Cardiovascular disease and Lancashire
Simon Collins Pubic health knowledge and intelligence analyst
Business Intelligence
May 2016
Cardiovascular disease and Lancashire
Cardiovascular disease
Cardiovascular diseases (CVD), sometimes referred to as circulatory diseases, are diseases of the
heart and blood vessels, including coronary heart disease (CHD), heart attack and stroke. CVD is
caused by reduced blood flow to the heart, brain or body caused by atheroma or thrombosis and is
common in people aged over 60.
The main causes of CVD are tobacco use, physical inactivity, an unhealthy diet and harmful alcohol
use.
Prevalence
Prevalence refers to the number of cases of a particular disease, which are present in a population at
a given time. It can be presented as a modelled estimate and as recorded prevalence. With the latter
of these referring to the number of known (recorded) cases of a particular disease within a population
group. In case of CVD, the recorded prevalence is based on the GP registered population.
The latest modelled estimates of CVD prevalence were developed in 2011 by the East of England
Public Health Authority (now part of Public Health England). According to the data the estimated
prevalence of cardiovascular disease in Lancashire-12 for people aged 16+ is 12.35% significantly
above the England (11.76%) and North West (12.27) estimates. Among the 12 Lancashire local
authorities, Burnley (13.99%), Fylde (14.34%), Lancaster (12.29%), Ribble Valley (13.06%), West
Lancashire (12.06%) and Wyre 13.90%) are all estimated to have significantly higher prevalence than
England.
Figure 1 : Modelled estimates of prevalence of CVD for 2011 by county districts (CD) 1
Recorded prevalence of CVD comes from the Quality and Outcomes Framework (QOF) disease
register and divided up over following conditions: Atrial fibrillation, coronary heart disease (CHD),
heart failure, hypertension, peripheral arterial disease and stroke & transient Ischaemic attack.
Patients may be present on more than of these CVD registers, making it difficult to determine the total
recorded CVD prevalence.
1
Source: East of England Public Health Observatory, 2011
1
Cardiovascular disease and Lancashire
Using the latest figures (2014/15) and concentrating on three of the key cardiovascular disease
groups, namely coronary heart disease (CHD), hypertension and stoke the following observations
were made :
Coronary heart disease (CHD)
 There are 48,018 people on the coronary heart disease (CHD) register, accounting for 4% of
the total GP-registered population of Lancashire-12.
 The 2011 estimates suggest there are 75,713 persons living in Lancashire-12 with CHD, an
increase on the recorded prevalence figure of 27,280 persons.
 All six CCGs in Lancashire-12 county have significantly higher prevalence of CHD than
England.
Hypertension
 There are 171,388 people on the hypertension disease register, accounting for 14.5% of the
GP registered population of Lancashire-12.
 The 2011 estimates suggest that the true hypertension prevalence in the GP registered
population of Lancashire-12 in 2011, was 25.8% (302,881 people), an increase on the
recorded prevalence figure of 131,493 persons.
 Four of the six CCGs in Lancashire-12 have significantly higher hypertension prevalence than
England : Chorley & South Ribble CCG, East Lancashire CCG, Fylde & Wyre CCG and West
Lancashire CCG.
Stroke
 There are 23,827 people on the stroke and transient ischaemic attack disease register,
accounting for 2% of the total GP registered population of Lancashire-12.
 The 2011 estimates suggest that the true stroke prevalence in the GP registered population of
Lancashire-12 in 2011, was 2.73% (32,296), an increase on the recorded prevalence figure of
8,835 persons.
 All six CCGs in Lancashire-12 have significantly higher stroke and transient ischaemic attack
prevalence than England.
Where the recorded prevalence was found to be significantly above the national prevalence, it is
important to note that this could be interpreted as a positive finding, indicating that the CCGs in
question have affective screening and diagnosis place that are successfully at identifying and
diagnosing patients.
Some of the differences seen between the recorded and estimated prevalence may be down to
undiagnosed cases were individuals are unware that they have a particular health condition. It is
possible that one of the outcomes of the Health Checks programme will be that CCGs and practices,
see an increase in the number of people on certain disease registers, such as the CVD registers. As
undiagnosed cases are identified and patients are added to the registers, ensuring they given the
support and treatment they require.
2
Cardiovascular disease and Lancashire
Mortality
Mortality from cardiovascular diseases has been gradually decreasing since 1995 and in
recent years Lancashire-12 has recorded fewer deaths from these diseases than from
malignant cancers. Studies suggest that this decline is due to combination of improved
cardiac treatments and a drop in the associated risk factor levels such as the decline in
smoking prevalence and the national smoking ban. Despite this deaths from CVD accounted
for 28% of all morality across Lancashire-12 between 2012 and 2014, with just over a 10,000
deaths being recorded. This gave the county an all-age directly standardised mortality rate
per 100,000 of 292.57 significantly above the national rate of 267.31. At a district level it was
found that Burnley (351.58), Hyndburn (344.13), Lancaster (296.84), Pendle (307.32),
Preston (301.17) and Rossendale (340.84) all recorded all-age 2012-14 CVD mortality rates
significantly above the national rate.
Reducing premature mortality, referred to as mortality in persons aged 74 or under, is a
major priority of both Public Health England and the NHS, with the NHS Health Check
programme playing a key role in achieving this goal. Around two-thirds of deaths among the
under 75s are caused by diseases and illnesses that are largely avoidable such as heart
disease and stroke (Department of Health's 'Living well for longer: a call to action to reduce
avoidable premature mortality' 2013). The latest published figures for Lancashire-12 show
that 27% of all CVD deaths recorded between 2012 and 2014 were considered premature
deaths, giving the county a directly standardised premature mortality rate per 100,000 of
85.53, significantly above the England rate of 75.72. Figure 5 below, provides a detailed
premature mortality breakdown for CVD by district and gender.
Figure 2 : CVD premature mortality Directly standardised rate per 100,000, 2012-2014 by England, North
West, Lancashire county and Lancashire county Districts (CD).
3
Cardiovascular disease and Lancashire
As with the all-age CVD mortality rate, the under 75 mortality rate is also declining at both a national
and local level. However, Lancashire has experienced a slower decline in the total number of
premature deaths from CVD between 1995 and 2014 compared to England (-55% vs -53%). This
means the inequality gap in under 75 CVD mortality between Lancashire and England as a whole is
widening.
Figure 3 below shows the decline of both the total premature mortality count and the premature
mortality rate for the Lancashire-12, whilst figure 4 benchmarks the Lancashire-12 rate against the
England rate. This important as it shows that whilst premature mortality from CVD is reducing in
Lancashire, the county continues to perform poorly against the national rate.
Figure 3 : Lancashire-12 CVD premature mortality count and premature mortality directly standardised
rate per 100,000 – 1995 to 2014
Figure 4 : CVD premature mortality directly standardised rate per 100,000 – 1995 to 2014 – England and
Lancashire-12
4
Cardiovascular disease and Lancashire
Using locally held mortality data sets to establish the main cardiovascular diseases that are causing
premature death in Lancashire-12, showed that between 2012 and 2014 over half (55%) of such
deaths related to Ischaemic heart diseases, also known as coronary heart disease (CHD). Such
diseases are usually caused by a build-up of fatty deposits on the walls of the arteries around the
heart. An individual's risk of developing such diseases is increased if they smoke, have high blood
pressure, have high blood cholesterol levels, do not take regular exercise and have diabetes.
Cerebrovascular diseases, also known as stroke, accounted 19% of deaths during this period. Stroke
has the same risk factors as coronary heart disease plus excessive drinking.
Figure 5 : Proportion of premature mortality from CVD 2012-2014 by ICD-10 block
5