Public Health Wales Observatory Under 75 Mortality Rates In

Public Health Wales Observatory Under 75 Mortality Rates In

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Public Health Wales Observatory
Under 75 mortality rates in the South East Wales health boards

Under 75 mortality rates in the South East Wales health boards
Author: Sara Thomas, Specialty Registrar and Gareth Davies, Public
Health Information Manager, Observatory Analytic Team
Date: 19 May 2010
Version: 1
Publication/ Distribution:
*
Directors of Public Health, South East Wales Health Boards
*
Public (Internet)
Purpose and Summary of Document:
During the development of the demography profile web resource an
increase in under 75 mortality was noted across three health boards in
the south east of Wales. This report explores potential reasons for
this and examines mortality trends into 2008 for Cwm Taf, Aneurin
Bevan and Cardiff & Vale University Health Boards.
Work Plan reference: HI 09
Contents
========
Under 75 mortality rates in the South East Wales health boards 1
1 Introduction 8
2 Aim and Objectives 10
3 Methodology 10
4 Results 10
5 Discussion 31
6 Conclusion 32
7 Recommendations 33
8 References 34
Appendix 1 35
Appendix 2 42
FIGURES
=======
Figure 1 Cwm Taf Health Board ‹75 mortality, all causes 10
==========================================================
Figure 2 Cardiff & Vale University Health Board ‹75 mortality,
==============================================================
all causes 11
=============
Figure 3 Aneurin Bevan Health Board ‹75 mortality, all causes 12
================================================================
Figure 4 Cwm Taf Health Board ‹75 mortality, all causes
=======================================================
(Registrations & occurrences) 13
================================
Figure 5 Aneurin Bevan Health Board ‹75 mortality, all causes
=============================================================
(Registrations & occurrences) 14
================================
Figure 6 Cardiff & Vale University Health Board ‹75 mortality,
==============================================================
all causes (Registrations & occurrences) 14
===========================================
Figure 7 Cwm Taf Health Board, cause of death ‹75, 1998-2008 15
===============================================================
Figure 8 Cwm Taf Health Board, ‹75 mortality, malignant
=======================================================
neoplasms 16
============
Figure 9 Cwm Taf Health Board, ‹75 mortality, circulatory
=========================================================
disease 17
==========
Figure 10 Cwm Taf Health Board, ‹75 mortality, respiratory
==========================================================
disease 17
==========
Figure 11 Cwm Taf Health Board, ‹75 mortality, digestive
========================================================
system 18
=========
Figure 12 Cwm Taf Health Board, ‹75 mortality, external causes 20
=================================================================
Figure 13 Cwm Taf Health Board, ‹75 mortality , all other causes 21
===================================================================
Figure 14 Aneurin Bevan Health Board, cause of death, ‹75
=========================================================
1998 – 2008 22
==============
Figure 15 Aneurin Bevan Health Board, ‹75 mortality, malignant
==============================================================
neoplasms 23
============
Figure 16 Aneurin Bevan Health Board, ‹75 mortality, circulatory
================================================================
disease 24
==========
Figure 17 Aneurin Bevan Health Board, ‹75 mortality, respiratory
================================================================
Disease 25
==========
Figure 18 Aneurin Bevan Health Board, ‹75 mortality, digestive
==============================================================
system 26
=========
Figure 19 Aneurin Bevan Health Board, ‹75 mortality, digestive
==============================================================
system 26
=========
Figure 20 Aneurin Bevan Health Board, ‹75 mortality, external
=============================================================
causes 27
=========
Figure 21 Aneurin Bevan Health Board, ‹75 mortality, all other
==============================================================
causes 28
=========
© 2010 Public Health Wales. Material contained in this document may be
reproduced without prior permission provided it is done so accurately
and is not used in a misleading context. Acknowledgement to Public
Health Wales to be stated.
----------------------------------------------------------------------
  Copyright in the typographical arrangement belongs to Public Health
Wales
---------------------------------------------------------------------
Executive summary
-----------------
During the development of the demography profile web resource an
increase in under 75 mortality was noted across three health boards in
the south east of Wales. This report explores potential reasons for
this and examines mortality trends into 2008 for Cwm Taf, Aneurin
Bevan and Cardiff & Vale University Health Boards.
A mortality rate increase seen in Cwm Taf between 2006 and 2007 was
also seen in Aneurin Bevan and Cardiff & Vale University Health Board
populations, in both males and females under 75 years. However, the
rates declined in all three heath boards in 2008. In Cardiff & Vale
Health Board the 2007 increase could be explained by delayed death
registration from one year into the next. The mortality rate increases
in Cwm Taf and Aneurin Bevan in 2007, reversed in 2008 may be related
to random variation.
Trend analysis of causes of death in Cwm Taf and Aneurin Bevan for the
period 1998 to 2008 identified that efforts to reduce under 75
mortality from circulatory diseases had been successful and that in
2008, malignancy was the main cause of death in both populations.
There has been little change in deaths due to respiratory disease
since 1998 in either Cwm Taf or Aneurin Bevan. Deaths due to digestive
system are small in number, but appear to be increasing slightly in
both health boards and across Wales. The increase in deaths due to
digestive system in Cwm Taf is largely attributable to alcoholic liver
disease. The impact of alcohol on mortality in Cwm Taf has also been
identified in the Lifestyle and Health Profile2.
This report identified some important public health issues including:
*
In both health board areas examined, malignancy overtook
circulatory disease as the highest age standardised under 75
mortality rate in the early 2000s; largely due to the more rapid
decline in circulatory disease.
*
Age standardised mortality rates for external causes remain
relatively unchanged in the last decade
Recommendations
*
Continued monitoring of the under 75 mortality trends across the
health boards to ensure the decrease in mortality is sustained and
comparable to temporal trends outside Wales.
*
Health improvement measures should be continued, particularly in
the areas of malignancy and respiratory disease, while not
neglecting circulatory disease. There is potential for further
reduction in mortality rates through encouraging healthy
lifestyles.
*
Analyses of mortality trends by deprivation would be helpful in
future.
*
Continued monitoring of deaths due to alcohol
*
An examination of external cause mortality could be explored to
examine for potential areas for preventative action.
1Introduction
=============
The developing Public Health Observatory for Wales published
demography profiles for Wales and the seven new health boards (HBs) in
June 20091. The Local Public Health Director for Merthyr and Rhondda
Cynon Taf (the areas which make up the new Cwm Taf Health Board area)
identified an increase in under 75 mortality rates for the Cwm Taf HB
population between 2006 and 2007 and requested the NPHS Health
Intelligence Domain to investigate this further. During the
development of the demography profile web resource the pattern was
noted across the other two health boards in the south east of Wales.
This pattern was sufficient to influence the all-Wales under 75
mortality rate which rose slightly between 2006 and 2007.
The European Age Standardised Mortality rates (EASR) for each of the
seven Health Boards in Wales fell from 1998 to 2007 (Table 1). The
smallest reduction in EASR was 12% in Cardiff & Vale with the largest
reduction of 31% seen in Powys. The confidence intervals suggest a
statistically significant difference in EASR for all Health Boards
from 1998 to 2007, which would need to be tested further. Trend data
for under 75 mortality for each health board from 1998 to 2007 is
included as Appendix 1.
This report details the further analyses undertaken of the mortality
data for the health boards of South East Wales.
Table 1. All cause mortality, all persons aged under 75 (Mortality
counts, crude and age standardised rates: 1998 to 2007 Number, Rates
and Confidence Intervals) Data source: ONS
Health Board
Betsi Cadwaladr University
Powys
Hywel Dda
Abertawe Bro Morgannwg University
Cardiff & Vale University
Cwm Taf
Aneurin Bevan
Year of registration
1998
2007
1998
2007
1998
2007
1998
2007
1998
2007
1998
2007
1998
2007
Number of deaths
2936
2503
554
426
1630
1375
2326
1922
1643
1426
1491
1303
2517
2183
Crude rate (per 100,000 population)
490
406
485
360
502
405
517
421
415
346
551
488
492
424
European Age Standardised Rate (per 100,000 population)
394
310
369
256
380
297
420
345
382
337
474
414
417
350
95% Confidence Interval
380 –
409
298 –
323
338 –
402
231 –
283
361 –
399
281 –
314
403 –
438
329 –
361
363 –
401
319 –
355
450 –
499
392 –
437
401 –
434
335 –
365
% reduction in European Age Standardised Rate
21
31
22
18
12
13
16
2Aim and Objectives
===================
The aim of the report was to explore potential explanations for the
increased under 75 mortality in 2007 in Aneurin Bevan, Cardiff and
Vale University and Cwm Taf Health Boards.
The objectives were to examine:
*
the influence of year of registration on reported under 75
mortality trends
*
the extent by which the rise in under 75 mortality is influenced
by
*
gender
*
cause of death
During this work 2008 data became available, and so this data is
included in analyses.
3Methodology
============
Trends were produced from mortality data for the three south east
Wales health boards. Data was obtained from death registrations
collated by the Office of National Statistics (ONS) and held on the
SQL server in Health Solutions Wales.
4Results
========
4.1Under 75 Mortality between 2006 and 2008
-------------------------------------------
Analysis of death registration data showed a rise in the age
standardised under 75 mortality rates from 2006 to 2007 for three
Health Boards, all of which were in the South East of Wales, namely
Cwm Taf, Cardiff and Vale University and Aneurin Bevan Health Boards.
Subsequent analysis of deaths registered in 2008, which became
available during the period of the investigation, showed that the
mortality rates for the three South East Wales health boards had
fallen again to near or below the EASR for 2006 (Figure 1-3).
Figure 1 Cwm Taf Health Board

The number of male deaths registered increased from 688 in 2006 to 771
(12.1% increase) in 2007 and the age standardised rate increased
similarly (12.6%). In 2008, the number of male deaths registered, fell
to 690 (10.5% decrease) and the EASR decreased by 12.2%, to almost the
2006 rate (448 per 100,000 population). Changes of this magnitude
could be due to random variation
The number of female deaths registered increased from 484 in 2006 to
532 (9.9% increase) in 2007 and the age standardised rate increased
similarly (9.2%). In 2008, the number of female deaths registered,
fell to 519 (2.4% decrease) and the EASR decreased by 3.2% to 312 per
100,000 population. Changes of this magnitude could be due to random
variation.
Figure 2 Cardiff & Vale University Health Board

The number of male deaths registered increased from 806 in 2006 to 877
(8.8% increase) in 2007 and the age standardised rate increased
similarly (8.0%). In 2008, the number of male deaths registered, fell
to 818 (6.7% decrease) and the EASR decreased by 8.6%, to the 2006
rate (396 per 100,000 population). Changes of this magnitude could be
due to random variation
The number of female deaths registered decreased from 554 in 2006 to
549 (0.9% decrease) in 2007 and the age standardised rate decreased
similarly (1.6%). In 2008, the number of female deaths registered,
fell again to 544 (0.9% decrease) and the EASR decreased by 2.1% to
242 per 100,000 population.
Figure 3 Aneurin Bevan Health Board
The number of male deaths registered increased from 1227 in 2006 to
1286 (7.8% increase) in 2007 and the age standardised rate increased
similarly (7.3%). In 2008, the number of male deaths registered, fell
to 1251 (2.7% decrease) and the EASR decreased by 3.6%, to just below
the 2006 rate (410 per 100,000 population). Changes of this magnitude
could be due to random variation
The number of female deaths registered increased from 832 in 2006 to
897 (7.8% increase) in 2007 and the age standardised rate increased
similarly (7.3%). In 2008, the number of female deaths registered,
fell to 841 (6.2% decrease) and the EASR decreased by 7.9% to 256 per
100,000 population. Changes of this magnitude could be due to random
variation.
4.2Investigation of the increase in mortality between 2006- 07
--------------------------------------------------------------
4.2.1Death occurrence and death registration
The mortality data had thus far been analysed by date of registration.
To identify the potential influence of delays in registration on
mortality trends, the data for 1998 to 2007 was re analysed by date of
occurrence (occurrence data for 2008 was incomplete) There was good
agreement between the profile of death registration and occurrence
data for Cwm Taf and Aneurin Bevan (Figures 4 and 5), which
consistently showed an increase in death rate between 2006 and 2007.
The profiles were not so well matched in Cardiff & Vale University
(Figure 6). Deaths that occurred in Cardiff & Vale University during
2005-06 may not have been registered until 2007 suggesting that the
apparent increase for Cardiff & Vale in 2007 was due to the timing of
registration rather than a true change of death occurrence.
Figure 4 Cwm Taf Health Board

Figure 5 Aneurin Bevan Health Board

F igure 6 Cardiff & Vale University Health Board
4.3Analysis of mortality data (registered deaths to 2008)
---------------------------------------------------------
A more detailed analysis of mortality data (by year of registration)
for Cwm Taf and Aneurin Bevan Health Boards for the period 1998 to
2008 was undertaken.
4.3.1Cwm Taf Health Board
Cause of death under 75 years
The main causes of death registered in Cwm Taf in 2008 were
malignancies 417 (34.5%), circulatory 359 (29.7%), respiratory 118
(9.8%) and digestive 106 (8.8%).
The all person analysis was repeated for the main causes of death
separately. The pattern of age standardised rates is summarised in
Figure 7.
Figure 7 Cwm Taf Health Board

Trend by cause
Malignant neoplasms
Figure 8

Malignant neoplasms were the underlying cause of death for over a
third of all deaths registered for Cwm Taf residents in 2008 (34.5%).
The number of deaths and age standardised mortality rates changed very
little between 2002 and 2005 year on year, having fallen markedly from
1999.
From 2005 to 2006 and 2006 to 2007 increases in both the numbers of
deaths and age standardised rates were apparent. From 2005 to 2006 the
number of deaths increased from 422 to 456 (8.1% increase) and the age
standardised rate increased similarly (6.9%). From 2006 to 2007 the
number of deaths increased from 456 to 476 (4.4% increase) and the age
standardised rate increased similarly (4.7%).
There was a decrease in numbers of registered deaths from malignant
neoplasms in 2008 to 417 (12.4% decrease) and the age standardised
rate decreased similarly (13.2%). The rate of death from malignant
neoplasms in 2008 (EASR of 128 deaths per 100,000 population) is the
lowest recorded in Cwm Taf since 1998.
Circulatory diseases
Figure 9

Circulatory diseases were the underlying cause of death for nearly a
third of all deaths registered for Cwm Taf residents in 2008 (29.7%).
The number of deaths and age standardised mortality rates fell across
the whole period year on year, except for inconsequential rises from
2004 to 2005 and 2007 to 2008.
Respiratory Diseases
Figure 10

Respiratory diseases were the underlying cause of death for one in ten
of all deaths registered for Cwm Taf residents in 2008 (9.8%). The
number of deaths and age standardised mortality rates fluctuated
considerably from 1998 to 2004 after which they had been fairly
constant until 2006. From 2006 to 2007 increases in both the numbers
of deaths and age standardised rates were apparent with the number of
deaths increasing from 108 to 141 (30.6% increase) and the age
standardised rate increasing similarly (25.7%). In 2008, the numbers
of deaths fell again to 118 (16.3% decrease) and the age standardised
rate decreased by 17.7% to just below the rate for 2004.
Digestive system
Figure 11

Diseases of the digestive system were the underlying cause of death
for one in eleven of all deaths registered for Cwm Taf residents in
2008 (8.8%). From 2006 to 2007, the number of deaths increased from 78
to 104 (33.3% increase) and the age standardised rate increasing
similarly (37.1%). There was a slight increase in numbers of deaths
(1.9%) and decrease in rate (1.4%) in 2008. There is an overall upward
trend in mortality from conditions of the digestive system.
Further analysis of digestive system deaths
A tabulation of the numbers of digestive disease deaths by ICD block
for Cwm Taf and Wales (Table 1 and Appendix 2) shows that the increase
in the average number of digestive disease deaths in Cwm Taf from the
period 2001/06 to 2007/08 was higher in Cwm Taf (25%) than across
Wales (13%). The increase appears almost wholly attributable to an
increase in the number of deaths due to diseases of the liver (an
increase of 21 deaths (35%) in Cwm Taf; an increase of 97 deaths (21%)
across Wales. Of the nine other digestive disease ICD-10 blocks, four
showed no change, one went down by one death and three went up by one,
two and three deaths respectively.
Looking in more detail at the liver deaths, the majority are due to
alcoholic liver disease (72% of the block K70-K77 are K70 – Alcoholic
liver disease). There was a 63% increase in deaths from alcoholic
liver disease from 2001/06 to 2007/08/ in Cwm Taf.
Table 1
Deaths from digestive system, diseases of the liver and alcoholic
liver disease 2001/06 compared to 2007/08
Source: ONS ADDE
 
Cwm Taf
Wales
Annual average deaths
% change
Add’l deaths per year
Annual average deaths
% change
Add’l deaths per year
Year
2001/06
2007/08
2001/06
2007/08
Total Digestive system
79
105
25
26
676
780
13
104
- Diseases of liver (K70-K77)
40
61
35
21
357
454
21
97
- Alcoholic liver disease (K70)
28
46
63
18
- Non alcoholic liver disease
(K70-K77)
12
16
33
4
External causes
Figure 12

External causes were the underlying cause of death for just over one
in twenty of all deaths registered for Cwm Taf residents in 2008
(5.1%). The number of deaths and age standardised mortality rates
fluctuated somewhat over the entire period though almost always
remained consistent with the Wales rate.
From 2006 to 2007 increases in both the numbers of deaths and age
standardised rates were apparent with the number of deaths increasing
from 59 to 86 (45.8% increase) and the age standardised rate
increasing similarly (39.6%). The rate fell again in 2008 by 23.9% to
below the rate for Wales.
All Other Causes
All other causes (i.e. causes other that those due to circulatory and
respiratory disease, malignant neoplasms, digestive system and
external causes) were the underlying cause of death for almost one in
eighteen of all deaths registered for Cwm Taf residents in 2007
(5.5%).
The number of deaths and age standardised mortality rates were
comparable to the Wales rate (Figure 13).
Figure 13

4.3.2Aneurin Bevan Health Board
Cause of death under 75 years
The main causes of death in Aneurin Bevan in 2008 were malignancies
775 (37%), circulatory 561 (26.8%), respiratory 212 (10.1%) and
digestive 144 (6.9%). The all person analysis was repeated for the
main causes of death separately. The pattern of age standardised rates
in Aneurin Bevan Health Board is summarised below (Figure 14).
Figure 14 Aneurin Bevan Health Board

Trend by cause
Malignant neoplasms
Malignant neoplasms were the underlying cause of death for over a
third of all deaths registered for Aneurin Bevan residents in 2008
(37%). The number of deaths and age standardised mortality rates have
fallen from 2000 to 2008 with minor fluctuations from year to year
(Figure 15).
From 2006 to 2007 increases in both the numbers of deaths and age
standardised rates were apparent. The number of deaths increased from
769 to 835 (8.6% increase) and the age standardised rate increased
similarly (7.6%).
There was a decrease in numbers of registered deaths from malignant
neoplasm in 2008 to 775 (7.2% decrease) and the age standardised rate
decreased similarly (9.3%). The rate of death from malignant neoplasm
in 2008 (EASR of 119 deaths per 100,000 population) is the lowest
record in Aneurin Bevan since 1998.
Figure 15

Circulatory diseases
Figure 16
Circulatory diseases were the underlying cause of death for
just over a quarter of all deaths registered for Aneurin Bevan
residents in 2008 (26.8%). The number of deaths and age standardised
mortality rates fell across the whole period.
Respiratory Diseases
Figure 17

Respiratory diseases were the underlying cause of death for one in ten
of all deaths registered for Aneurin Bevan residents in 2008 (10.1%).
The age standardised mortality rates in Aneurin Bevan followed a
similar profile to the rest of Wales since 1998. From 2006 to 2007
increases in both the numbers of deaths and age standardised rates
were apparent with the number of deaths increasing from 173 to 204
(17.9% increase) and the age standardised rate increasing similarly
(18.7%). In 2008, the numbers of deaths increased to 212 (3.9%
increase) with minimal change in age standardised rate (0.5%
decrease).
Digestive system
Diseases of the digestive system were the underlying cause of death
for one in fifteen of all deaths registered for Aneurin Bevan
residents in 2008 (6.9%). The mortality rate has fluctuated about the
EASR for Wales. There has been a very slight upward trend in Aneurin
Bevan residents and Wales since 1998.
Figure 18

Figure 19

External causes
Figure 20

External causes were the underlying cause of death for just over one
in nineteen of all deaths registered for Aneurin Bevan residents in
2008 (5.3%). The number of deaths and age standardised mortality rates
fluctuated somewhat over the entire period though almost always below
the Wales rate.
All Other Causes
All other causes (i.e. causes other that those due to circulatory and
respiratory disease, malignant neoplasms, digestive system and
external causes) were the underlying cause of death for almost one in
seventeen of all deaths registered for Aneurin Bevan residents in 2007
(5.9%). The number of deaths and age standardised mortality rates are
comparable to the Wales rate (Figure 21).
Figure 21

5Discussion
===========
This report has presented an overview of mortality rates in the under
75 populations of Health Boards in three south east Wales health
boards in 2007. Trends in mortality data are important indicators used
to inform public health action as well as to evaluate interventions
already implemented.
In interpreting these analyses it should be borne in mind that there
is often a time lag between exposure or event and outcome. It can take
many years for changes in lifestyle behaviour, occupation, wider
physical and socio-cultural environment to impact on mortality rates.
The increase in mortality rate identified in Cwm Taf between 2006 and
2007 was also seen in Aneurin Bevan and Cardiff & Vale University
Health Board populations. The increase in rate was seen in both males
and females.
Subsequent analysis of deaths registered in 2008, which became
available during the period of the investigation, showed that the
mortality rates for the three South East Wales health boards had
fallen again to near or below the EASR for 2006. The declining rate is
reassuring and turned an important public health question into a more
academic potential question of what factors contributed to the
increase in mortality rates between 2006 and 2007.
There was no apparent difference in mortality rates calculated from
the number of deaths registered in 2005, 2006 and 2007 to the number
of deaths which occurred in these years for Cwm Taf and Aneurin Bevan.
Death registrations could therefore be considered a good proxy for
death occurrence in these populations. However, there was a difference
for Cardiff & Vale with a pattern suggesting that the increase in
death registrations for the health board population in 2007 may have
arisen from a delay in the registration of deaths which occurred in
2005 and 2006. As such there was no increase in mortality rate by year
of occurrence for Cardiff & Vale from 2006-2007. This analysis could
not be performed on 2008 data, since occurrence data for 2008 was
incomplete at the time of analysis.
Analysis of the cause of death since 1998 identified that malignancies
and circulatory disease are the main causes of death among residents
under 75 years of Aneurin Bevan (37 & 26.8% respectively) and Cwm Taf
(34.5 & 29.7% respectively in 2008. Since 1998, the decline in deaths
due to circulatory disease has left malignancies as the main cause of
death in both populations.
There has been little change in deaths due to respiratory disease
since 1998 in either Cwm Taf or Aneurin Bevan Health Board areas.
Deaths due to digestive system are small in number, but appear to be
increasing slightly in both Health Boards and across Wales. Deaths due
to digestive system in Cwm Taf are mostly attributable to alcoholic
liver disease. Alcohol intake was highlighted in the Cwm Taf lifestyle
and health profile1. The 2009 Wales Centre for Health Alcohol and
Health in Wales report3 showed the rising trend for alcohol related
mortality across Wales has been slowing for men but not for women.
Deaths due to external causes have shown minor fluctuations around the
Wales rate, with a slight downward trend in Cwm Taf since 1998 and an
unchanged position in Aneurin Bevan.
The profile of deaths due to respiratory diseases for Cwm Taf showed a
large decrease from 1999 to 2001, which was also apparent in Aneurin
Bevan and Wales. This would appear to be consistent with the
introduction of the ICD 10 coding of diseases. An ONS report by Brock
et al 4 identified that the number of deaths assigned to respiratory
diseases as a whole decreased by 22% as a result of the introduction
of ICD-10 in 2001, which was mainly due to changes in the use of
selection rule 3 for coding the underlying cause of deathi.
6Conclusion
===========
An increase in under 75 mortality rate was seen in Cwm Taf, Aneurin
Bevan and Cardiff & Vale University Health Board populations from 2006
to 2007. However, the rates declined in all three heath boards in
2008. In Cardiff & Vale Health Board the 2007 increase could be
explained by delayed death registration from one year into the next.
The mortality rate increases in Cwm Taf and Aneurin Bevan in 2007,
reversed in 2008 may be related to random variation.
Trend analysis of causes of death in Cwm Taf and Aneurin Bevan for the
period 1998 to 2008 identified that efforts to reduce mortality from
circulatory diseases had been successful and that in 2008, malignancy
was the main cause of death in both populations.
This report identified some important public health issues including:
*
In both areas examined, malignancy overtook circulatory disease as
the highest age standardised under 75 mortality rate in the early
2000s largely due to the more rapid decline in circulatory
disease.
*
Age standardised mortality rates for external causes remain
relatively unchanged in the last decade
7Recommendations
================
*
Continued monitoring of the under 75 mortality trends across the
health boards to ensure the decrease in mortality is sustained and
comparable to temporal trends outside Wales.
*
Health improvement measures should be continued, particularly in
the areas of malignancy and respiratory disease, while not
neglecting circulatory disease. There is potential for further
reduction in mortality rates through encouraging healthy
lifestyles.
*
Analyses of mortality trends by deprivation would be helpful in
future.
*
Continued monitoring of deaths due to alcohol
*
An examination of external cause mortality could be explored to
examine for potential areas for preventative action.
8References
===========
1 Wales Centre for Health and National Public Health Service for
Wales. Demography Profile: Cwm Taf Health Board. June 2009. Available
at: http://www.wch.wales.nhs.uk [Accessed on 6 April 2010]
2 Public Health Wales. Profiles of Lifestyle and Health: Cwm Taf
Health Board Available at:
http://www.wales.nhs.uk/sites3/Documents/568/Lifestyle%5FCwmTaf%28E%29.pdf
[Accessed on 26 February 2010]
3 Wales Centre for Health. A profile of Alcohol and Health in Wales.
April 2009. Available at: http://www.wch.wales.nhs.uk [Accessed on 6
April 2010]
4 The impact of introducing ICD-10 on analysis of respiratory
mortality trends in England and Wales Anita Brock, Clare Griffiths and
Cleo Rooney Office for National Statistics Health Statistics Quarterly
Spring 2006. Available at:
http://www.statistics.gov.uk/articles/hsq/1420.pdf. [Accessed on 5
February 2010]
Appendix 1
==========

Mortality counts, crude and age standardised rates: 1998 to 2007
Betsi Cadwaladr University LHB
All causes, all persons aged under 75
Number, Rates and Confidence Intervals
Age group
 
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Count
2936
2973
2764
2677
2663
2638
2542
2596
2506
2503
Crude rate
490
496
458
442
438
432
415
424
408
406
LCL
380
383
353
339
335
328
316
317
303
298
EASR
394.1
397.3
366.3
352.9
348.6
341.4
328.6
329.4
315.1
310.1
UCL
409
412
381
367
362
355
342
343
328
323
Data source: ONS
The EASR for Betsi Cadwaladr University LHB:
*
fell every year from 1999 to 2007, with the exception of an
insignificant rise in 2005. The rate in 2007 was 21% lower than
the rate in 1998.
*
was lower than, or consistent with, the rate for Wales during this
period.
*
was in the middle of the range of rates of the seven new Local
Health Boards in 2007.

Mortality counts, crude and age standardised rates: 1998 to 2007
Powys Teaching LHB
All causes, all persons aged under 75
Number, Rates and Confidence Intervals
Age group
 
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
31.0
29.9
27.9
28.7
28.6
28.5
27.4
26.4
26.2
24.9
Count
554
520
464
504
496
488
485
455
446
426
Crude rate
485
456
406
441
432
421
415
388
378
360
LCL
338
314
276
296
293
285
275
257
250
231
EASR
368.8
344.2
303.6
324.6
322.1
313.2
301.9
283.4
276.1
255.8
UCL
402
376
334
355
353
344
331
312
304
283
Data source: ONS
The EASR for Powys Teaching LHB:
*
fell every year from 1999 to 2007, with the exception of an
insignificant rise between 2000 and 2001. The rate in 2007 was 31%
lower than the rate in 1998.
*
was consistently lower than the rate for Wales during this period.
*
was the lowest of the seven new Local Health Boards in 2007.

Mortality counts, crude and age standardised rates: 1998 to 2007
Hywel Dda LHB
All causes, all persons aged under 75
Number, Rates and Confidence Intervals
Age group
 
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Count
1630
1618
1450
1546
1532
1527
1443
1440
1370
1375
Crude rate
502
496
442
470
463
458
430
429
406
405
LCL
361
362
322
342
337
327
308
302
285
281
EASR
380.0
381.2
339.5
359.7
354.7
344.9
325.3
318.9
300.9
297.3
UCL
399
401
358
378
373
363
343
336
318
314
Data source: ONS
The EASR for Hywel Dda LHB:
*
fell every year from 1999 to 2007, with the exception of an
insignificant rise between 2000 and 2001. The rate in 2007 was 22%
lower than the rate in 1998.
*
was lower than, or consistent with, the rate for Wales during this
period.
*
was the second lowest out of the seven new Local Health Boards in
2007.

Mortality counts, crude and age standardised rates: 1998 to 2007
Abertawe Bro Morgannwg University LHB
All causes, all persons aged under 75
Number, Rates and Confidence Intervals
Age group
 
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Count
2326
2246
2162
2049
1991
2060
1961
1872
1929
1922
Crude rate
517
501
484
460
446
459
434
414
425
421
LCL
403
393
379
364
348
360
337
320
334
329
EASR
420.3
410.3
396.1
380.7
363.9
376.6
352.5
335.4
350.2
344.9
UCL
438
428
413
398
381
394
369
351
366
361
Data source: ONS
The EASR for Abertawe Bro Morgannwg University LHB:
*
fell every year from 1998 to 2002, and exhibited an overall
downward trend despite mild fluctuations in subsequent years. The
rate in 2007 was 18% lower than the rate in 1998.
*
was generally higher than, but consistent with, the rate for Wales
over the entire period.
*
was in the middle of the range of rates of the seven new Local
Health Boards in 2007

Mortality counts, crude and age standardised rates: 1998 to 2007
Cardiff and Vale University LHB
All causes, all persons aged under 75
Number, Rates and Confidence Intervals
Age group
 
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Count
1643
1691
1612
1472
1480
1482
1411
1378
1360
1426
Crude rate
415
426
404
370
371
371
351
341
333
346
LCL
363
380
370
336
338
339
323
312
306
319
EASR
381.8
399.3
389.0
354.4
356.6
356.8
340.7
329.0
323.1
336.7
UCL
401
419
409
373
375
376
359
347
341
355
Data source: ONS
The EASR for Cardiff & Vale University LHB:
*
fluctuated over the period but exhibited an overall downward
trend. The rate in 2007 was 12% lower than the rate in 1998. As
for the other south east LHBs an increase is apparent between 2006
and 2007.
*
was almost identical to the rate for Wales for most of the period.
*
was in the middle of the range of rates for the seven new Local
Health Boards for 2007.

Mortality counts, crude and age standardised rates: 1998 to 2007
Cwm Taf LHB
All causes, all persons aged under 75
Number, Rates and Confidence Intervals
Age group
 
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Count
1491
1501
1391
1293
1309
1305
1203
1200
1172
1303
Crude rate
551
558
521
486
493
491
451
450
439
488
LCL
450
458
427
400
403
400
360
360
350
392
EASR
474.1
482.0
451.2
423.1
426.5
422.9
381.1
381.5
371.2
413.9
UCL
499
507
476
447
450
447
403
404
393
437
Data source: ONS
The EASR for Cwm Taf LHB:
*
fluctuated over the period but exhibited an overall downward
trend. The rate in 2007 was 13% lower than the rate in 1998. An
unusually substantial increase between 2006 and 2007 is apparent.
These recent fluctuations will be further reviewed.
*
was higher than the rate for Wales for all of the period.
*
was the highest of the seven new Local Health Boards in 2007.

Mortality counts, crude and age standardised rates: 1998 to 2007
Aneurin Bevan LHB
All causes, all persons aged under 75
Number, Rates and Confidence Intervals
Age group
 
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Count
2517
2529
2423
2432
2316
2259
2234
2143
2059
2183
Crude rate
492
495
474
476
452
440
434
416
400
424
LCL
401
408
389
390
370
359
350
331
319
335
EASR
417.2
424.4
405.2
406.2
385.6
374.0
365.6
345.7
333.6
349.7
UCL
434
441
422
423
402
390
381
361
349
365
Data source: ONS
The EASR for Aneurin Bevan LHB:
*
fell every year from 2001 to 2006, and exhibited an overall
downward trend. The rate in 2007 was 16% lower than the rate in
1998. As for the other south east LHBs and increase is apparent
between 2006 and 2007.
*
was higher than, but sometimes consistent with, the rate for Wales
for all of the period.
*
was the second highest of the seven new Local Health Boards in
2007
Appendix 2
==========
Digestive System Mortality by ICD Code
Cwm Taf Health Board and Wales
Data source: ONS
 
Cwm Taf
Wales
 
Annual average deaths
% change
additional deaths
Annual average deaths
% change
additional deaths
ICD Code
2001/06
2007/08
2001/06
2007/08
K00-K14: Diseases of oral cavity, salivary glands and jaws
0
0
0
0
0
0
0
0
K20-K31: Diseases of oesophagus, stomach and duodenum
10
10
-3
0
86
75
-15
-11
K35-K38: Diseases of appendix
0
0
0
0
4
2
0
-2
K40-K46: Hernia
2
2
0
1
11
16
29
5
K50-K52: Noninfective enteritis and colitis
1
2
0
0
17
22
23
5
K55-K63: Other diseases of intestines
17
19
10
2
115
124
7
9
K65-K67: Diseases of peritoneum
1
2
0
1
12
14
10
1
K70-K77: Diseases of liver
40
61
35
21
357
454
21
97
K80-K87: Disorders of gallbladder, biliary tract and pancreas
6
9
0
3
56
55
-2
-1
K90-K93: Other diseases of the digestive system
3
2
0
-1
18
20
9
2
Total
79
105
25
26
676
780
13
104
Date: 8 April 2010
Version: 1
Page: 8 of 42