Health Survey for England 2010. Adult trend tables. www.ic.nhs.uk (accessed June 2012). Copyright 2011, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved
167
Figure 5.2a Prevalence of high blood pressure in men, by age, England 1998 to 2010
90 80 70 60 Prevalence (%) 50 40 30 20 10 0 2006 2008 2009 2007 2003 2000 2005 2002 1998 2001 2010 2010
16-24 25-34
35-44 45-54
55-64 65-74
75 and over
Figure 5.2b Prevalence of high blood pressure in women, by age, England 1998 to 2010
90 80 70 60 Prevalence (%) 50 40 30 20 10 0 2006 2000 2008 2009 2002 2003 2005 2007 1998 2001 35-44 45-54
16-24 25-34
55-64 65-74
75 and over
168
Table 5.3 Blood pressure levels, by sex and age, England 2010
All ages Blood pressure level Men Normotensive untreated Normotensive treated Hypertensive treated Hypertensive untreated All with high blood pressure Base Women Normotensive untreated Normotensive treated Hypertensive treated Hypertensive untreated All with high blood pressure Base 71 11 8 10 29 2,200 97 1 0 2 3 286 96 1 0 3 4 328 90 2 1 6 10 412 74 8 4 14 26 391 54 19 11 17 47 323 37 24 19 20 63 245 21 35 31 14 79 215 69 10 7 15 32 2,139 5 5 341 0 6 6 369 95 94 75 4 1 20 25 404 63 10 5 22 37 380 49 18 12 20 51 296 35 27 21 18 65 214 21 42 25 12 79 135 % 1624 % 2534 % 3544 % 4554 % 5564 % 6574 % 75+ %
Notes: Informants were classified as having high blood pressure if their systolic blood pressure was 140mmHg or over or their diastolic blood pressure was 90mmHg or over, or they were taking medicine affecting blood pressure. Treated means taking medication prescribed for high blood pressure. Data are weighted for non response. Source: Joint Health Surveys Unit (2011) Health Survey for England 2010. The Information Centre: Leeds. Copyright 2011, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved.
169
Figure 5.3 Prevalence of high blood pressure, by sex and age, England 2010
90 80 70 60 Prevalence (%) 50 40 30 20 10 0 1624 Men Women 2534 3544 4554 5564 6574 75+
170
Table 5.4 Blood pressure levels, by sex and age, Scotland 2008/09
All ages Blood pressure level Men Normotensive untreated Normotensive treated Hypertensive treated Hypertensive untreated All with high blood pressure Base Women Normotensive untreated Normotensive treated Hypertensive treated Hypertensive untreated All with high blood pressure Base 70 8 8 14 30 1,213 99 0 0 2 2 99 94 0 0 6 6 140 89 3 0 9 11 230 70 8 6 16 30 208 52 12 11 25 48 237 33 20 20 27 67 180 30 21 29 20 70 119 65 8 6 20 35 953 86 0 0 15 15 63 85 0 0 12 12 100 76 2 3 19 24 162 68 7 7 19 32 169 48 19 6 28 52 193 29 23 22 26 71 168 33 19 19 30 68 98 % 1624 % 2534 % 3544 % 4554 % 5564 % 6574 % 75+ %
Notes: Aged 16 and over and with a valid blood pressure reading. Source: Scottish Executive (2010). Scottish Health Survey. http://www.scotland.gov.uk/Publications (accessed June 2012).
171
Figure 5.4 Prevalence of high blood pressure, by sex and age, Scotland 2008/09
80
70
60
50 Prevalence (%)
40
30
20
10
0 1624 Men Women 2534 3544 4554 5564 6574 75+
172
Table 5.5 Prevalence of high blood pressure, by sex and age, Wales 2010
All ages % Men Base Women Base 20 7,420 20 8,579 16-24 % 0 882 1 919 25-34 % 1 831 1 1,073 35-44 % 7 1,082 7 1,330 45-54 % 19 1,333 13 1,472 55-64 % 35 1,361 30 1,520 65-74 % 46 1,109 45 1,247 75+ % 50 822 59 1,018
Notes: Data refer to adults over 16 years of age who are currently being treated for high blood pressure, and are not based upon blood pressure measurements. Because of differences in data collection techniques, these results are incomparable with prevalence estimates for England and Scotland collected by the Health Survey series. Source: Welsh Assembly Government (2011) Welsh Health Survey 2010. Welsh Assembly: Cardiff.
Table 5.6 Blood pressure levels, by sex and Strategic Health Authority, England 2008
North East North West Yorkshire and the Humber East Midlands West Midlands East of England London South East Coast South Central South West
% Men Normotensive untreated Normotensive treated Hypertensive treated Hypertensive untreated All with high blood pressure Base Women Normotensive untreated Normotensive treated Hypertensive treated Hypertensive untreated All with high blood pressure Base 67 11 7 14 33 340 70 7 7 16 30 294
71 6 5 18 29 530
64 7 8 20 36 428
64 7 8 21 36 425
73 9 5 13 27 396
68 8 6 19 32 468
72 11 5 12 28 417
69 9 7 15 31 338
70 8 7 15 30 323
69 7 5 19 31 422
70 7 7 16 30 681
71 9 8 12 29 542
69 9 8 14 31 508
70 11 6 13 30 479
70 10 8 12 30 536
75 11 7 7 25 511
75 8 4 12 25 437
75 8 7 10 25 397
75 7 7 12 25 505
Notes: Data are weighted for non response. Informants were classified as having high blood pressure if their systolic blood pressure was 140mmHg or over or their diastolic blood pressure was 90mmHg or over, or they were taking medicine affecting blood pressure. Treated means taking medication prescribed for high blood pressure. Adults aged 16 and over. Source: Joint Health Surveys Unit (2010). Health Survey for England 2008: Physical activity and fitness. The Information Centre: Leeds. Copyright 2010, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved
173
Table 5.7 Blood pressure levels, by sex and equivalised household income, England 2009
Highest % Men Normotensive untreated Normotensive treated Hypertensive treated Hypertensive untreated All with high blood pressure Base Women Normotensive untreated Normotensive treated Hypertensive treated Hypertensive untreated All with high blood pressure Base 77 7 4 11 23 272 76 7 3 14 24 275 77 4 7 12 23 246 74 8 9 8 26 280 66 8 8 18 34 224 71 6 4 18 29 269 71 7 7 15 29 253 70 8 4 17 30 185 67 10 5 18 33 205 71 9 5 14 29 149 2nd % 3rd % 4th % Lowest %
Notes: Equivalised household income is a measure that takes account of all individuals within a household that are dependent upon the income. Data are weighted for non response. Adults aged 16 and over. Source: Joint Health Surveys Unit (2010) Health Survey for England 2009. The Information Centre: Leeds. Copyright 2010, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved
Table 5.8 Prevalence of high blood pressure, by sex and ethnic group, England 2004
General population High blood pressure Men Base Women Base % 32 4,108 29 5,075 Bangladeshi % 16 99 19 144 Black African % 25 123 19 154 Black Caribbean % 38 155 32 243 Chinese % 20 153 16 166 Indian % 33 265 18 320 Irish % 36 240 29 328 Pakistani % 20 162 15 207
Notes: Adults aged 16 and over with a valid blood pressure reading and data on medication. Informants were classified as having high blood pressure if their systolic blood pressure was 140mmHg or over or their diastolic blood pressure was 90mmHg or over, or they were taking medication for high blood pressure. General population refers to the whole population of England, regardless of ethnicity. Source: Department of Health (2005) Health Survey for England 2004. The Health of Minority Ethnic Groups. The Stationery Office: London. Copyright 2005, Reused with the permission of The Health and Social Care Information Centre. All rights reserved.
174
Table 5.9 Prevalence of high blood pressure, by sex, Europe 2008

Men % Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan TFYR Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan 48.0 42.6 49.8 42.6 46.0 51.2 39.3 47.2 48.1 49.8 42.4 47.6 40.6 52.9 47.4 42.3 49.9 44.8 39.4 50.0 40.2 47.0 37.4 42.2 48.5 47.1 51.2 52.1 42.1 43.3 49.6 42.4 46.3 49.3 46.5 48.4 47.1 46.2 50.1 49.6 50.4 41.5 43.1 41.6 46.4 48.0 36.2 47.0 52.2 42.2 41.5 Women % 42.0 30.9 46.0 33.4 41.1 42.3 30.4 46.6 40.9 43.4 32.0 37.6 28.4 42.2 36.3 29.3 43.5 34.3 32.7 41.0 27.3 34.2 29.9 33.6 41.4 42.8 42.2 43.4 31.3 33.8 42.0 30.8 35.2 42.4 37.4 43.3 41.7 41.3 43.0 42.0 42.3 31.7 32.5 28.2 43.3 42.6 35.8 42.2 44.6 32.8 36.5 Total % 44.9 36.7 47.8 38.0 43.4 46.6 34.8 47.1 44.5 46.7 37.0 42.7 34.5 47.3 41.9 35.7 46.5 39.7 36.1 45.5 33.8 40.6 33.6 37.9 44.8 45.0 46.6 47.7 36.7 38.6 45.6 36.6 40.9 46.0 41.9 45.9 44.5 43.8 46.6 45.8 46.4 36.7 37.9 34.8 44.8 45.4 36.1 44.6 48.3 37.5 39.1
Notes: Adults aged 25 years and over. Age-standardized estimate of prevalence of raised blood pressure (SBP140 OR DBP90 OR on medication). Source: WHO Global Health Observatory. http://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence/en/index.html (Accessed June 2012).
175
Figure 5.9 Prevalence of high blood pressure, by country, Europe 2008

60
50
40 Prevalence (%)
30
20
10
0
Israel Iceland Denmark Belgium Switzerland France Greece Turkey Netherlands Andorra Luxembourg Spain Cyprus United Kingdom Italy Sweden Austria Malta Uzbekistan Germany Ireland Norway Finland Portugal Czech Republic Azerbaijan Russian Federation Bulgaria Romania Turkmenistan Kazakhstan Tajikistan Albania Kyrgyzstan TFYR Macedonia Hungary Montenegro Slovakia Republic of Moldova Poland Slovenia Georgia Belarus Latvia Serbia Croatia Bosnia and Herzegovina Estonia Lithuania Armenia Ukraine
Table 5.10 Cholesterol recommendations for the United Kingdom

United Kingdom Total cholesterol 1 HDL cholesterol 2 Target 3 <4.0mmol/l in individuals with established cardiovascular disease, diabetes, or at high risk of developing cardiovascular disease. 1mmol/l in individuals with established cardiovascular disease, and those at high risk of the disease. An audit level of total cholesterol of 5 mmol/l should be used to assess progress in people with CVD, in recognition that more than a half of patients will not achieve a total cholesterol of less than 4 mmol/l or an LDL cholesterol of less than 2 mmol/l.
Notes: The original recommendation for total cholesterol levels of less than 5mmol/l for individuals with cardiovascular disease, diabetes, or at high risk of developing cardiovascular disease, originally set in 1998 by the Joint British Societies is retained for audit purposes. Source: 1. British Cardiac Society, British Hypertension Society, Diabetes UK, HEART UK, Primary Care Cardiovascular Society, The Stroke Association (2005). JBS2: Joint British Societies guidelines on prevention of cardiovascular diseases in clinical practices. Heart. 91 (suppl V): v1-v52. 2. Sacks FM, for the expert group on HDL-cholesterol (2002). The role of high density lipoprotein (HDL) cholesterol on the prevention of coronary heart disease; Expert group recommendations. American Journal of Cardiology. 90: 139-143. 3. National Institute for Health and Clinical Excellence (2008) Lipid modification. NICE: London.
176
Table 5.11 Prevalence of high cholesterol levels, by sex and age, England 1994 to 2008
All ages % Men 1994 1998 2003 unweighted 2003 weighted 2006 2008 Women 1994 1998 2003 unweighted 2003 weighted 2006 2008 Unweighted base (2008): Men Women 3,349 3,925 295 276 418 501 613 741 597 730 675 781 440 489 311 407 77 67 71 66 61 61 44 27 34 31 31 36 57 44 50 55 42 42 70 59 62 69 58 56 82 74 78 79 78 76 95 88 88 84 84 83 97 91 87 77 76 75 93 89 82 75 67 66 75 66 70 66 57 58 32 23 28 26 20 25 61 50 60 60 53 52 82 70 77 77 68 74 88 78 82 81 74 76 90 81 81 80 73 70 87 76 69 67 54 53 79 72 63 64 47 39 1624 % 2534 % 3544 % 4554 % 5564 % 6574 % 75+ %
Notes: Data from 1994 to 1998 are unweighted data, for 2003 weighted and unweighted data is shown, for 2006 only weighted data are presented. High cholesterol levels >5.0 mmol/l total cholesterol. Source: Joint Health Surveys Unit (2009) Health Survey for England 2008. The Information Centre: Leeds, and previous editions. Copyright 2009, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved.
177
Figure 5.11 Prevalence of high cholesterol levels, of 5.0mmol/l and over, England 2008
Table 5.12 Low HDL cholesterol by sex and age, England 2008
All ages % Men Women Base Men Women 3,349 3,924 295 276 418 501 613 741 597 730 675 780 440 489 311 407 7.2 1.7 1624 % 4.8 3.4 2534 % 7.4 2.1 3544 % 7.5 1.1 4554 % 7.6 1.6 5564 % 7.6 1.0 6574 % 8.8 1.1 75+ % 6.9 1.4
Notes: Data are weighted for non response. Low HDL cholesterol levels diagnosed by 1.0mmol/l total HDL cholesterol. Source: Joint Health Surveys Unit (2009) Health Survey for England 2008. Physical activity and fitness. The Information Centre: Leeds. Copyright 2009, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved.
178
Table 5.13 Prevalence of high total cholesterol levels and low HDL cholesterol levels, by sex, English Strategic Health Authority and Scotland 2008
Yorkshire and the Humber East Midlands West Midlands Scotland % Men 5.0mmol/l total cholesterol 1.0mmol/l HDL cholesterol Women 5.0mmol/l total cholesterol 1.0mmol/l HDL cholesterol Base Men Women 341 344 242 260 476 558 375 448 307 353 318 402 366 374 368 409 299 380 249 299 349 441 58 5.5 56 3.1 60 2.0 61 1.6 68 1.2 61 1.5 61 1.6 57 2.5 65 0.7 61 1.5 64 0.4 57 18.3 57 7.9 57 7.3 58 4.6 58 7.8 58 7.3 54 8.5 52 7.6 62 9.0 64 4.7 59 7.4 East England
London
South Central
South East Coast
South West
Notes: Data are weighted for non-response, and estimates are age-standardised to account for differing age structures. Adults aged 16 and over. Source: Joint Health Surveys Unit (2009) Health Survey for England 2008. Physical activity and fitness. The Information Centre: Leeds. Copyright 2009, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved. Scottish Executive (2010). Scottish Health Survey 2008. Personal communication.
North East %
North West %
179
Table 5.14 Prevalence of high total cholesterol levels and low HDL cholesterol levels, by sex and equivalised household income, England 2006
Equivalised household income quintile Highest Men Mean HDL cholesterol % < 1.0 mmol/l HDL cholesterol Mean total cholesterol % 5.0 mmol/l total cholesterol Women Mean HDL cholesterol % < 1.0 mmol/l HDL cholesterol Mean total cholesterol % 5.0 mmol/l total cholesterol Base Men Women 720 708 697 724 605 732 488 731 376 515 1.7 0.5 5.5 64 1.6 1.1 5.4 60 1.6 1.6 5.5 64 1.5 2.3 5.3 58 1.5 4.2 5.4 64 1.4 7.6 5.3 59 1.4 5.6 5.4 60 1.3 10.6 5.2 57 1.3 11.0 5.3 58 1.3 14.4 5.2 53 2nd 3rd 4th Lowest
Notes: Data are weighted for non response and age-standardised. Adults aged 16 and over. For method of age-standardisation see source. Source: Joint Health Surveys Unit (2008) Health Survey for England 2006. Cardiovascular disease and risk factors. The Information Centre: Leeds. Copyright 2008, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved
180
Table 5.15 Prevalence of high total cholesterol levels and low HDL cholesterol levels, by sex and ethnic group, England 2004
Bangladeshi General population (2003) % Men 5.0mmol/l total cholesterol 1.0mmol/l HDL cholesterol Women 5.0mmol/l total cholesterol 1.0mmol/l HDL cholesterol Base Men Women 3,814 4,460 87 98 103 118 137 195 101 108 234 256 244 300 137 143 67 2 55 8 44 3 56 1 52 1 53 4 67 2 53 6 66 6 60 20 55 2 51 4 60 8 60 11 67 5 55 20
Black Caribbean
Pakistani
Chinese
Black African
Indian
Irish
Notes: Data are weighted for non-response and age-standardised. General population refers to the whole population of England, regardless of ethnicity. For method of age-standardisation see source. Adults aged 16 and over. Source: Department of Health (2006) Health Survey for England 2004. The Health of Minority Ethnic Groups. The Stationery Office: London. Copyright 2006, Reused with the permission of The Health and Social Care Information Centre. All rights reserved
181
Table 5.16 Obesity targets for the United Kingdom
England1 Children Scotland2 Children Wales Northern Ireland3
To halt the year-on-year rise in obesity among children under 11 by 2010 in the context of a broader strategy to tackle obesity in the population as a whole. Reduce the rate of increase in the proportion of children with their Body Mass Index outside a healthy range by 2018. No target set. To halt the rise in obesity by March 2010.
Source: 1. Department of Health (2004) National Standards, Local Action: Health and Social Care Standards and Planning Framework 2005/06 and 2007/08. DH: London. PSA Target 3. 2. The Scottish Government (2007). National Indicators. The Scottish Government: Edinburgh 3. Northern Ireland Audit Office (2009). Obesity and Type 2 Diabetes in Northern Ireland. NIAO: Belfast.
182
Table 5.17 Body mass index (BMI) by sex and age, England 2010
All ages % Men Body Mass Index (kg/m2) Less than 18.5 18.5 to less than 25 25 to less than 30 30 to less than 40 40 or more Prevalence of obese (30 kg/m2) Base Women Body Mass Index (kg/m2) Less than 18.5 18.5 to less than 25 25 to less than 30 30 to less than 40 40 or more Prevalence of obese (30 kg/m2) Base 2 40 32 22 4 26 3,843 6 62 21 9 2 11 387 2 49 28 18 3 21 559 2 42 30 22 4 26 693 0 36 34 26 5 30 750 1 29 39 28 4 32 613 0 26 37 32 5 37 460 2 33 32 25 2 27 381 1 31 42 25 2 26 3,144 5 61 22 12 0 13 334 2 41 37 17 2 19 431 0 24 49 26 2 28 553 0 21 44 33 2 35 533 0 19 44 34 2 37 552 0 18 53 27 1 28 446 0 24 50 25 1 26 295 1624 % 2534 % 3544 % 4554 % 5564 % 6574 % 75+ %
Notes: Adults with a valid height and weight measurement. Data are weighted for non-response. BMI Categories- Under weight: Less than 18.5, Normal weight: 18.5 to less than 25, Over weight: 25 to less than 30, Obese: more than 30 Source: Joint Health Surveys Unit (2011) Health Survey for England 2010. The Information Centre: Leeds. Copyright 2011, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved.
183
Figure 5.17 Prevalence of overweight and obesity, by sex and age, England 2010
Table 5.18 Mean waist circumference and percentage with raised waist circumference, by sex and age, England 2010
All ages % Men Mean waist circumference (cm) % raised waist circumference Base Women Mean waist circumference (cm) % raised waist circumference Base 88.3 46 3,037 80 18 266 84 34 381 88 45 548 90 50 608 93 62 514 93 64 377 91 59 343 98 34 2,364 86 13 207 93 17 291 99 35 415 101 42 410 103 50 427 103 49 355 102 47 259 16-24 % 25-34 % 35-44 % 45-54 % 55-64 % 65-74 % 75+ %
Notes: Raised waist circumference: greater than 102 cm in men and greater than 88 cm in women. Source: Joint Health Surveys Unit (2011) Health Survey for England 2010. The Information Centre: Leeds. Copyright 2011, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved.
184
Table 5.19 Prevalence of overweight and obesity in children, by sex and age, England 2010
Age (years) 2 10 Boys Overweight Obese Total overweight and obese Base Girls Overweight Obese Total overweight and obese Base 13 14 27 1,453 17 17 33 766 14 15 29 2,219 14 15 30 1,466 14 20 34 837 14 17 31 2,303 11 15 Total
Notes: Overweight is defined as 85th UK National BMI percentile; obese is defined as 95th UK National BMI percentile. Source: Joint Health Surveys Unit (2011) Health Survey for England 2010. The Information Centre: Leeds. Copyright 2011, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved.
185
Table 5.20 Prevalence of body mass index (BMI) status categories in children, by sex and school year, England 2010/11
Underweight % Reception Boys Girls Both Year 6 Boys Girls Both 1.1 1.5 1.3 64.0 66.6 65.3 14.3 14.4 14.4 20.6 17.4 19.0 254,006 241,347 495,353 1.2 0.8 1.0 75.0 77.9 76.4 13.8 12.6 13.2 10.1 8.8 9.4 276,750 264,505 541,255 Healthy Weight % Overweight % Obese % Base
Notes: Definitions based on UK national BMI reference charts. Source: Department of Health Cross-Government Obesity Unit (2011). Lifestyle Statistics / National Child Measurement Programme 2010/11. The Information Centre: Leeds.
186
Table 5.21 Prevalence of obesity, by sex and age, England 1994 to 2010
All ages % Men 1994 1998 2003 2006 2008 2010 Women 1994 1998 2003 2006 2008 2010 Base (2010) Men Women 3,144 3,843 334 387 431 559 553 693 533 750 552 613 446 460 295 381 17 21 23 24 25 26 9 12 15 13 15 11 14 18 21 20 22 21 19 24 26 27 29 26 19 26 31 30 32 30 28 31 31 33 34 32 27 31 33 39 37 37 17 22 27 29 27 27 14 17 22 24 24 26 6 5 9 10 8 13 10 17 19 22 19 19 16 18 26 27 28 28 18 22 29 30 32 35 18 24 28 36 36 37 18 22 30 32 35 28 16 16 21 18 23 26 1624 % 2534 % 3544 % 4554 % 5564 % 6574 % 75+ %
Notes: Data from 1994 to 1998 are unweighted data, from 2003 onwards weighted data are presented. Obesity defined as BMI 30kg/m2 Source: Joint Health Surveys Unit (2011) Health Survey for England 2010. The Information Centre: Leeds, and previous editions. Copyright 2011, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved.
187
Figure 5.21 Prevalence of obesity, by sex , England 1994 to 2010

30
25
20 Prevalence (%)
15
10
0 2006 2008 1998 2003 1994 2010
Men
Women
188
Table 5.22 Prevalence of overweight and obesity in children, by sex, England, Scotland, Wales, Northern Ireland
1995 % England Boys Overweight Obese Overweight including obese Base Girls Overweight Obese Overweight including obese Base Scotland Boys Overweight including obese Base Girls Overweight including obese Base Wales Boys Overweight including obese Base Girls Overweight including obese Base Northern Ireland Boys Overweight including obese Base Girls Overweight including obese Base 30 252 25 252 34 1,326 38 1,351 28 1,675 29 1,191 27 630 28 558 28 1,742 32 1,172 36 637 31 641 13 12 25 1,901 12 12 24 2,014 13 12 26 3,069 14 14 27 1,872 14 14 27 950 13 14 27 841 15 14 30 1,699 14 17 31 3,636 15 16 31 1,393 17 18 35 8,228 13 18 31 1,091 14 15 29 2,670 14 16 31 2,792 14 15 29 2,740 14 15 29 2,219 13 11 24 1,918 14 12 26 2,132 13 13 26 3,063 15 13 28 1,981 14 16 31 977 12 14 27 877 15 15 31 1,653 14 17 31 3,745 15 17 32 1,452 14 19 33 624 16 18 34 1,102 13 17 31 2,822 14 17 31 2,885 15 17 31 2,880 14 17 31 2,303 1996 % 1997 % 1998 % 1999 % 2000 % 2001 % 2002 % 2003 % 2004 % 2005 % 2006 % 2007 % 2008 % 2010 %
Notes: Children were defined as overweight or obese using the 85th and 95th percentiles of the UK reference curves (known as the National BMI percentile classification). For English data, 2003 - 2010 estimates have been weighted for non-response. All of the Scottish and Northern Ireland estimates are weighted for non-response. Source: Joint Health Surveys Unit (2011). Health Survey for England 2010. The Information Centre: Leeds. Copyright 2011, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved. Scottish Centre for Social Research (2011). Scottish Health Survey 2010. The Scottish Government: Edinburgh. Welsh Assembly Government (2011). Welsh Health Survey 2010. Welsh Assembly: Cardiff. Public Health Information & Research Branch (2012). Health Survey Northern Ireland. Department of Health, Social Services & Public Safety: Belfast. Personal communication.
189
Figure 5.22 Prevalence of obese children, by sex, England 1995 to 2010

20 18 16 14 12 10 8 6 4 2 0 2006 2007 2004 2008 2005 2000 2003 2002 1998 1997 2001 1996 1999 1995 2010
Prevalence (%)
Boys
Girls
190
Table 5.23 Prevalence of Body mass index (BMI) status categories, by sex and Strategic Health Authority, England 2010
BMI <25 Normal % Strategic Health Authority (SHA) Men North East North West Yorkshire and the Humber East Midlands West Midlands East of England London South East Coast South Central South West Women North East North West Yorkshire and the Humber East Midlands West Midlands East of England London South East Coast South Central South West 40 42 37 35 39 46 39 48 37 42 31 33 32 33 35 28 32 28 36 31 30 25 30 30 25 25 24 22 26 26 60 58 61 63 60 53 56 50 61 56 341 497 363 374 374 418 381 362 338 395 28 30 30 28 27 33 35 29 33 34 43 41 42 40 45 40 40 46 40 41 27 26 26 30 28 27 25 23 28 29 69 67 68 69 72 67 64 69 67 66 249 425 296 309 317 363 302 270 279 334 BMI 25 < 30 Overweight % BMI 30 Obese % BMI 25 Overweight including obese % Unweighted bases
Notes: Adults aged 16 and over. Data are weighted for non-response. Source: Joint Health Surveys Unit (2011) Health Survey for England 2010. The Information Centre: Leeds. Copyright 2011, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved.
191
Table 5.24 Body mass index, by sex and equivalised household income quintile, England 2010
Equivalised household income quintile Highest % Body mass index (kg/m2) Men BMI < 25: Normal BMI 25 < 30: Overweight BMI 30: Obese BMI 25: Overweight including obese Unweighted bases Women BMI < 25: Normal BMI 25 < 30: Overweight BMI 30: Obese BMI 25: Overweight including obese Unweighted bases 48 32 17 49 643 42 34 23 57 674 38 34 26 60 651 36 29 33 63 644 36 28 34 62 548 28 47 24 71 617 26 26 27 73 587 31 38 29 67 543 34 37 28 65 482 34 35 28 63 353 2nd % 3rd % 4th % Lowest %
Table 5.25 Raised waist circumference, by sex and equivalised household income quintile, England 2010
Equivalised household income quintile Highest % Raised waist circumference Men Unweighted bases Women Unweighted bases 33 474 36 514 34 459 42 535 32 427 50 546 41 372 52 490 36 283 53 438 2nd % 3rd % 4th % Lowest %
192
Table 5.26 Body mass index (BMI), waist-hip ratio and waist circumference, by sex and ethnic group, England 2004
Black Caribbean
Black African
Bangladeshi
General population
Pakistani
Chinese
Indian
Irish
Men Mean Body Mass Index (BMI) Percentage with BMI of 30 kg/m2 and over Mean waist-hip ratio Percentage with waist-hip ratio 0.95 and over Mean waist circumference Percentage with waist circumference 102cm and over Women Mean Body Mass Index (BMI) Percentage with BMI of 30 kg/m2 and over Mean waist-hip ratio Percentage with waist-hip ratio 0.85 and over Mean waist circumference Percentage with waist circumference 88cm and over Bases (unweighted) Men Women 5,397 5,554 138 171 156 200 209 314 182 185 310 345 311 405 197 224 26.8 23 0.82 30 86.4 41 25.7 17 0.85 50 85.7 43 28.8 38 0.81 32 90.2 53 28.0 32 0.83 37 88.4 47 23.2 8 0.81 22 77.6 16 26.2 20 0.82 30 83.9 38 26.7 21 0.83 37 87.4 43 27.1 28 0.84 39 87.7 48 27.1 23 0.92 33 96.5 31 24.7 6 0.91 32 88.7 12 26.4 17 0.87 16 90.6 19 27.1 25 0.90 25 92.5 22 24.1 6 0.87 17 86.8 8 25.8 14 0.92 38 93.0 20 27.2 25 0.93 36 97.3 33 25.9 15 0.92 36 95.0 30
Notes: Adults aged 16 and over. Data are weighted for non-response. General population refers to the whole population of England, regardless of minority ethnic groups. Source: Joint Health Surveys Unit (2005) Health Survey for England 2004. The Health of Minority Ethnic Groups. Department of Health: London. Copyright 2005, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved.
193
Figure 5.26a Body mass index, waist-hip ratio and waist circumference in men, by ethnic group, England 2004
40
35
30
25 Prevalence (%)
20
15
10
0 Black Caribbean Black African BMI of 30 kg/m2 and over Indian Pakistani Bangladeshi Chinese Irish General population
Waist-hip ratio 0.95 and over
Waist circumference 102cm and over
Figure 5.26b Body mass index, waist-hip ratio and waist circumference in women, by ethnic group, England 2004
60
50
40 Prevalence (%)
30
20
10
0 Black Caribbean Black African BMI of 30 kg/m2 and over Indian Pakistani Bangladeshi Chinese Irish General population
Waist-hip ratio 0.95 and over
Waist circumference 102cm and over
194
Table 5.27 Prevalence of childhood overweight, by sex, Europe latest available year
Year Age group (years) Boys % Austria Belgium Bulgaria Crete Cyprus Czech Republic Denmark England Estonia* Finland France Germany Greece Hungary Iceland Italy Latvia* Luxembourg* Malta* Netherlands Northern Ireland Norway Poland Portugal Poland Romania* Russian Federation Slovakia Slovenia Spain Sweden Switzerland Turkey 2003 1998-2009 2004 2005-06 2003 2005 1996-2007 2009 2005-06 2005-06 2006-07 2008 2003 2005 1998 2008 2005-06 2005-07 2005-06 2003 2005 2003-06 2000 2008 2000 2005-06 2005 2001 2007 1999-2000 2000 2007 2001 8 to 12 5 to 15 5 to 17 10 to 12 11 6 to 17 5 to 16 5 to 17 11, 13 & 15 11, 13 & 15 3 to 17 4 to 16 13 to 17 7 to 14 9 8 to 9 11, 13 & 15 11, 13 & 15 11, 13 & 15 5 to 16 2 to 15 5 to 15 7 to 17 10 to 18 7 to 17 11, 13 & 15 7 to 11 7 to 17 6 to 17 5 to 17 10 6 to 13 12 to 17 22.5 27.3 22.0 45.0 30.2 24.6 14.1 21.8 12.7 18.7 13.1 22.6 27.8 25.5 22.0 35.9 10.0 15.0 31.0 14.7 27.0 12.9 16.3 23.5 16.3 14.7 17.3 17.5 28.7 32.9 17.0 16.7 11.3 Girls % 16.7 26.7 17.9 37.0 28.8 16.8 15.3 26.1 7.0 13.0 14.9 17.7 16.0 25.9 25.5 35.9 5.7 10.0 28.0 17.9 25.0 14.7 12.4 21.6 12.4 8.7 16.9 16.2 24.4 22.9 19.5 13.1 10.3
Notes: All studies used IOTF definitions for childhood overweight and obesity, except Austria and Belgium, which used 90th and 85th percentiles of reference populations. *indicates self-reported data. Italy: study did not provide results by gender, therefore results for all children combined are presented. Source: International obesity taskforce (2012) Global Childhood Overweight. IOTF. http://www.iaso.org/iotf/obesity/. (Accessed June 2012)
195
Table 5.28 Prevalence of diagnosed diabetes, by sex and age, England 2010
All ages % Men Base Women Base 6.3 4,179 5.3 4,329 16-24 % 0.5 646 0.4 610 25-34 % 1.3 701 1.7 686 35-44 % 2.5 755 2.5 760 45-54 % 6.9 721 4.1 730 55-64 % 11.1 607 8 631 65-74 % 15.2 429 12.2 470 75+ % 15.9 318 13.2 442
Notes: Prevalence rates are weighted for non-response. Source: Joint Health Surveys Unit (2011) Health Survey for England 2010. The Information Centre: Leeds. Copyright 2011, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved
Table 5.29 Prevalence of diagnosed diabetes, by sex and age, Scotland 2008/09
All ages % Men Base Women Base 5.8 6,130 4.3 7,866 16-24 % 0.3 518 0.9 719 25-34 % 1.1 723 1.5 1,031 35-44 % 1.3 1,013 2.2 1,428 45-54 % 5.7 1,139 3.2 1,365 55-64 % 11.9 1,100 6.4 1,367 65-74 % 13.2 970 9 1,066 75+ % 14.2 667 9.9 890
Notes: Prevalence rates are weighted for non-response. Respondents were prompted to recall whether they had ever been diagnosed with diabetes by a doctor. Source: Scottish Centre for Social Research (2011) Scottish Health Survey 2009 revisions. The Scottish Government: Edinburgh.
196
Table 5.30 Prevalence of diagnosed diabetes, by sex and age, Wales 2010
All ages % Men Base Women Base 7 7,420 6 5,879 16-24 % 0 882 1 919 25-34 % 1 831 1 1,073 35-44 % 4 1,082 2 1,330 45-54 % 7 1,333 5 1,472 55-64 % 12 1,361 7 1,520 65-74 % 15 1,109 12 1,247 75+ % 16 822 14 1,018
Notes: Prevalence rates are weighted for non-response. Respondents were prompted to recall whether they had ever been diagnosed with diabetes by a doctor. Source: Welsh Assembly Government (2011) Welsh Health Survey 2010. Welsh Assembly: Cardiff.
Table 5.31 Prevalence of diagnosed diabetes, by sex and age, Northern Ireland 2005/06 and 2010/11
2005/06 All ages % Men Base Women Base 4 1,743 4 2,497 16-24 % 0 153 0 254 25-34 % 0 278 1 428 35-44 % 1 344 1 501 45-54 % 5 305 2 417 55-64 % 8 275 5 334 65-74 % 8 236 11 312 75+ % 14 152 10 251 5 2010/11 All ages % 5
Notes: Respondents were prompted to recall whether they had ever been diagnosed with diabetes by a doctor. Source: Central Survey Unit (2007) Northern Ireland Health and Wellbeing Survey 2005/06. Northern Ireland Statistics and Research Agency: Belfast. Public Health Information & Research Branch (2012). Health Survey Northern Ireland. Department of Health, Social Services & Public Safety: Belfast
197
Table 5.32 Prevalence of diagnosed diabetes, by sex and country, United Kingdom 1991 to 2010
Unweighted base (latest year)
1991 % Men England Scotland Wales Northern Ireland Women England Scotland Wales Northern Ireland 2 2
1993 %
1994 %
1998 %
2001 %
2003 %
2004 %
2005 %
2006 %
2007 %
2008 %
2009 %
2010 %
2.9
3.3
4.3 3.8 5 4 6 7 4
5.6
6.5 5.8 6 7 7
6.3
6,854 2,841
7,412 1,743
1.9
2.5
3.4 3.7 5 2 4 5 4
4.2
4.5 4.3 6 6 6
5.3
7,307 3,622
8,606 2,497
Notes: Estimates are reported to the appropriate level of accuracy one decimal place where possible, no decimal places when not. Estimates are based on self-report of being diagnosed for diabetes by a doctor. Methods are broadly comparable across studies, but small differences may affect comparability. For example, some, but not all, of the estimates are weighted for non-response. All estimates are for adults aged 16 and over. See source for details. Source: Joint Health Surveys Unit (2011) Health Survey for England 2010. The Information Centre: Leeds, and previous editions. Copyright 2011, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved. Scottish Centre for Social Research (2011) Scottish Health Survey 2009 revisions. The Scottish Government: Edinburgh, and previous editions. Welsh Assembly Government (2011) Welsh Health Survey 2010. Welsh Assembly: Cardiff, and previous editions. Central Survey Unit (2007) Northern Ireland Health and Wellbeing Survey 2005/06. Northern Ireland Statistics and Research Agency: Belfast, and previous editions.
198
Figure 5.32a Prevalence of diagnosed diabetes in men, by country, United Kingdom 1991 to 2010
8
C.
A.
B.
5 Prevalence (%)
D.
0 2006 2008 2009 2004 2000 2005 2003 2002 2007 1994 1996 1998 1992 1993 1995 1997 2001 1999 1991 2010
C. A.
A. England
B. Scotland
C. Wales
D. Northern Ireland
Figure 5.32b Prevalence of diagnosed diabetes in women, by country, United Kingdom 1991 to 2010
7
5
B.
Prevalence (%)
D.
0 2006 2008 2009 2007 2004 2000 2005 2002 2003 1997 1998 2001 1991 1992 1993 1994 1996 1995 1999 2010
A. England
B. Scotland
C. Wales
D. Northern Ireland
199
Table 5.33 Prevalence of diagnosed diabetes, by sex and Government Office Region, England 2006
North West % 6.5 847 4.3 1,030 Yorkshire and the Humber % 6.3 570 5.4 732 East Midlands % 4.6 548 4.1 692 West Midlands % 5.8 576 5.4 748 East of England % 5.4 651 4.2 740 South West % 4.9 528 2.6 696
North East % Men Unweighted base Women Unweighted base 5.2 298 4.8 389
London % 6.0 678 4.3 763
South East % 4.7 929 3.9 1,135
Notes: Estimates are based on self-report of being diagnosed with diabetes by a doctor. Adults aged 16 and over. Estimates are age-standardised and have been weighted for non-response. Source: Joint Health Surveys Unit (2008) Health Survey for England 2006. Cardiovascular disease and risk factors. The Information Centre: Leeds. Copyright 2008, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved
Table 5.34 Prevalence of diagnosed diabetes, by sex and household income, England 2009
Equivalised household income tertile Highest % Men Base Women Base 4.8 681 1.2 703 Middle % 8.3 557 4.9 699 Lowest % 6.0 483 6.3 642
Notes: Estimates are based on self-report of being diagnosed with diabetes by a doctor. Adults aged 16 and over. Estimates are age-standardised and have been weighted for non-response. Source: Joint Health Surveys Unit (2010) Health Survey for England 2009. The Information Centre: Leeds. Copyright 2010, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved
200
Table 5.35 Prevalence of diagnosed diabetes, by sex and ethnic group, England 2004
General population % Men Type 1 Type 2 Types 1 and 2 combined Unweighted base Women Type 1 Type 2 Types 1 and 2 combined Unweighted base 0.3 3.1 3.4 8,234 0.6 4.5 5.2 478 0.1 2.0 2.1 469 0.8 7.6 8.4 653 3.3 3.3 375 5.9 5.9 634 0.3 2.0 2.3 656 0.2 8.4 8.6 508 0.6 3.8 4.3 6,602 0.2 8.0 8.2 411 0.7 4.3 5.0 390 0.5 9.5 10.0 414 0.3 3.4 3.8 348 0.9 9.2 10.1 550 3.6 3.6 497 7.3 7.3 433 Bangladeshi % Black African % Black Caribbean % Chinese % Indian % Irish % Pakistani %
Notes: Numbers may not add exactly due to rounding. Estimates are based on self-report of being diagnosed with diabetes by a doctor. Adults aged 16 and over. Estimates are age-standardised and have been weighted for non-response. General population refers to the whole population of England, regardless of ethnicity. Blank cells indicate non existence of data. Source: Joint Health Surveys Unit (2005) Health Survey for England 2004. The Information Centre: Leeds. Copyright 2005, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved
201
Figure 5.35 Prevalence of diagnosed diabetes, by ethnic group, England 2004

12
10
8 Prevalence (%)
0 General population Men Black Caribbean Women Black African Indian Pakistani Bangladeshi Chinese Irish
202
Table 5.36 Prevalence of diabetes in adults, Europe 1980 to 2009

1980-84 Albania Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Malta Netherlands Norway Portugal Republic of Moldova Romania Russian Federation Slovakia Slovenia Spain Sweden Tajikistan TFYR Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan 0.4 0.4 0.5 0.4 0.3 0.3 0.4 1.0 1.3 0.4 1.7 3.0 0.3 1.1 2.9 0.2 0.8 1.9 0.3 1.8 0.4 1.9 0.3 1.9 0.3 1.9 0.3 2.0 0.3 2.1 0.3 2.2 3.5 0.4 0.3 2.3 3.7 0.4 0.3 2.4 3.9 0.4 0.3 2.5 4.1 0.4 0.3 2.6 4.3 0.6 0.3 1.0 0.2 1.0 0.1 1.1 0.1 1.1 0.2 1.3 0.2 1.3 0.2 1.4 0.2 0.2 0.3 2.8 2.5 0.6 2.0 2.9 6.1 0.9 0.6 1.0 3.3 2.8 1.0 0.7 1.3 3.8 3.4 5.0 5.1 0.8 0.2 0.4 1.1 0.9 0.7 0.4 1.1 1.0 5.2 1.9 2.0 2.0 4.8 0.9 1.1 1.3 4.2 0.9 1.4 1.4 4.7 0.7 1.6 1.5 4.9 0.8 1.8 1.5 5.1 1.0 1.9 1.6 5.2 1.1 2.1 1.7 5.3 1.2 2.2 1.8 5.3 6.5 1.3 2.0 1.9 5.5 5.7 5.6 6.2 1.4 2.7 1.5 3.0 1.5 2.7 0.1 0.2 0.2 4.4 0.1 2.6 0.2 3.0 3.7 0.6 0.4 1.1 1.2 0.7 0.4 1.5 1.5 6.5 0.6 0.4 1.5 1.5 6.6 0.8 0.5 1.5 1.7 6.8 0.9 0.5 1.7 2.0 7.1 3.8 0.8 0.5 1.7 2.1 7.6 3.2 0.2 3.7 4.2 0.9 0.5 2.1 2.2 3.9 4.5 0.9 0.5 2.3 1.7 4.1 4.6 1.0 0.5 2.6 1.8 4.8 1.2 0.6 2.8 2.0 6.4 3.0 2.2 4.7 4.8 1.1 0.2 0.2 0.2 0.2 0.2 0.1 0.2 0.2 0.2 1.8 1.9 2.1 0.6 1.0 2.3 2.8 1.1 2.6 3.0 1.0 1.1 1.1 1.1 1.2 1.3 1.3 1.4 1.5 1.6 2.7 2.8 2.9 3.1 3.3 0.5 1.0 3.4 0.6 1.2 4.1 0.7 1.2 4.8 2.4 0.6 1.2 0.5 1.2 2.9 1.3 1.6 5.8 2.4 0.5 1.3 3.2 1.2 1.7 6.4 2.8 6.4 3.0 6.5 3.2 6.7 3.5 7.0 3.8 7.2 4.0 7.3 4.2 2.9 3.4 3.5 3.7 4.0 7.3 4.4 7.4 4.7 7.5 0.6 1.4 2.8 1.1 1.1 1.2 0.6 1.5 0.6 1.5 0.6 1.6 3.5 1.3 1.7 1.6 1.5 0.6 1.7 0.6 0.8 1.1 1.1 1.1 1.1 1.1 1.0 1.1 1.1 1.2 4.7 0.8 1.8 0.9 1.9 1.1 1.9 3.6 1.3 1.2 2.1 1985-89 1990-94 1995-99 2000 2001 2002 2003 2004 2005 2006 2007 0.1 1.3 2008 0.1 1.4 2009 0.1 1.5
Notes: Where years are given as 5-year ranges, values are the averages of available data for the 5 years. Empty cells indicate no data were available. Source: WHO (2012) European Health for All Database. http://www.euro.who.int/en/what-we-do/data-and-evidence/databases/european-health-for-all-databasehfa-db2 (accessed July 2012).
203
6. Economic costs
204
6. Economic costs
As well as human costs, both cardiovascular disease (CVD) and coronary heart disease (CHD) have major economic consequences for the United Kingdom. The economic costs provided here are the most up to date available, but are not comparable to previous estimates published in the Coronary Heart Disease Statistics series. While the methods used are similar between the 2006 and 2009 studies, the data which underlies the estimates for the two years differs. Consequently, data that may have previously been based on assumptions may now be based on actual data, and vice-versa.
Health care costs CVD cost the health care system in the UK around 8.6 billion in 2009 1,2. This represents a cost per capita of 141. The cost of hospital care for people who have CVD accounts for 50% of these costs, whereas 23% of the cost is due to drugs (Table 6.1 and Figure 6.1a). CHD and stroke each cost the health care system in the UK around 1.8 billion in 2009 1,2. This represents a cost per capita of 29 each for the two conditions. The cost of hospital care for people who have CHD accounts for about 56% of these costs. The hospital costs for stroke account for 82% of the total health care costs (Table 6.1, Figures 6.1a to 6.1c). Non-health care costs Looking only at the health care costs of CVD grossly underestimates the total cost of CVD in the UK. Production losses from death and illness in those of working age and from the informal care of people with the disease contribute greatly to the overall financial burden. In 2009, production losses due to mortality and morbidity associated with CVD cost the UK over 6 billion, with around 21% of this cost due to death and 13% due to illness in those of working age. The cost of informal care for people with CVD in the UK was around 3.8 billion 3 in 2009 (Table 6.2). In 2009, production losses due to mortality and morbidity associated with CHD cost the UK over 3 billion, with around 33% of this cost due to death and 14% due to illness in those of working age. The cost of informal care for people with CHD in the UK was around 1.7 billion 3 in 2009. Production losses due to mortality and morbidity associated with stroke cost the UK almost 1 billion. The cost of informal care for people with stroke was 1 billion in 2009 (Table 6.2). Total costs Overall CVD is estimated to cost the UK economy 19 billion a year. Of the total cost of CVD to the UK, around 46% is due to direct health care costs, 34% to productivity losses, and 20% to the informal care of people with CVD (Table 6.2). Overall CHD is estimated to cost the UK economy over 6.7 billion a year. Of the total cost of CHD to the UK, around 27% is due to direct health care costs, 47% to productivity losses, and 26% to the informal care of people with CHD (Table 6.2). International differences Table 6.3 shows the relative costs of cardiovascular related diseases for the 27 member states of the European Union for 2009. The cost per capita of CVD is highest in Germany (374) and lowest in Romania (37). The cost in the UK (156) is lower than the average for the European Union (212) (Table 6.3).
1. The estimates for this chapter are from a cost of illness study by researchers at the Health Economics Research Centre, Department of Public Health, University of Oxford. 2. This estimate does not include the money spent on non-clinical activities concerned with the primary prevention of CVD and CHD, for example, public anti-smoking campaigns, nutrition education etc. However, the cost of drugs prescribed in primary care for both primary and secondary prevention is included. 3. The cost of informal care is equivalent to the opportunity costs of unpaid care. It is a measure of the amount of money that carers forgo to provide unpaid care for their spouse, friend or relative living with CVD.
205
Table 6.1 Health care costs of CVD, CHD and stroke ( thousands), United Kingdom, 2009
CVD Primary care Outpatient care A&E Inpatient care Medications Total health care costs Cost per capita Percentage of total health care expenditure 1,247,279 1,140,361 171,810 4,843,730 2,232,610 9,635,790 156 6% 1,123,675 1,027,352 154,784 4,363,721 2,011,360 8,680,892 141 6% CHD 120,364 399,865 58,518 1,122,043 296,609 1,997,400 32 1% 108,436 360,239 52,718 1,010,850 267,216 1,799,459 29 1% Stroke 44,438 180,121 35,278 1,623,543 95,651 1,979,031 32 1% 40,034 162,271 31,782 1,462,651 86,172 1,782,910 29 1%
Notes: Estimates originally calculated in Euros. They have been converted using 1 = 1.11, the approximate exchange rate in 2009. For details of methods and sources used, see http://www.ehnheart.org/cvd-statistics.html Source: Nichols M, Townsend N, Luengo-Fernandez R, Leal J, Grey A, Scarborough P, Rayner M (2012). European Cardiovascular Disease Statistics 2012. European Heart Network, Brussels, European Society of Cardiology, Sophia Antipolis.
Figure 6.1a Health care costs of cardiovascular disease (CVD), United Kingdom 2009
Primary care (13%) Outpatient care (12%) A&E (2%) Inpatient care (50%) Medications (23%)
Figure 6.1c Health care costs of stroke, United Kingdom 2009
Figure 6.1b Health care costs of coronary heart disease (CHD), United Kingdom 2009
206
Table 6.2 Totals costs of CVD, CHD and stroke ( thousands), United Kingdom 2009
CVD Direct health care costs Productivity loss due to mortality Productivity loss due to morbidity Informal care costs Total % of total 46% 21% 13% 20% CHD % of total 27% 33% 14% 26% Stroke % of total 48% 17% 9% 27%
9,635,790 4,466,456 2,715,698 4,215,296 21,033,240
8,680,892 4,023,834 2,446,575 3,797,564 18,948,865
1,997,400 2,473,550 1,021,775 1,915,000 7,407,725
1,799,459 2,228,423 920,518 1,725,225 6,673,626
1,979,031 702,379 353,501 1,118,357 4,153,267
1,782,910 632,774 318,469 1,007,529 3,741,682
Notes: Estimates originally calculated in Euros. They have been converted using 1 = 1.11, the approximate exchange rate in 2009. For details of methods and sources used, see http://www.ehnheart.org/cvd-statistics.html Source: Nichols M, Townsend N, Luengo-Fernandez R, Leal J, Grey A, Scarborough P, Rayner M (2012). European Cardiovascular Disease Statistics 2012. European Heart Network, Brussels, European Society of Cardiology, Sophia Antipolis.
207
Table 6.3 Health care costs of CVD, CHD and stroke ( thousands), European Union 2009
CVD Cost per capita Percentage of total health care expenditure 8% 6% 13% 7% 14% 5% 17% 12% 6% 11% 11% 14% 6% 10% 17% 12% 4% 11% 8% 17% 6% 12% 10% 8% 8% 8% 6% 9% CHD Cost per capita Percentage of total health care expenditure 2% 1% 2% 1% 2% 1% 4% 3% 1% 2% 2% 2% 1% 2% 5% 3% 1% 2% 2% 4% 1% 2% 3% 1% 1% 2% 1% 2% Stroke Cost per capita Percentage of total health care expenditure 1% 1% 2% 1% 3% 1% 4% 5% 1% 2% 2% 2% 0% 2% 4% 2% 0% 1% 2% 2% 1% 2% 2% 1% 1% 2% 1% 2%
Austria Belgium Bulgaria Cyprus Czech Rep. Denmark Estonia Finland France Germany Greece Hungary Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Poland Portugal Romania Slovakia Slovenia Spain Sweden UK Total EU
280 221 46 84 150 226 124 368 198 374 249 100 208 241 90 75 270 117 352 109 114 37 110 130 173 263 156 212
59 46 7 17 26 49 30 76 26 66 52 16 44 43 27 17 51 22 96 24 18 5 27 21 32 65 32 40
53 24 6 9 34 43 28 139 24 73 50 13 14 45 19 11 26 9 83 14 15 6 17 18 23 61 32 38
Notes: For details of methods and sources used, see http://www.ehnheart.org/cvd-statistics.html Source: Nichols M, Townsend N, Luengo-Fernandez R, Leal J, Grey A, Scarborough P, Rayner M (2012). European Cardiovascular Disease Statistics 2012. European Heart Network, Brussels, European Society of Cardiology, Sophia Antipolis.
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Were the nations heart charity. Our vision is a world where people dont die prematurely from heart disease. Well achieve this through pioneering research, vital prevention activity and ensuring quality care and support for everyone living with heart disease. But we urgently need your help. We rely on your donations of time and money to continue our life-saving work. Because together we can beat heart disease. Please get involved at www.bhf.org.uk Acknowledgements The compilers would like to thank Brian Steenson, Ed Dicks, Katie Larkins, Catherine Kelly, Peter Weissberg, Lynn Girdwood, Michael Goldacre, Julie Ramsay, Rachel Stewart and Mary Scarlett for their help in producing this publication.
We are the nations heart charity, dedicated to saving lives through pioneering research, patient care, campaigning for change and by providing vital information. But we urgently need your help. We rely on your donations of time and money to continue our life-saving work. Because together we can beat heart disease.
bhf.org.uk/ statistics
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Information & support on anything heart-related Phone lines open 9am to 5pm Monday to Friday Similar cost to 01 or 02 numbers
British Heart Foundation Greater London House 180 Hampstead Road London NW1 7AW T 020 7554 0000 F 020 7554 0100
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Coronary heart disease statistics

A compendium of health statistics 2012 edition

Coronary heart disease statistics A compendium of health statistics 2012 edition

Coronary heart disease statistics 2012

British Heart Foundation and University of Oxford

Coronary heart disease statistics 2012

British Heart Foundation and University of Oxford

Coronary heart disease statistics 2012

British Heart Foundation and University of Oxford

Coronary heart disease statistics 2012

British Heart Foundation and University of Oxford

Coronary heart disease statistics 2012

British Heart Foundation and University of Oxford

Coronary heart disease statistics 2012

British Heart Foundation and University of Oxford

Coronary heart disease statistics 2012

British Heart Foundation and University of Oxford

Coronary heart disease statistics 2012

CVD Inequalities target

CHD Inequalities target Northern Ireland No target set.

British Heart Foundation and University of Oxford

Death rate per 100,000

Absolute gap in death rates per 100,000

Target for 2010

Coronary heart disease statistics 2012

100 Death rate per 100,000

Target for 2010

500 Death rate per 100,000

0 2006 2004 2008 2009 2005 2002 2003 2007 2001

Target for 2010

British Heart Foundation and University of Oxford

Coronary heart disease (I20-I25)

Respiratory disease (J00-J99)

Coronary heart disease statistics 2012

Men Women Total

All diseases of the circulatory system (I00-I99)

Men Women Total Men Women Total Men Women Total

Coronary heart disease (I20-I25)

Men Women Total Men Women Total

Men Women Total

Colo-rectal cancer (C18-C21)

Men Women Total

Lung cancer (C33,C34)

Men Women Total

Breast cancer (C50)

Men Women Total

Other cancers (C00-C17, C22-C32, C35-C49, C51-D48)

Men Women Total Men Women Total

Respiratory disease (J00-J99)

Injuries and poisoning (V01-Y98)

Men Women Total

All other causes

Men Women Total

British Heart Foundation and University of Oxford

Figure 1.3a Deaths by cause in men, United Kingdom 2010

Figure 1.3b Deaths by cause in women, United Kingdom 2010

Coronary heart disease statistics 2012

British Heart Foundation and University of Oxford

Death rate per 100,000

Coronary heart disease statistics 2012

3544 3544 4554 5564 6574

British Heart Foundation and University of Oxford

Coronary heart disease statistics 2012