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SIMD 2009 Health Domain – Clarification of ISD indicators and data
ISD is responsible for the production of the majority of the Health domain indicators (see list
below) for SIMD 2009. This document briefly summarises for each indicator: the most up-todate calendar year data available; any issues surrounding the indicator (e.g. ICD10 codings,
any related targets etc); and advice given where applicable. It also answers queries that
arose from the 7 November 2008 meeting on SIMD Update and domain development –
Health Domain.
1.
2.
3.
4.
5.
Standardised all-cause mortality ratio
Hospital episodes relating to alcohol use
Hospital episodes relating to drug use
Emergency admissions to hospital
Proportion of the population who are prescribed drugs for anxiety, depression or
psychosis
6. Proportion of live singleton births of low birthweight
Standardised All-Cause Mortality Ratio
No suggestions for methodological changes or investigations arose at the 7 November 2008
meeting. Thus the indicator unchanged would yield the same definition and methodology,
differing only with years of information being used, i.e.

4-year cumulative deaths and mid-year population estimates produced by the GROS
(2004-2007) by sex and by 5-year age bands will be used to calculate actual deaths,
expected deaths and the indirectly standardised mortality ratio, for persons, by datazone.
Hospital Episodes Relating to Alcohol Use
A number of questions and suggestions surrounding this indicator were raised at the meeting,
in particular regarding comparability with the SG spending review national target (Alcoholrelated hospital admissions per 100,000 population).
http://www.scotland.gov.uk/Publications/2007/11/30090722/31

Should the ICD10 disease codes used match those used in the SG spending review
national target?
The ICD10 codes used for the national target are based on ISD’s current core alcoholrelated code set – see Appendix A.
ISD has recently carried out an in-depth internal review of its current core alcohol-related
code set. The purpose of the review is to define more precisely the set of ICD10 codes
that best capture those conditions that are wholly attributable to alcohol. This requires
consideration not only of the definitions of the codes but also the ways in which they are
used in practice. The review has resulted in changes to the current set of codes. Some
new codes have been added and others removed. The revised set of codes can be seen
in Appendix B. The impact of the proposed revised codings along with further information
on the review and resulting consultation process is available at:
http://www.alcoholinformation.isdscotland.org/alcohol_misuse/3986.html
ISD will use the current core alcohol-related code set until the ISD Alcohol Bulletin is
published on Tuesday 24th February, when it will adopt the revised code set.
As for whether any updated SG spending review national target will adopt this revised
code set, at present no talks have been held. A decision as to whether the SIMD 2009 will
adopt these revised codes will have to be made. ISD considers that the revised set of
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codes more accurately and precisely captures those conditions that are wholly
attributable to alcohol, and therefore would recommend that these codes be used.

Does the SG spending review national target include Psychiatric Hospital
Discharge Records (SMR04)?
It had been suggested at the meeting that if the national target indicator included SMR04,
then SIMD 2009 should also include it, otherwise not. The national target indicator
excluded SMR04 and was based solely on the number of general acute inpatient and day
case discharges (SMR01).
The data completeness of SMR04 is deemed good, with data for financial year 2006/07
considered complete and 2007 calendar year currently 98% complete. Including SMR04
discharges would add approximately 17,104p (7.3%) extra episodes over the time period
2004-2007. ISD would recommend the inclusion of the SMR04 data in producing the
SIMD 2009.
The following methodology used in calculating this indicator will be unchanged:


4-year cumulative hospital episodes, and mid-year population estimates produced by the
GROS (2004-2007) by sex and by 5-year age bands will be used to calculate actual
episodes, expected episodes and the indirectly standardised ratio, for persons, by
datazone.
Episodes that were transferred to another hospital are excluded from the data using the
‘discharge/transfer’ to code (Note: This applies to SMR01 data but not SMR04 data).
Transfers within the same hospital are included.
Hospital Episodes Relating to Drug Use
The ICD10 codes used for SIMD 2006 to identify episodes relating to drug use were:









F11 – Mental and behavioural disorders due to the use of opioids
F12 – Mental and behavioural disorders due to the use of cannabinoids
F13 – Mental and behavioural disorders due to the use of sedatives or hypnotics
F14 – Mental and behavioural disorders due to the use of cocaine
F15 – Mental and behavioural disorders due to the use of other stimulants, including
caffeine
F16 – Mental and behavioural disorders due to the use of hallucinogens
F17 – Mental and behavioural disorders due to the use of tobacco
F18 – Mental and behavioural disorders due to the use of volatile solvents
F19 – Mental and behavioural disorders due to multiple drug use and use of other
psychoactive substances
On consulting the Substance Misuse Team at ISD regarding the appropriateness of these
codings, it was found that they treat ‘Mental and behavioural disorders due to the use of
tobacco’ as a separate matter, and exclude F17 from any analysis regarding hospital
episodes relating to drug abuse. ISD therefore recommends excluding F17 in producing the
SIMD 2009.
ISD also recommends SMR04 data be included in producing the SIMD 2009. Including
SMR04 data would add approximately 6,585p (6.0%) extra episodes over the time period
2004-2007.
The following methodology used in calculating this indicator will be unchanged:
p
Provisional and undergoing quality assurance procedures, therefore caution is recommended when
interpreting these figures
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

4-year cumulative hospital episodes, and mid-year population estimates produced by the
GROS (2004-2007) by sex and by 5-year age bands will be used to calculate actual
episodes, expected episodes and the indirectly standardised ratio, for persons, by
datazone.
Episodes that were transferred to another hospital are excluded from the data using the
‘discharge/transfer’ to code. (Note: This applies to SMR01 data but not SMR04 data).
Transfers within the same hospital are included.
Emergency Admissions to Hospital
No suggestions for methodological changes or investigations were voiced at the meeting.
Thus the indicator definition and methodology remain unchanged apart from the years of data
used, i.e.


4-year cumulative emergency hospital episodes, and mid-year population estimates
produced by the GROS (2004-2007) by sex and by 5-year age bands will be used to
calculate actual episodes, expected episodes and the indirectly standardised ratio, for
persons, by datazone
Emergency Admission types: deliberate self inflicted injury or poisoning; road traffic
accident; home accident (includes accidental poisoning); other injury (includes accidental
poisoning); other (excludes accidental poisoning)
Proportion of the Population who are Prescribed Drugs for Anxiety, Depression
or Psychosis
Methodology for this indicator is not ideal, however at present this is the best thing available.
The methodology was also used in the Scottish Public Health Observatory (ScotPHO) Health
and Wellbeing Profiles:
http://www.scotpho.org.uk/home/Comparativehealth/Profiles/chp_profiles.asp
Both definition and methodology will remain unchanged from SIMD 2006 (see Appendix C).
Proportion of Live Singleton Births of Low Birthweight
There will be no definitional or methodological changes to this indicator. At present the
maternity data (SMR02) is 96% complete for calendar year 2007; however there is to be
another update by the end of the week (Friday 30th January) which may improve the
completeness a bit more.


Numerator – all live singleton births with weight <2,500g in a 4-year period (2004-2007)
Denominator – all live singleton births in a 4-year period (2004-2007).
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Appendix A: ISD’s current ICD10 codes used for reporting alcoholrelated discharges from Scottish hospitals
ICD 10 Code
Description
E24.4
Alcohol induced Pseudo-Cushing’s syndrome
E51.2
Wernicke’s Encephalopathy
E52
Niacin deficiency [pellara]
F10
Mental & behavioural disorders due to use of alcohol
G31.2
Degeneration of nervous system due to alcohol
G62.1
Alcoholic polyneuropathy
G72.1
Alcoholic myopathy
I42.6
Alcoholic cardiomyopathy
K29.2
Alcoholic gastritis
K70
Alcoholic liver disease
K86.0
Alcohol-induced chronic pancreatitis
O35.4
Maternal care for (suspected) damage to foetus from alcohol
P04.3
Foetus and newborn affected by maternal use of alcohol
Q86.0
Fetal alcohol syndrome (dysmorphic)
R78.0
Finding of alcohol in blood
T50.6
Antidotes and chelating agents, not elsewhere classified
T51.0
Toxic effect of ethanol
T51.1
Toxic effect of methanol
T51.9
Toxic effect of alcohol, unspecified
X45
Accidental poisoning by and exposure to alcohol
X65
Intentional self-poisoning by and exposure to alcohol
Y15
Poisoning by and exposure to alcohol undetermined intent
Y57.3
Alcohol deterrents
Y90
Evidence of alcohol involvement determined by blood alcohol level
Y91
Evidence of alcohol involvement determined by level intoxication
Z13.3
Special screening exam for mental/behavioural disorders
Z50.2
Alcohol rehabilitation
Z63.7
Other stressful life events affecting family and household
Z71.4
Alcohol abuse counselling and surveillance
Z72.1
Alcohol use
Z81.1
Family history of alcohol abuse
Z86.4
Personal history of psychoactive substance abuse
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Appendix B: ISD’s revised ICD10 codes used for reporting alcoholrelated discharges from Scottish hospitals
ICD 10 Code
Description
E24.4
Alcohol induced Pseudo-Cushing’s syndrome
E51.2
Wernicke’s Encephalopathy
F10
Mental & behavioural disorders due to use of alcohol
G31.2
Degeneration of nervous system due to alcohol
G62.1
Alcoholic polyneuropathy
G72.1
Alcoholic myopathy
I42.6
Alcoholic cardiomyopathy
K29.2
Alcoholic gastritis
K70
Alcoholic liver disease
K86.0
Alcohol-induced chronic pancreatitis
O35.4
Maternal care for (suspected) damage to foetus from alcohol
P04.3
Foetus and newborn affected by maternal use of alcohol
Q86.0
Fetal alcohol syndrome (dysmorphic)
R78.0
Finding of alcohol in blood
T51.0
Toxic effect of ethanol
T51.1
Toxic effect of methanol
T51.9
Toxic effect of alcohol, unspecified
X45
Accidental poisoning by and exposure to alcohol
X65
Intentional self-poisoning by and exposure to alcohol
Y15
Poisoning by and exposure to alcohol undetermined intent
Y57.3
Alcohol deterrents
Y90
Evidence of alcohol involvement determined by blood alcohol level
Y91
Evidence of alcohol involvement determined by level intoxication
Z50.2
Alcohol rehabilitation
Z71.4
Alcohol abuse counselling and surveillance
Z72.1
Alcohol use
The following codes were removed:
ICD 10 Code
Description
E52
Niacin deficiency [pellagra]
T50.6
Antidotes and chelating agents, not elsewhere classified
Z81.1
Family history of alcohol abuse
Z13.3
Special screening exam for mental/behavioural disorders
Z63.7
Other stressful life events affecting family and household
Z86.4
Personal history of psychoactive substance abuse
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The following codes have been newly included:
ICD 10 Code
Description
E24.4
Alcohol-induced Pseudo-Cushing’s syndrome
E51.2
Wernicke’s Encephalopathy
T51.1
Toxic effect of methanol
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APPENDIX C:
Proportion of population being prescribed drugs for anxiety or
depression or psychosis – further details
This indicator is the estimated number of patients being prescribed hypnotic, antipsychotic or
antidepressant drugs in 2007. This information is derived from prescriptions data at practice
level and Community Health Index (CHI) populations.
The Prescribing Team within ISD maintains a detailed database of all NHS prescriptions
dispensed in the community in Scotland. The information is supplied to ISD by Practitioner
Services Division (PSD) who are responsible for the processing and pricing of all
prescriptions dispensed in Scotland. Hypnotic, antipsychotic and antidepressant drugs can be
identified through the British National Formulary (BNF) Codes :
BNF 4.1.2 is Anxiolytics
BNF 4.2 is Antipsychotics
BNF 4.3 is Antidepressants
An average daily quantity (Defined Daily Doses - a World Health Organisation standard) for
each drug was used to calculate, from the weight of the total prescriptions, an average count
of people being prescribed any one of these drugs. The one year of data was treated as a
sample from time. If, for example, a person was given a daily prescription by their GP they
should appear 365 times within the year. Each prescription would therefore be counted as
1/365 of a person. By summing the whole year one person would be counted.
In this way the number of patients being prescribed hypnotic, antipsychotic or antidepressant
drugs for each practice can be calculated along with the rate. The number of patients in each
data zone being prescribed hypnotic, antipsychotic or antidepressant drugs can be estimated
using the practice rates and the population of each practice living in each data zone. The
source for this data is an extract from the CHI.
The final indicator is calculated by summing the estimated number of patients being
prescribed the various drugs and presenting this as a proportion of the data zone population
estimated from the CHI extract.
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