33. TREND IN EARLY MORTALITY RATES FROM ALL CIRCULATORY DISEASES
TABLE 1 – INDICATOR DESCRIPTION
| Information component | Pg 3 Health Inequalities: changes over time |
| Subject category / domain(s) | Health inequalities: changes over time |
| Indicator name (* Indicator title in health profile) | Trend in early mortality rates from all circulatory diseases |
| PHO with lead responsibility | SEPHO |
| Date of PHO dataset creation | December 2006 |
| Indicator definition | Mortality from all circulatory diseases, directly age-standardised rate, persons, under 75, 1995-97 to 2003-05 (average of annual rates), per 100,000 European Standard population |
| Geography | England, GOR, Local Authority: Counties, County Districts, Metropolitan County Districts, Unitary Authorities, London Boroughs (boundaries as at April 2006). |
| Timeliness | The Compendium mortality from all circulatory diseases indicator is updated annually, usually around November following the publication by ONS of the new year’s mortality extract (usually in May) and mid-year population estimates (usually August-September). |
| Rationale:What this indicator purports to measure | Trend in early mortality from all circulatory diseases. |
| Rationale:Public Health Importance | Circulatory disease accounts for 40% of all deaths (30% under 75). Mortality is a direct measure of health care need reflecting the overall circulatory disease burden on the population, both the incidence of disease and the ability to treat it. The mortality rate may be improved by reducing the population’s risk (e.g. encouraging healthier lifestyles and reducing exposure to smoking), by earlier detection of disease and by more effective treatment.The Our Healthier Nation target is to reduce the number of deaths from circulatory disease in people aged under 75 years by at least 40% by 2010. The baseline for monitoring this target is the three year period 1995-97. The trend charts presented in the health profiles show the three year moving averages of annual mortality rates from all circulatory disease from the 1995-7 baseline to the most recently available years of data (2003-05 average) compared against the national trend. |
| Rationale: Purpose behind the inclusion of the indicator | To monitor premature mortality due to circulatory diseases over time.To reduce premature deaths from circulatory diseases. |
| Rationale:Policy relevance | The under 75 circulatory disease mortality rate is a key target indicator in the 1999 Public Health White Paper ‘Saving Lives: Our Healthier Nation’. The target is to reduce the number of deaths from circulatory disease in people aged under 75 years by at least two-fifths by 2010. The baseline for monitoring this target is the three year period 1995-97.This measure supports delivery of the Department of Health PSA targets and LDP and is relevant to Choosing Health, Coronary Heart Disease NSF and Programme for Action. |
| Interpretation: What a high / low level of indicator value means | An upward sloping trend line indicates that the early mortality rate from all circulatory diseases is worsening.A downward sloping trend line indicates that the early mortality rate from all circulatory diseases is improving.If the trend line for the local authority is consistently above the trend line for England then early death rates from circulatory diseases have been consistently higher than those for England for the stated period.If the trend line for the local authority is consistently below the trend line for England then early death rates from circulatory diseases have been consistently lower than those for England for the stated period.If the gap between the local authority trend line and the England trend line is widening then inequalities in early mortality rates from all circulatory diseases are worsening.If the gap between the local authority trend line and the England trend line is narrowing then inequalities in early mortality rates from all circulatory diseases are improving. |
| Interpretation: Potential for error due to type of measurement method | Coverage can be considered to be complete as the registration of deaths is a legal requirement. Data quality for the relevant fields (age, sex, underlying cause of death, area of residence) is extremely high. There is the potential for the underlying cause of death to be incorrectly attributed on the death certificate and, therefore, the cause of death misclassified. |
| Interpretation: Potential for error due to bias and confounding | The rates are age-standardised. This improves the comparability of rates for different areas, or between different time periods, by taking into account differences in the age structures of the populations being compared. |
TABLE 2 – INDICATOR SPECIFICATION
| Indicator definition: Variable | Mortality from all circulatory diseases (ICD10 I00 –I99, ICD9 390-459 adjusted) |
| Indicator definition: Statistic | Directly age-standardised rate |
| Indicator definition: Gender | Persons |
| Indicator definition: age group | Under 75 |
| Indicator definition: period | 1995-97 to 2003-05 (average of annual rates) |
| Indicator definition: scale | Per 100,000 European Standard population |
| Geography: geographies available for this indicator from other providers | England & Wales, ONS area, Primary Care Organisation, Strategic Health Authority.Available from National Centre for Health Outcomes Development (NCHOD) website www.nchod.nhs.ukData can also be found at Neighbourhood Renewal Unit Public Service Agreement Floor Targets (www.fti.neighbourhood.gov.uk/default.asp). |
| Dimensions of inequality: subgroup analyses of this dataset available from other providers | Age, gender available from NCHOD. |
| Data extraction: Source | NCHOD. |
| Data extraction: source URL | Data received directly from NCHOD. |
| Data extraction: date | Dec 2006 |
| Numerator: definition | Deaths from all circulatory disease, classified by underlying cause of death (ICD10 I00 – I99, ICD9 390-459 adjusted), registered in the respective calendar years 1995-97 to 2003-05, in people aged under 75. |
| Numerator: source | Office for National Statistics (ONS) |
| Denominator: definition | 2001 Census based mid-year population estimates for respective calendar years 1995 to 2005, people aged under 75, current as at 24 August 2006 |
| Denominator: source | ONS |
| Data quality: Accuracy and completeness | Coverage can be considered to be complete as the registration of deaths is a legal requirement. Data quality for the relevant fields (age, sex, underlying cause of death, area of residence) is extremely high. Area of residence is allocated by ONS using the postcode and the National Statistics Postcode Directory – records without a valid area code are excluded but the number of such records is negligible. |
TABLE 3 – INDICATOR TECHNICAL METHODS
| Numerator: extraction | Extraction by NCHOD. |
| Numerator: aggregation /allocation | Deaths were assigned to geographical areas using the area code supplied in the mortality extract. This is derived from postcode of residence by the ONS using the National Statistics Postcode Directory (NSPD). |
| Numerator data caveats | Area of residence is allocated by ONS using the postcode and the National Statistics Postcode Directory – records without a valid area code are excluded but the number of such records is negligible.Mortality counts are derived from the annual DH mortality extract supplied by ONS and are based on the original underlying cause of death for which there is nearly 100% coverage on the mortality register. In January 2001, the ONS implemented a change from ICD-9 to ICD-10 for coding causes of death in England & Wales. As part of an exercise to investigate the effects of this change, the ONS also re-coded all deaths registered in 1999. Deaths for years prior to 1999 and for year 2000 have not been re-coded. The numbers of deaths observed in the years 1995-98 and 2000 have, therefore, been adjusted to give “expected” numbers of deaths which would have been coded to this cause in ICD-10. This was done by multiplying the ICD-9 based death counts by the appropriate ICD-10/9 comparability ratio published by the ONS. For this indicator the following ICD-10/9 comparability ratios were used: Males aged 0-74: 1.012; Females aged 0-74: 1.015. Adjusted person counts are the sum of the adjusted male and female counts |
| Denominator data caveats | Data are based on the latest revisions of ONS mid-year population estimates for the respective years, current as at 24 August 2006. |
| Methods used to calculate indicator value | The directly age-standardised rate (DSR) is the rate of events that would occur in a population with a standard age structure if that population were to experience the age-specific rates of the subject population. The standard population used is the European Standard Population. The age groups used are: Under 1, 1-4, 5-9,…, 80-84, 85+. The rate for 2003-05 has been calculated as the simple average of the individual annual rates. The rate is expressed per 100,000 population. |
| Small Populations: How Isles of Scilly and City of London populations have been dealt with | Isles of Scilly and City of London are excluded from the lower tier datasets but included in England, Regional and County figures. |
| Disclosure Control | None applied. |
| Confidence Intervals calculation method | Not applicable – Trend chart presented without Confidence Intervals |
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