Briefing Paper: The Health of the Grampian population
1. Introduction
This briefing paper sets out information about the burden of disease in our local
population. It shows how our population profile is expected to change in the next
5 to 10 years. Understanding the make-up of the population is important if we are
to design health services that will provide the best possible care for people. Using
the demographic information and what we know about the prevalence of disease
we can build a profile of what services we need. Emphasis is placed on where
things need to change if we are to continue to improve the health of the
Grampian population and reduce health inequalities.
2 Population
2.2 Grampian has a census population of 544980, and includes some of the most
deprived areas is Scotland. The GP registered population is higher than the
census figure at 570,135 total registered population.
2.3 Population forecast highlights that the population of Grampian is changing; it is
estimated that the population of children aged 0-14 years is expected to decrease
from levels estimated in 2006 by about 12% by 2031 in Grampian. Similarly, the
population of those aged 15-64 years is expected to decrease by 5% from levels
estimated in 2006 while the population of those aged 65 years and over will
increase by 51% from levels estimated in 2006.
2.4 In 2008, the birth rate in Grampian was 59.5 births per 1000 women 15-44 years
of age. This was higher than the Scottish national average of 57.2 per 1000.
2.5 There are significant variations in demography between the 3 local authority
areas.
3 Life expectancy
3.2 Life expectancy and mortality trends are important indicators of the health of a
population, particularly when compared with other areas regionally and nationally.
It provides an indicator of the progress being made in addressing health
inequalities.
3.3 Life expectancy at birth has overall increased for both women and men in
Grampian over the past 20 years particularly in women. However, in 2005-2007
Grampian was ranked 3rd in Scotland compared to 2nd in 1995-1997.
3.4 There are significant variations between the 3 local authority areas with Aberdeen
City ranked 19th, Moray 17th and Aberdeenshire 3rd in 2005-2007 compared to
13th, 5th and 2nd respectively in 1995-1997 indicating that although life expectancy
is increasing, it is not at the same pace as seen in other local authority areas in
Scotland.
3.5 There are also significant variations in life expectancy between the sexes in
Grampian and the local authority areas.
3.6 Life expectancy is significantly lower in the most deprived 15% of the population
of Grampian.
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4 Life stages
4.2 The 4 main causes of hospital admission in all age groups are diseases of the
digestive system, injury and poisoning, diseases of the circulatory,
musculoskeletal and connective tissue and respiratory systems.
4.3
Children
4.3.1
Infant mortality is a useful indicator of the health of the overall population and
it is strongly associated with deprivation. Whilst infant mortality in Grampian is
not different from the Scottish national average of 4.5 per 1000 live births,
significant variations exist between the 3 CHP areas.
4.3.2
Two thirds of death in childhood occurs in children under the age of 1 year
and 50% of these occur before the age of 4 weeks.
4.3.3
The main causes of mortality in children aged between 1 and 14 years are
external causes 29% and cancer 18%.
4.3.4
There is a clear association between death in children and deprivation
4.3.5
Rates of childhood obesity are increasing in keeping with national trends.
4.3.6
Although recent survey suggests that the number of young people drinking
has decreased in Grampian, the average number of units consumed has
however increased.
4.3.7
Although uptake rates of immunisation against infectious diseases are above
national averages, Children in the more deprived areas appear to be
vaccinated at a later age compared with children in the less deprived areas
especially for MMR 2
4.3.8
Whilst teenage pregnancy rates in Grampian have been consistently lower
than Scottish national average since 2001, pregnancy rates in deprived areas
are more than three times those observed in the least deprived areas.
Significant variations in teenage pregnancy rates are also observed between
the 3 CHP areas.
4.3.9
In 2007, 20.3% of pregnant women were current smokers at their first
antenatal booking
4.3.10 5.7% of babies in Grampian were born with low birth weight, LBW (<2500
grams) in 2008/09. Aberdeen City had the highest rate of LBW at 6.5%.
4.4
Working age population
4.4.1
Analysis in our Population Needs Assessment shows that the main causes of
premature mortality in Grampian are cancer, coronary heart disease CHD,
injury and external causes highlighting a need for action in these areas.
4.4.2
There is a relationship between the level of mortality from these diseases and
lifestyle choices that increase the risk of them occurring. Smoking, alcohol
and obesity are particularly relevant.
4.4.3
In Grampian about 21% of the adult population are smokers. There is no
significant difference between the sexes in the level of smoking.
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4.4.4
A high proportion of smokers are from the most deprived community. In 2007,
42% of individuals in the 15% most deprived communities were smokers in
comparison to 23% in the rest of the population.
4.4.5
In Grampian, about 122,501 adults are estimated to be obese and 167,405
are overweight i.e. three out of five adults are either overweight or obese and
1 in 5 are obese. Individuals who are obese are at increased risk of type 2
diabetes, cancer, heart and liver disease.
4.4.6
The numbers of cancer cases diagnosed especially colorectal, breast, lung
and prostate are projected to increase during the period 2011-2020.
4.4.7
Uptake of colorectal screening is lower for men compared to women. Uptake
is particularly low in deprived areas.
4.4.8
A recent survey in Grampian indicates that whilst there have been
improvements in the level of oral health over the last 30 years, the majority
(54.6%) of adults in Grampian do not have access to regular NHS dental care
and 11.6% are unable to get any dental care.
4.5
Elderly population
4.5.1
Significant proportions of individuals aged 65 years and over in Grampian
have one or multiple long term conditions and this is bound to increase in the
future due the fact that this population group is increasing and people are also
living longer.
4.5.2
Fifty two percent (52%) of women and 48% of men aged 70 years and over
have long standing illnesses.
4.5.3
Forty percent (40%) of all admissions in Grampian in 2007/2008 were in
patients aged 65 years and older. Majority of this were emergency
admissions. Whilst many of these admissions are necessary on medical
grounds, there is recognition that better management of these conditions in
the community may prevent some of these admissions. This would be in line
with ‘shifting the balance of care’ agenda.
5
Mental health
5.2.1
It is estimated that the prevalence of new diagnoses of depression is about
5.78 per 100 registered patients in Grampian (QOF, 2009).
5.2.2
In 2007/08, 8% of all psychiatry admissions in Scotland were in Grampian.
5.2.3
Although the rate of suicide has remained relatively stable in male and
females since 1985 in Grampian, suicide rates in men are three to four times
those seen in women.
5.2.4
Suicide rates in 10-24 year olds in 2004-2008 in the least deprived areas of
Grampian were 3-4 times those seen in the least deprived areas.
6 Hospital Acquired Infection
6.2 In 2009, the overall rate of S. aureus bacteraemias for Grampian was 0.355 S.
aureus bacteraemia cases per 1000 acute occupied bed days (AOBDs). This
corresponds to a decrease of 6.5% compared to the previous quarter (from 0.355
to 0.332).
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6.3 Annual rates of clostridium difficile infection in patients 65 years and older in
Grampian has fallen from 1.97 per 1000 total occupied bed days AOBDs in 2008
to 1.25 per total AOBDs 1000 in 2009.
6.4 Rates of CDI per 1000 total AOBDs in patients aged 15-64 years in acute
hospitals in Grampian has also decreased from 2008 rates.
7 Summary: What does this mean for service planners

An ageing population means that the prevalence of long term conditions including
dementia and certain cancers will increase thus putting greater demand on health
services in the future. End of life care will also become increasingly important.
Service planners need to take this into consideration.

The strong link between poverty, deprivation and many key measures of health in
children means that improving the health of children in Grampian is very much
linked to reducing health inequalities and should be a priority.

A relatively higher morbidity from diseases of the digestive system, injury and
poisoning, diseases of the circulatory, musculoskeletal and connective tissue and
respiratory systems in all age population groups highlights the need to prioritise
these areas.

A relatively higher mortality from cancer, CHD and injury in working age
population group highlights the need to tackle this area.

As a priority, smoking and obesity should be tackled since rising levels of both
lifestyle risk factors will reduce quality of life and life expectancy whilst placing
significant increased pressures on health services due to associated increases in
conditions such as diabetes, heart disease, arthritis, mental health problems and
cancers.

It is projected that there would be substantial increases in colorectal, breast and
lung cancers in the next 10 years relative to actual cases seen between 2001 and
2005. Colorectal and breast cancer can be prevented through screening. Explicit
plans to improve uptake of bowel cancer screening particularly among men and
breast cancer for women should be a priority.

Improving mental health especially tackling the inequality of suicide in men and
young people from deprived areas should be a priority.

Small pockets of vulnerable individuals that are hard to reach may not be
accessing services e.g. immunisation, screening, that they need to stay healthy
and it is important that NHS Grampian identifies ways to make these services
more accessible to the ‘hard to reach groups’.

The significantly high proportion of emergency admission in elderly requires a
review of emergency care utilisation to assess whether or not their care could
have been provided outside the hospital if different types of support were
available.

Improving access to dental care should continue to be a priority.
Dr E Okpo
Consultant in Public Health Medicine
November 2010
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