Cardiovascular Disease Joint Strategic Needs Assessment 2015 - … · Cardiovascular Disease...
Transcript of Cardiovascular Disease Joint Strategic Needs Assessment 2015 - … · Cardiovascular Disease...
Cardiovascular Disease Joint
Strategic Needs Assessment
2015
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Contents -
Section Number Section Page Number
1 Introduction 2
1.1 Population, Geography & Current CVD Prevalence
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1.2 Predicted Future CVD Prevalence 16
2 Epidemiology 19
2.1 Mortality (including premature mortality) overview
19
2.2 LCG/Deprivation Quintile Epidemiology Overview
25
2.2.1 Coronary Heart Disease 29
2.2.2 Heart Failure 34
2.2.3 Stroke 37
2.2.4 Hypertension 42
2.2.5 Angiography 44
2.2.6 Revascularisation 46
3 Lifestyle Determinants 48
3.1 Risk Factors Associated with Cardiovascular Disease Overview
48
3.2 Ethnicity 48
3.3 Smoking 53
3.4 Physical Inactivity 59
3.5 Poor Diet 61
3.6 Obesity 64
3.7 Harmful Use of Alcohol 69
3.8 Diabetes 72
3.9 Modifiable Risk Factors – Population Level Interventions
75
4 Services for Cardiovascular Disease
78
4.1 Health Checks in Primary Care 78
4.2 Hospital Services – Quality Standards & National Audit Data
79
4.2.1 Cardiovascular Disease (MINAP) 80
4.2.2 Stroke (SSNAP) 83
4.2.3 Tackling CHD Inequalities Programme
85
5 Evidence of Effectiveness 86
5.1 Individual Level Interventions 86
5.2 Population Level Interventions 91
5.3 Clinical Guidance & Quality Standards
96
5.4 Effective CVD Prevention Programmes
101
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1. Introduction
Joint Strategic Needs Assessments (JSNAs) analyse the health needs of populations to inform and
guide commissioning of health, well-being and social care services within local authority areas. The
JSNA process helps identify current and future health and wellbeing needs, leading to agreed
commissioning priorities to improve outcomes and reduce health inequalities.
JSNA analysis includes assessment of:
Demography
Social and environmental context
Lifestyle/Risk Factors
Burden of Ill-Health
Current service provision and projected future requirements
JSNAs contribute towards the evidence base that informs the decisions taken by our Health and Wellbeing Board to improve the health and wellbeing of everyone in Peterborough. This JSNA focuses specifically on cardiovascular disease (CVD) - an umbrella term for all diseases of the heart and circulation, including coronary heart disease (CHD), stroke and peripheral arterial disease. There are eight local commissioning groups (LCGs) within the remit of Cambridgeshire & Peterborough Clinical Commissioning Group, as highlighted in the below table. This JSNA focuses primarily on the two LCGs within C&P CCG that are most closely associated with Peterborough City Council, ‘Borderline LCG’ and ‘Peterborough LCG’. Data pertaining to other LCGs will be presented in other projects by Cambridgeshire County Council’s Public Health Intelligence team.
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Figure 1 – Cambridgeshire & Peterborough CCG Local Commissioning Group Data
Local Commissioning Group Number of General Practices Registered Population at
01/01/2015
Borderline 10 109,972
CAM Health 9 88,413
CATCH 28 232,971
Hunts Care Partners 17 123,020
Hunts Health 9 69,829
Isle of Ely 10 96,168
Peterborough 20 143,613
Wisbech 4 49,476
Total 107 913,462
Source: Cambridgeshire & Peterborough Clinical Commissioning Group Cardiovascular Disease Cardiovascular disease (CVD) is generally caused by reduced blood flow to the heart, brain or body due to atheroma or thrombosis (blockages of the arteries). It is increasingly common after the age of 60 and relatively rare below the age of 30. Plaques (plates) of fatty atheroma build up in arteries during adult life; these can eventually cause narrowing of the arteries, or trigger a local thrombosis (blood clot) which completely blocks blood flow.1 CVD causes more than a quarter of all deaths in the UK, or around 160,000 deaths each year. There are an estimated 7 million people living with CVD in the UK. The total cost of premature death, lost productivity, hospital treatment and prescriptions relating to cardiovascular disease is estimated at £19 billion.2 The Global Burden of Disease Study3 has demonstrated that the UK does not perform well compared with a range of similar countries in terms of CVD related mortality and disability. Coronary Heart Disease CHD is caused by the narrowing of coronary arteries (the arteries that supply the heart muscle with oxygen-rich blood) due to gradual build-up of fatty material –atheroma-within their walls. CHD is the UK's single biggest killer; nearly one in six men and one in ten women die from coronary heart disease4. CHD is responsible for around 73,000 deaths in the UK each year, an average of 200 people each day, or one every seven minutes. Around 23,000 people under the age of 75 in the UK die from CHD each year. Approximately 2.3 million people are living with CHD in the UK - over 1.4 million
1 NICE: Prevention of cardiovascular disease: https://www.nice.org.uk/guidance/ph25 2 British Heart Foundation: https://www.bhf.org.uk/~/media/files/research/heart-statistics/cardiovascular-disease-statistics---headline-statistics.pdf 3 The LANCET: http://www.thelancet.com/global-burden-of-disease 4 NHS: http://www.nhs.uk/Conditions/Coronary-heart-disease/Pages/Introduction.aspx
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men and 850,000 women. Death rates from coronary heart disease are highest in Scotland and the north of England and lowest in the south of England.2 Stroke & Transient Ischaemic Attack (TIA) A stroke happens when the blood supply to part of the brain is cut off, causing brain cells to become
damaged or die. The two most common types of stroke are ischaemic and haemorrhagic stroke:
Ischaemic strokes happen when the artery that supplies blood to the brain is blocked, for
example by a blood clot.
Haemorrhagic strokes happen when a blood vessel bursts and bleeds into the brain,
damaging brain tissue and depriving brain cells of blood and oxygen.
Without a constant blood supply, brain cells will be damaged or die, which can affect the way the
body and mind work. Stroke causes more than 40,000 deaths in the UK each year.5 In the UK there
are 235,000 hospital episodes attributed to stroke each year. It is estimated that 1.3 million people
living in the UK have had a stroke - 650,000 men and 650,000 women. Almost half of these people
are under the age of 75.2
A transient ischaemic attack (also called a TIA or mini-stroke) happens when there is a temporary blockage in the blood supply to the brain. A TIA doesn’t cause permanent damage to the brain and the symptoms usually pass within 24 hours.2 However, a TIA needs assessment for stroke risk and referral for investigation and preventive treatment.
Aortic Disease
The aorta is the largest blood vessel in the body. The most common type of aortic disease is an aortic
aneurysm, where the wall of the aorta becomes weakened and bulges outwards. The aorta is usually
around 2cm wide but can swell to over 5.5cm; if a large aneurysm bursts, it causes internal bleeding
and can cause death.
Abdominal aortic aneurysms (AAAs) are most common in men over 65; a rupture accounts for more
than 1 in 50 of all deaths in this group and a total of 6,000 deaths in England and Wales each year.6
All men are invited for a screening test when they turn 65. If there is evidence of widening of the
aorta they are offered an elective operation or followed up with repeat tests if the aneurysm does
not meet the threshold for surgery.
Peripheral Arterial Disease
Peripheral arterial disease (PAD), also known as peripheral vascular disease (PVD) is a condition in
which a build-up of fatty deposits (called atheroma and made up of cholesterol and other waste
substances) in the arteries restricts blood supply to leg muscles. Many people within the condition
have no symptoms. However it can cause pain in the legs when walking which usually disappears
after a short rest; this is known as ‘intermittent claudication’.7
5 Jump Start: http://jumpstartonline.co.uk/blog/11/heart-stroke-and-dvt/ 6 NHS: http://www.nhs.uk/conditions/repairofabdominalaneurysm/Pages/Introduction.aspx 7 http://www.nhs.uk/conditions/peripheralarterialdisease/Pages/Introduction.aspx
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PAD/PVD is most prevalent amongst people aged over 60, with one in five affected by the condition.
Men tend to develop the condition more often than women, and smokers, those with high blood
pressure/high cholesterol and those with type 1/type 2 diabetes are also more susceptible. The five
main suggestions recommended to mediate the risk of developing PAD/PVD are:
Stop smoking
Exercise regularly
Maintain a healthy weight
Eat a healthy diet
Moderate consumption of alcohol.
Vascular Dementia
Although having similar risk factors as CVD and being caused by similar processes in the blood
vessels of the brain, vascular dementia or vascular cognitive impairment is not included in this CVD
JSNA as dementia is classified as a mental disorder. A stroke, multiple small strokes or damage to the
small blood vessels in the brain can cause dementia. The NHS Health Check programme offers
information on the signs and symptoms of dementia to people over 65 years of age and identifies
vascular risk factors for all CVD in those age 40-75 without a pre-existing condition.
1.1 Population, Geography & Current CVD Prevalence
Data from the Cambridgeshire County Council Research Group showed Peterborough to have a
population of 183,700 in 2011. This is predicted to rise by 20.1% to 220,700 by 2021 and then a
further 6.6% to 235,300 by 2031. Population growth to 2021 is expected to be particularly high for
males in the 90+, 85-89, 70-74 and 5-9 age groups, with increases of 100.0%, 50.0%, 42.9% and
40.7% respectively. Among females, the highest growth predictions are for the 90+, 5-9, 70-74 and
35-39 age groups, with predicted rises of 50.0%, 43.6%, 43.3% and 32.3% respectively.
Figure 2 – Peterborough Population Projected to 2031
Source: Cambridgeshire County Council Research Group
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Comprehensive data regarding the overall demographics of Peterborough City Council, including a
detailed exploration of various population growth estimates, is included in our JSNA core dataset,
available via the Public Health Intelligence section of the Peterborough City Council website.
This JSNA assesses the current and future health needs of the population of the Borderline and
Peterborough Local Commissioning Groups (LCGs) via a focus on the number of people registered at
each of the 30 General Practices that comprise the two LCGs - 10 within Borderline and 20 within
Peterborough.
This focus on our 'GP Registered Population' allows us to utilise routinely published data at this level
and to concentrate on residents who attend practices within the remit of this JSNA, whilst
simultaneously excluding residents who may live in Peterborough but receive healthcare advice and
treatment at providers outside of the scope of this JSNA.
‘Deprivation quintile’ refers to the registered population’s level of deprivation as calculated by the
English Indices of Deprivation 2010 which collates data on seven different dimensions of deprivation
(income, employment, health/disability, education, crime, housing/services and living environment)
to give one final ‘deprivation score’8 indicating overall levels of deprivation. A placement in a higher
deprivation quintile suggests higher levels of deprivation amongst a population, therefore quintile 1 =
least deprived and quintile 5 = most deprived.
The table below shows the composition of quintiles of deprivation within Cambridgeshire &
Peterborough CCG. Borderline & Peterborough registered populations account for 17 of 22 (77.3%)
of practices in the most deprived quintile and 24 of 43 (55.8%) of practices within the most deprived
two quintiles in the CCG. Conversely, Borderline & Peterborough registered populations comprise
only 2 of 42 (4.8%) practices in the least deprived two quintiles.
Figure 3: Cambridgeshire & Peterborough CCG Practices by Quintile of Deprivation
LCG Quintile 1 (Least Deprived) Quintile 2 Quintile 3 Quintile 4 Quintile 5 (Most Deprived) Total
BORDERLINE 0 2 2 4 2 10
CAM HEALTH 2 2 2 2 1 9
CATCH 14 5 6 3 0 28
HUNTS CARE PARTNERS 4 5 5 3 0 17
HUNTS HEALTH 0 3 4 2 0 9
ISLE OF ELY 1 4 1 4 0 10
PETERBOROUGH 0 0 2 3 15 20
WISBECH 0 0 0 0 4 4
QUINTILE TOTAL 21 21 22 21 22 107
Source: Quintiles generated based on ranks of Index of Multiple Deprivation Scores 2010
8 UK Govt: http://data.gov.uk/dataset/index-of-multiple-deprivation
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The tables and map below outline the geographical location of each of the 30 general practices within
the Borderline & Peterborough LCGs.
Figure 4: Borderline & Peterborough LCGs General Practices
# Local Commissioning Group Practice
Code Practice Name
1 Borderline D81020 NENE VALLEY MEDICAL PRACTICE
2 Borderline D81022 THORNEY
3 Borderline D81029 OLD FLETTON SURGERY
4 Borderline D81031 YAXLEY GROUP PRACTICE
5 Borderline D81039 JENNER HEALTH CENTRE
6 Borderline D81046 NEW QUEEN STREET SURGERY
7 Borderline D81053 BRETTON MEDICAL PRACTICE
8 Borderline D81630 HAMPTON HEALTH
9 Borderline K83017 WANSFORD SURGERY
10 Borderline K83023 OUNDLE
11 Peterborough D81006 NORTH STREET MED.PRACTICE
12 Peterborough D81007 PARK MEDICAL CENTRE
13 Peterborough D81019 MINSTER MEDICAL PRACTICE
14 Peterborough D81023 PASTON HEALTH CENTRE
15 Peterborough D81024 THOMAS WALKER
16 Peterborough D81026 LINCOLN ROAD SURGERY
17 Peterborough D81063 WESTGATE
18 Peterborough D81065 WELLAND MEDICAL PRACTICE
19 Peterborough D81073 WESTWOOD CLINIC
20 Peterborough D81605 HUNTLY GROVE PRACTICE
21 Peterborough D81615 THORPE ROAD SURGERY
22 Peterborough D81616 HODGSON MEDICAL CENTRE
23 Peterborough D81618 AILSWORTH MEDICAL CENTRE
24 Peterborough D81620 PARNWELL MEDICAL CENTRE
25 Peterborough D81624 DOGSTHORPE MEDICAL CENTRE
26 Peterborough D81625 THISTLEMOOR MEDICAL CENTRE
27 Peterborough D81629 BUSHFIELD
28 Peterborough D81631 MILLFIELD MEDICAL CENTRE
29 Peterborough D81645 THE GRANGE MEDICAL CENTRE
30 Peterborough Y00486 BOTOLPH BRIDGE COMMUNITY HEALTH
Source: Cambridgeshire & Peterborough Clinical Commissioning Group
Figure 5: Borderline & Peterborough LCG General Practice Map
Source: Ordnance Survey /Cambridgeshire & Peterborough CCG
The table below describes GP registered populations for the practices within the Borderline and Peterborough LCGs for 2013/14, the most recent time period for which
practice-level QOF data are available for many of the indicators used within this JSNA. Practices are ranked by total registered population. Where a practice is geographically
located within a Peterborough City Council Electoral Ward, the ward is stated in column ‘Ward – Geographically located within’. The adjacent column ‘Ward – Majority
population registered within’ shows where the majority of residents registered with the practice live.
Figure 6: Borderline LCG & Peterborough LCG General Practice Overview 2013/14
LCG Practice Name Ward - Geographically located within Ward - Majority population registered
within Deprivation
Quintile* Population
Borderline NEW QUEEN STREET SURGERY N/A (Outside Peterborough UA) N/A (Outside Peterborough UA) 2 15,993
Peterborough NORTH STREET MED.PRACTICE Central East 4 15,506
Borderline YAXLEY GROUP PRACTICE N/A (Outside Peterborough UA) N/A (Outside Peterborough UA) 1 15,295
Peterborough THISTLEMOOR MEDICAL CENTRE North North 4 14,199
Peterborough PASTON HEALTH CENTRE Paston Paston 4 13,341
Borderline NENE VALLEY MEDICAL PRACTICE Orton Longueville Orton Longueville 4 12,054
Borderline BRETTON MEDICAL PRACTICE Bretton North Bretton North 5 11,915
Peterborough MILLFIELD MEDICAL CENTRE Park Central 5 11,798
Borderline OLD FLETTON SURGERY Fletton Fletton 3 11,720
Borderline OUNDLE N/A (Outside Peterborough UA) N/A (Outside Peterborough UA) 1 10,892
Peterborough LINCOLN ROAD SURGERY Central Werrington South 3 10,736
Peterborough WESTGATE Central Central 5 9,793
Peterborough PARK MEDICAL CENTRE Park Park 4 8,884
Borderline HAMPTON HEALTH Orton & Hampton Orton & Hampton 1 8,193
Borderline JENNER HEALTH CENTRE N/A (Outside Peterborough UA) N/A (Outside Peterborough UA) 2 7,975
Borderline THORNEY Eye & Thorney Eye & Thorney 2 7,653
Peterborough THOMAS WALKER Park Park 3 6,976
Peterborough BOTOLPH BRIDGE COMMUNITY HEALTH Fletton Fletton 2 6,821
Borderline WANSFORD SURGERY N/A (Outside Peterborough UA) N/A (Outside Peterborough UA) 1 6,794
Peterborough BUSHFIELD Orton Waterville Orton Waterville 4 5,439
Peterborough WESTWOOD CLINIC Ravensthorpe Ravensthorpe 5 5,134
Peterborough THORPE ROAD SURGERY West West 2 5,076
Peterborough DOGSTHORPE MEDICAL CENTRE Welland Welland 5 4,914
Peterborough WELLAND MEDICAL PRACTICE Dogsthorpe Dogsthorpe 5 4,387
Peterborough MINSTER MEDICAL PRACTICE Park East 3 3,982
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LCG Practice Name Ward - Geographically located within Ward - Majority population registered
within Deprivation
Quintile* Population
Peterborough HODGSON MEDICAL CENTRE Werrington North Werrington North 1 3,949
Peterborough THE GRANGE MEDICAL CENTRE West West 2 2,941
Peterborough AILSWORTH MEDICAL CENTRE Glinton & Wittering Glinton & Wittering 1 2,367
Peterborough HUNTLY GROVE PRACTICE Park Park 3 2,051
Peterborough PARNWELL MEDICAL CENTRE East East 3 1,632
Source: Public Health England, National General Practice Profiles
*Quintiles in this table calculated for the 30 practices that comprise Borderline & Peterborough LCGs only.
Figure 7: Estimated General Practice Populations 65+, 2021 & 2031
The table below estimates population growth by registered practice of resident for the 65+ and 85+ age groups to illustrate possible future CVD burden, based on
Cambridgeshire Research Group estimates of 12.06% population growth between 2015-2021 and 22.5% between 2015 and 2031. April 2015 population totals are used as
the baseline, rather than the 2013/14 populations used above (which are required due to the most recent available QOF data covering the 2013/14 period). This
methodology is relatively crude due to being based on current population estimates; actual changes will vary depending on future demographic changes and planned
housing development. The number of residents aged 65+ registered with Borderline/Peterborough LCG practices in April 2015 is 35,732 for April 2015 and is estimated to
increase to 40,041 by 2021 and subsequently to 49,051 by 2031. 4,772 persons aged 85 or older were registered with a Borderline/Peterborough LCG practice in April 2015;
this is predicted to rise to 5,348 by 2021 and 6,551 by 2031.
Blue = Borderline LCG Practice
Green = Peterborough LCG Practice
GP NAME Total Population
2015 Estimated Total 2021 Estimated Total 2031 Total 65+ 2015
Total 65+ 2021
Total 65+ 2031 Total 85+ 2015 Total 85+ 2021 Total 85+ 2031
AILSWORTH MEDICAL CENTRE 2,343 2,626 2,870 405 454 556 48 54 66
BOTOLPH BRIDGE COMMUNITY HEALTH 6,823 7,646 8,358 525 588 721 56 63 77
BRETTON MEDICAL PRACTICE 11,924 13,362 14,607 1,572 1,762 2,158 146 164 200
BUSHFIELD 5,446 6,103 6,671 685 768 940 93 104 128
DOGSTHORPE MEDICAL CENTRE 4,939 5,535 6,050 314 352 431 36 40 49
HAMPTON HEALTH 8,295 9,295 10,161 413 463 567 97 109 133
HODGSON MEDICAL CENTRE 4,001 4,484 4,901 469 526 644 69 77 95
HUNTLY GROVE PRACTICE 2,052 2,299 2,514 448 502 615 57 64 78
JENNER HEALTH CENTRE 7,929 8,885 9,713 1,836 2,057 2,520 271 304 372
LINCOLN ROAD SURGERY 10,674 11,961 13,076 2,148 2,407 2,949 319 357 438
MILLFIELD MEDICAL CENTRE 12,060 13,514 14,774 568 637 780 78 87 107
MINSTER MEDICAL PRACTICE 3,998 4,480 4,898 802 899 1,101 120 134 165
NENE VALLEY MEDICAL PRACTICE 12,114 13,575 14,840 1,548 1,735 2,125 165 185 227
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GP NAME Total Population
2015 Estimated Total 2021 Estimated Total 2031 Total 65+ 2015
Total 65+ 2021
Total 65+ 2031 Total 85+ 2015 Total 85+ 2021 Total 85+ 2031
NEW QUEEN STREET SURGERY 16,126 18,071 19,754 2,942 3,297 4,039 350 392 480
NORTH STREET MED.PRACTICE 15,496 17,365 18,983 3,083 3,455 4,232 480 538 659
OLD FLETTON SURGERY 11,757 13,175 14,402 2,101 2,354 2,884 304 341 417
OUNDLE 10,792 12,094 13,220 2,324 2,604 3,190 324 363 445
PARK MEDICAL CENTRE 8,893 9,965 10,894 1,365 1,530 1,874 224 251 307
PARNWELL MEDICAL CENTRE 1,660 1,860 2,034 111 124 152 11 12 15
PASTON HEALTH CENTRE 13,449 15,071 16,475 1,558 1,746 2,139 222 249 305
THE GRANGE MEDICAL CENTRE 2,927 3,280 3,586 321 360 441 51 57 70
THISTLEMOOR MEDICAL CENTRE 14,495 16,243 17,756 836 937 1,148 72 81 99
THOMAS WALKER 6,964 7,804 8,531 1,324 1,484 1,818 215 241 295
THORNEY 7,659 8,583 9,382 1,525 1,709 2,093 191 214 262
THORPE ROAD SURGERY 5,154 5,776 6,314 660 740 906 83 93 114
WANSFORD SURGERY 6,851 7,677 8,392 1,495 1,675 2,052 219 245 301
WELLAND MEDICAL PRACTICE 4,353 4,878 5,332 313 351 430 21 24 29
WESTGATE 9,914 11,110 12,145 1,150 1,289 1,579 176 197 242
WESTWOOD CLINIC 5,121 5,739 6,273 537 602 737 42 47 58
YAXLEY GROUP PRACTICE 15,386 17,242 18,848 2,354 2,638 3,231 232 260 318
Borderline LCG Total 108,833 121,958 133,320 10,248 11,484 14,068 1,383 1,550 1,898
Peterborough LCG Total 140,762 157,738 172,433 25,484 28,557 34,983 3,389 3,798 4,652
Peterborough & Borderline LCG Total 249,595 279,696 305,754 35,732 40,041 49,051 4,772 5,348 6,551
Source: Cambridgeshire County Council Research Group
Figure 8: CVD & Associated Conditions by Practice
The table below ranks the practices within Borderline & Peterborough LCGs by estimated prevalence
of cardiovascular disease and also provides prevalence estimates for coronary heart disease,
hypertension and stroke. These data are based on the Quality Outcomes Framework (QOF). QOF
data are collected by primary care services (general practices). They represent GP diagnosed disease
and hence GP recorded levels of illness (prevalence), rather than true population prevalence which
would include undiagnosed disease. QOF data are not available by age and hence a practice, or a
geographic area, with a relatively older population would expect to have a higher level of disease
than an area with a younger population, for most cardiovascular diseases.
Comparisons of local values to local or national benchmarks are made through an assessment of
‘statistical significance’. 95% confidence intervals provide a measure of uncertainty around a
calculated value which arises due to random variation. If the confidence interval for a local value
excludes the value for the benchmark, the difference between the local value and the benchmark is
said to be ‘statistically significant’.
The percentage of the population aged over 40 (the age at which it is first possible to receive an NHS
Health Check)9; over 60 and over 80 is also included. Dark blue cells represent a percentage above
the Peterborough value whereas light blue cells represent a percentage below the Peterborough
value.
This table illustrates that a key contributing factor to the expected prevalence of CVD and associated
conditions is an older population, even if the population is relatively affluent. Need in relation to
CVD is likely to be highest in areas of relative deprivation with an older population and the below
data suggest need to be highest for populations within the electoral wards of Park, Central, East and
Fletton. Prevalence calculations are taken from Public Health England’s National GP Practice
Profiles.10
9 NHS: http://www.nhs.uk/Conditions/nhs-health-check/Pages/NHS-Health-Check.aspx 10 http://fingertips.phe.org.uk/profile/general-practice
LCG Practice Name Ward - Geographically
located within
Ward - Majority population registered
within
Deprivation Quintile*
Age 40+
Age 60+ Age 80+
Estimated prevalence of CVD (%,
all ages) 2011
Estimated prevalence of CHD (%,
all ages) 2011
Estimated prevalence of
hypertension (%, all ages) 2011
Estimated prevalence of stroke (%, 2011, all
ages)
Peterborough MINSTER MEDICAL
PRACTICE Park East 3 54.6% 26.4% 5.9% 11.5 6.2 29.5 2.7
Peterborough HUNTLY GROVE
PRACTICE Park Park 3 53.3% 26.3% 6.6% 10.9 6.2 27.8 2.5
Peterborough NORTH STREET MED.PRACTICE
Central East 2 51.2% 25.8% 6.2% 10.6 5.7 27.4 2.4
Peterborough THOMAS WALKER Park Park 3 50.6% 25.3% 6.3% 10.6 5.6 27.3 2.4
Peterborough LINCOLN ROAD
SURGERY Central Werrington South 3 51.7% 25.4% 6.3% 10.5 5.6 27.1 2.4
Borderline JENNER HEALTH CENTRE N/A (Outside Peterborough
UA) N/A (Outside
Peterborough UA) 4 58.0% 29.0% 7.0% 10.9 5.4 28.8 2.4
Borderline OLD FLETTON SURGERY Fletton Fletton 3 50.3% 23.1% 5.2% 10.1 5.3 26.3 2.2
Borderline WANSFORD SURGERY N/A (Outside Peterborough
UA) N/A (Outside
Peterborough UA) 1 60.8% 28.8% 5.4% 10.8 4.9 27.0 2.2
Peterborough PARK MEDICAL CENTRE Park Park 2 46.7% 20.1% 4.9% 9.0 4.8 24.1 2.0
Borderline THORNEY Eye & Thorney Eye & Thorney 4 54.1% 25.4% 5.1% 9.7 4.7 26.6 2.0
Borderline NEW QUEEN STREET
SURGERY N/A (Outside Peterborough
UA) N/A (Outside
Peterborough UA) 4 52.9% 24.4% 4.8% 9.7 4.7 26.5 2.0
Peterborough AILSWORTH MEDICAL
CENTRE Glinton & Wittering Glinton & Wittering 1 56.1% 23.8% 4.8% 9.2 4.1 24.2 1.9
Borderline BRETTON MEDICAL
PRACTICE Bretton North Bretton North 5 43.6% 18.5% 2.7% 8.0 4.1 22.2 1.7
Borderline NENE VALLEY MEDICAL
PRACTICE Orton Longueville Orton Longueville 2 42.8% 17.5% 2.8% 8.0 4.0 22.2 1.7
Peterborough WESTGATE Central Central 5 41.3% 16.0% 3.7% 8.2 4.0 22.0 1.7
Peterborough THE GRANGE MEDICAL
CENTRE West West 4 39.4% 16.8% 3.2% 7.4 3.9 20.9 1.5
Peterborough WELLAND MEDICAL
PRACTICE Dogsthorpe Dogsthorpe 5 32.3% 10.0% 1.4% 6.6 3.9 16.9 1.5
Borderline OUNDLE N/A (Outside Peterborough
UA) N/A (Outside
Peterborough UA) 1 56.4% 27.6% 5.5% 9.6 3.9 25.4 1.8
Peterborough PASTON HEALTH
CENTRE Paston Paston 2 42.5% 16.1% 3.3% 7.7 3.8 21.2 1.6
Peterborough DOGSTHORPE MEDICAL
CENTRE Welland Welland 5 30.2% 9.4% 1.5% 6.4 3.7 16.3 1.4
Borderline YAXLEY GROUP
PRACTICE N/A (Outside Peterborough
UA) N/A (Outside
Peterborough UA) 1 49.8% 20.8% 3.0% 8.6 3.6 21.9 1.7
Peterborough THORPE ROAD SURGERY West West 4 45.8% 17.0% 3.2% 7.9 3.6 22.4 1.6
Peterborough BUSHFIELD Orton Waterville Orton Waterville 2 43.6% 18.1% 3.5% 7.3 3.6 20.5 1.5
Peterborough WESTWOOD CLINIC Ravensthorpe Ravensthorpe 5 39.8% 14.4% 2.0% 7.1 3.5 20.0 1.4
Peterborough HODGSON MEDICAL
CENTRE Werrington North Werrington North 1 49.9% 16.5% 3.4% 7.6 3.3 22.0 1.5
Peterborough THISTLEMOOR MEDICAL
CENTRE North North 2 33.0% 9.3% 1.3% 6.0 2.7 17.0 1.1
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LCG Practice Name Ward - Geographically
located within
Ward - Majority population registered
within
Deprivation Quintile*
Age 40+
Age 60+ Age 80+
Estimated prevalence of CVD (%,
all ages) 2011
Estimated prevalence of CHD (%,
all ages) 2011
Estimated prevalence of
hypertension (%, all ages) 2011
Estimated prevalence of stroke (%, 2011, all
ages)
Peterborough MILLFIELD MEDICAL
CENTRE Park Central 5 24.8% 6.5% 1.4% 5.8 2.7 14.6 1.2
Peterborough BOTOLPH BRIDGE
COMMUNITY HEALTH Fletton Fletton 4 36.0% 10.9% 1.9% 6.0 2.4 17.0 1.1
Peterborough PARNWELL MEDICAL
CENTRE East East 3 32.2% 10.1% 1.3% 5.6 2.3 16.1 1.0
Borderline HAMPTON HEALTH Orton & Hampton Orton & Hampton 1 29.5% 6.8% 1.8% 4.7 1.4 12.0 0.8
- Cambridgeshire & Peterborough CCG
- - - 47.9% 21.2% 4.3% 8.9 4.0 23.2 1.8
- England - - - 49.3% 22.1% 4.6% 9.5 4.7 24.7 2.1
Source: Public Health England, National General Practice Profiles
*Quintiles calculated for the 30 practices that comprise Borderline & Peterborough LCGs only.
1.2 Predicted Future CVD Prevalence
Figure 9: CVD & Associated Conditions – Predicted Future Prevalence11
The table below illustrates predicted growth rates in numbers of residents registered to GP Practices within the Borderline & Peterborough LCGs. These figures are based
on current disease prevalence estimates from Public Health England12 and the Cambridgeshire Research Group’s growth predictions to 2031, which suggest population
growth of 12.06% over the 6 years 2015-2021 and 22.5% over the 16 years 2015-2031. The estimates are resultantly susceptible to revision based on future demographic
changes, local growth/housing strategy etc. Most data within this JSNA are based on 2013/14 national GP practice profiles, to allow us to fully assess all available
information. However, the below table includes registered population data from April 2015 to allow us to more accurately project future demand; population numbers
therefore differ between this table and others within the JSNA based on published 2013/14 data.
LCG Practice
Code Practice Name
Ward - Geographically located within
Ward - Majority
population registered
within
Deprivation Quintile
Total Registered Population
Estimated persons with CVD Estimated persons with CHD Estimated persons with
hypertension Estimated persons with
stroke
2015 2021 2031 2015 2021 2031 2015 2021 2031 2015 2021 2031
Borderline D81046 NEW QUEEN
STREET SURGERY
N/A (Outside Peterborough
UA)
N/A (Outside Peterborough
UA) 2 16,126 1,486 1,673 1,890 669 753 851 3,902 4,393 4,963 312 351 396
Peterborough D81006 NORTH STREET MED.PRACTICE
Central East 4 15,496 1,402 1,578 1,783 736 829 936 3,741 4,212 4,759 308 347 392
Borderline D81031 YAXLEY GROUP
PRACTICE
N/A (Outside Peterborough
UA)
N/A (Outside Peterborough
UA) 1 15,386 1,219 1,372 1,550 557 627 708 3,450 3,885 4,389 241 272 307
Peterborough D81625 THISTLEMOOR
MEDICAL CENTRE
North North 4 14,495 866 975 1,102 341 384 434 2,465 2,776 3,136 155 174 197
Peterborough D81023 PASTON HEALTH CENTRE
Paston Paston 4 13,449 1,421 1,600 1,808 767 864 976 3,685 4,150 4,688 323 363 410
Borderline D81020 NENE VALLEY
MEDICAL PRACTICE
Orton Longueville
Orton Longueville
4 12,114 1,325 1,492 1,686 754 849 959 3,367 3,791 4,283 307 346 391
Peterborough D81631 MILLFIELD MEDICAL CENTRE
Park Central 5 12,060 1,166 1,313 1,483 561 632 714 3,194 3,597 4,063 245 276 312
Borderline D81053 BRETTON MEDICAL PRACTICE
Bretton North Bretton North 5 11,924 1,373 1,546 1,747 744 837 946 3,520 3,963 4,477 316 356 402
11 PHE: http://fingertips.phe.org.uk/profile/general-practice 12 PHE: http://fingertips.phe.org.uk/profile/general-practice/data
17
LCG Practice
Code Practice Name
Ward - Geographically located within
Ward - Majority
population registered
within
Deprivation Quintile
Total Registered Population
Estimated persons with CVD Estimated persons with CHD Estimated persons with
hypertension Estimated persons with
stroke
2015 2021 2031 2015 2021 2031 2015 2021 2031 2015 2021 2031
Borderline D81029 OLD FLETTON
SURGERY Fletton Fletton 3 11,757 1,235 1,391 1,571 663 747 843 3,183 3,584 4,049 280 316 357
Borderline K83023 OUNDLE N/A (Outside Peterborough
UA)
N/A (Outside Peterborough
UA) 1 10,792 688 774 875 402 452 511 1,762 1,984 2,241 152 171 194
Peterborough D81026 LINCOLN ROAD
SURGERY Central
Werrington South
3 10,674 620 698 789 285 321 362 1,563 1,760 1,988 126 142 160
Peterborough D81063 WESTGATE Central Central 5 9,914 1,080 1,216 1,374 531 598 675 2,855 3,215 3,631 236 265 300
Peterborough D81007 PARK MEDICAL
CENTRE Park Park 4 8,893 708 797 901 361 406 459 1,974 2,222 2,510 147 166 187
Borderline D81630 HAMPTON
HEALTH Orton &
Hampton Orton &
Hampton 1 8,295 391 440 497 118 133 150 996 1,121 1,267 62 70 79
Borderline D81039 JENNER HEALTH
CENTRE
N/A (Outside Peterborough
UA)
N/A (Outside Peterborough
UA) 2 7,929 773 870 983 373 420 475 2,113 2,379 2,688 162 182 206
Borderline D81022 THORNEY Eye & Thorney Eye & Thorney 2 7,659 772 870 982 402 453 512 2,013 2,267 2,561 171 193 218
Peterborough D81024 THOMAS WALKER
Park Park 3 6,964 496 558 631 242 273 308 1,392 1,568 1,771 99 112 126
Borderline K83017 WANSFORD
SURGERY
N/A (Outside Peterborough
UA)
N/A (Outside Peterborough
UA) 1 6,851 726 817 923 387 436 492 1,869 2,105 2,378 166 186 211
Peterborough Y00486
BOTOLPH BRIDGE
COMMUNITY HEALTH
Fletton Fletton 2 6,823 407 459 518 185 208 235 1,157 1,302 1,471 76 86 97
Peterborough D81629 BUSHFIELD Orton
Waterville Orton
Waterville 4 5,446 444 500 565 218 246 278 1,197 1,348 1,522 94 106 120
Peterborough D81615 THORPE ROAD
SURGERY West West 2 5,154 444 500 565 188 212 239 1,127 1,268 1,433 86 97 110
Peterborough D81073 WESTWOOD
CLINIC Ravensthorpe Ravensthorpe 5 5,121 286 322 363 120 135 153 822 926 1,046 52 58 66
Peterborough D81624 DOGSTHORPE
MEDICAL CENTRE
Welland Welland 5 4,939 361 406 459 176 198 224 1,012 1,140 1,287 73 83 93
Peterborough D81065 WELLAND MEDICAL PRACTICE
Dogsthorpe Dogsthorpe 5 4,353 472 532 601 214 241 272 1,177 1,325 1,497 98 110 124
Peterborough D81616 HODGSON MEDICAL CENTRE
Werrington North
Werrington North
1 4,001 297 335 378 157 177 200 836 941 1,063 62 70 79
18
LCG Practice
Code Practice Name
Ward - Geographically located within
Ward - Majority
population registered
within
Deprivation Quintile
Total Registered Population
Estimated persons with CVD Estimated persons with CHD Estimated persons with
hypertension Estimated persons with
stroke
2015 2021 2031 2015 2021 2031 2015 2021 2031 2015 2021 2031
Peterborough D81019 MINSTER MEDICAL PRACTICE
Park East 3 3,998 304 343 387 133 150 169 880 991 1,119 59 66 75
Peterborough D81645 THE GRANGE
MEDICAL CENTRE
West West 2 2,927 193 217 245 114 129 145 495 558 630 43 48 55
Peterborough D81618 AILSWORTH
MEDICAL CENTRE
Glinton & Wittering
Glinton & Wittering
1 2,343 188 211 239 94 106 120 519 585 661 39 44 49
Peterborough D81605 HUNTLY GROVE
PRACTICE Park Park 3 2,052 197 221 250 79 89 101 522 588 664 36 41 46
Peterborough D81620 PARNWELL MEDICAL CENTRE
East East 3 1,660 127 143 162 63 71 80 351 396 447 26 29 33
Peterborough
LCG 140,762 14,167 15,952 18,020 6,955 7,832 8,847 37,776 42,536 48,051 2,997 3,375 3,812
Borderline LCG 108,833 7,300 8,220 9,286 3,679 4,143 4,680 19,365 21,805 24,632 1,556 1,752 1,979
Peterborough & Borderline LCGs
249,595 21,467 24,171 27,306 10,635 11,975 13,527 57,141 64,340 72,683 4,553 5,127 5,791
Source: Public Health England, National General Practice Profiles
*Quintiles calculated for the 30 practices that comprise Borderline & Peterborough LCGs only.
2. Epidemiology
2.1 Mortality (including premature mortality) overview
Figure 10: Public Health Outcomes Framework – Healthcare & Premature Mortality Overview13
Data from Public Health England show Peterborough to be a substantial negative outlier with regards mortality rates
from causes considered preventable and under 75 mortality rates from all cardiovascular diseases. Peterborough is
statistically significantly high for seven of nine related metrics, whereas the East of England region is collectively
statistically significantly low for all nine indicators.
Source: Public Health Outcomes Framework
13 PHE: http://www.phoutcomes.info/public-health-outcomes-framework#gid/1000044/pat/6/ati/102/page/0/par/E12000006/are/E06000031
20
Figure 11: Breakdown of Life Expectancy Gap between Peterborough and England by Broad Cause of Death, 2010-
201214
Source: Public Health England ‘Segmenting Life Expectancy Gaps By Cause Of Death’
The life expectancy gap at birth for Peterborough residents versus England overall is 1.3 years for males
(Peterborough = 77.9, England 79.2) and 0.5 years for females (Peterborough = 82.5, England = 83.0). The table
above illustrates Public Health England projections of the contributing causes to this life expectancy gap. Circulatory
disease is, by some margin, the largest contributing factor to the life expectancy gap for both males (accounting for
33.6% of the gap) and females (53.9% of the gap). Within this figure, ‘circulatory diseases’ include coronary heart
disease and stroke.
Figure 1215 below illustrates life expectancy years gained or lost if Peterborough had the same mortality rates as
England as a whole, by broad cause of death 2010-2012.
14 London Knowledge & Intelligence Team http://www.lho.org.uk/LHO_Topics/Analytic_Tools/Segment/Documents/LA_E06000031.pdf 15 London Knowledge & Intelligence Team http://www.lho.org.uk/LHO_Topics/Analytic_Tools/Segment/Documents/LA_E06000031.pdf
Figure 12: Life expectancy years gained/lost – most common conditions
Source: Public Health England ‘Segmenting Life Expectancy Gaps By Cause Of Death’
Figure 13: Mortality from all circulatory diseases (all ages), Directly Age-Standardised Rate 1995-2013
Source: Health & Social Care Information Centre
22
Peterborough’s directly age-standardised rate (DSR) for mortality from circulatory diseases is 222.9/100,000 for females (England DSR = 221.8/100,000) and 313.0/100,000
for males (England = 332.7/100,000). The Peterborough mortality rates have fallen more substantially than those for England over the last three years for which data are
available, bringing Peterborough close to the national rate for both males and females.
Figure 14: Mortality from all circulatory diseases (under 75), Directly Age- Standardised Rate 1995-2013
Source: Health & Social Care Information Centre
Peterborough’s directly age-standardised mortality rate for circulatory diseases, age under 75 is 66.4/100,000 for females and 124.25/100,000 for males. This compares
unfavourably with the England rates of 47.3/100,000 for females and 107.5/100,000 for males and illustrates that there is a disparity between the standardised rate of
mortality from circulatory diseases in Peterborough for people of all ages, which is relatively similar to the national rate, and the rate of mortality for under 75s (i.e.
premature mortality) which is above the national rate for females for every year since 2008 and males for every year since 1998. In addition, the graph suggests a widening
gap in premature CVD mortality for females in Peterborough which needs to be monitored and addressed.
23
Figure 15: Mortality from Coronary Heart Disease, Directly Age-standardised rate 1995-2013
Source: Health & Social Care Information Centre
The DSR for females in Peterborough for coronary heart disease is 94.6/100,000 in 2013; for England the DSR is 83.4. Although the Peterborough DSR for males is also
above the England rate, 176.1/100,000 vs 174.7 nationally, this difference is markedly less pronounced.
Figure 16: Mortality from Coronary Heart Disease, (under 75) Directly Age-standardised rate 1995-2013
Source: Health & Social Care Information Centre
24
The directly age standardised rate of mortality from coronary heart disease for females is 30.6/100,000 in 2013, an increase from 22.2/100,000 in 2012. Nationally, the rate
for 2013 is 17.7. For males, the directly age standardised rate has fallen for the third consecutive year, to 86.6/100,000. Nationally the age standardised rate has also fallen
in three consecutive years and is now 65.4/100,000.
Figure 17: Mortality from Stroke, Directly Age-Standardised Rate 1995-2013
Source: Health & Social Care Information Centre
Peterborough’s DSR from stroke, all ages, is marginally below the England rate for both females (57.6/100,000 vs 65.1/100,000) and males (64.1/100,000 vs 68.7/100,000).
Figure 18: Mortality from stroke (under 75), Directly Age-Standardised Rate 1995-2013
Source: Health & Social Care Information Centre
25
Peterborough’s DSR of mortality from stroke under the age of 75 years is similar to England’s for females (11.8/100,000 vs 11.6/100,000 nationally). For males,
Peterborough’s rate fell from 17.5/100,000 in 2012 to 10.9/100,000 in 2013; this latter figure is substantially better than the England rate of 16.0/100,000.
Figure 19: Mortality from Hypertensive Disease, Directly Age-Standardised Rate 1995-2013
Source: Health & Social Care Information Centre
Peterborough’s DSR for mortality from hypertensive disease for women is similar to the national rate (10.6/100,000 vs 9.0/100,000). For males, the Peterborough rate is
6.6/100,000, almost half of the national rate of 10.3/100,000 (although due to small numbers, this could be an anomaly rather than indicative of a consistent trend).
2.2 Cambridgeshire & Peterborough Clinical Commissioning Group Local Commissioning Group/Quintiles of Deprivation Epidemiology
Within the below tables, a cell shaded green illustrates the value being statistically significantly low in comparison to Cambridgeshire & Peterborough CCG, which usually
means the value for the Local Commissioning Group/quintile is ‘better’ than the CCG, i.e. a lower prevalence of stroke. Conversely, a red cell indicates the value is
statistically significantly high and therefore usually ‘worse’ than the CCG – the exception to this is indicators such as numbers of angiography/revascularisation procedures
performed, which may relate to CHD/CVD prevalence.
26
Figure 20: Epidemiology Summary (LCGs, QOF Prevalence Data 2013/14)
Data show that the Borderline LCG has a statistically significantly low prevalence of atrial fibrillation and a statistically significantly high prevalence of stroke, diabetes,
hypertension, smoking and obesity in comparison to the whole of Cambridgeshire & Peterborough Clinical Commissioning Group. Peterborough LCG has a statistically
significantly low prevalence of CHD, stroke, hypertension and atrial fibrillation and a statistically significantly high prevalence of diabetes, smoking and obesity.
Peterborough’s significantly low prevalence of conditions such as CHD and stroke may be partially explained by only 12.7% of registered population being aged 65+,
compared to 15.9% within the CCG as a whole, as CVD prevalence is higher in relatively older people.
LCG Age 65+ Age 85+ CHD Stroke Heart Failure Diabetes Hypertension Atrial Fibrillation Smoking Obesity
BORDERLINE 16.2% 2.1% 3.0% 1.6% 0.7% 6.2% 14.3% 1.3% 19.7% 9.6%
CAM HEALTH 13.9% 2.5% 2.4% 1.3% 0.6% 4.3% 10.7% 1.5% 15.8% 6.1%
CATCH 15.0% 2.1% 2.4% 1.2% 0.5% 4.0% 10.9% 1.4% 13.7% 6.1%
HUNTS CARE PARTNERS 19.2% 2.4% 3.6% 1.7% 0.7% 6.6% 15.0% 1.9% 18.2% 10.0%
HUNTS HEALTH 16.2% 1.9% 3.1% 1.5% 0.6% 5.8% 14.3% 1.7% 18.2% 9.3%
ISLE OF ELY 18.0% 2.2% 3.3% 1.5% 0.7% 6.5% 13.5% 1.7% 18.5% 9.7%
PETERBOROUGH 12.7% 1.7% 2.7% 1.3% 0.6% 6.4% 12.2% 1.0% 25.5% 10.7%
WISBECH 19.8% 2.5% 3.9% 2.0% 0.7% 7.3% 15.1% 1.8% 26.7% 12.1%
CCG 15.9% 2.1% 2.9% 1.5% 0.6% 5.6% 12.8% 1.5% 18.6% 8.7%
Source: 2013/14 Quality Outcomes Framework Data
Figure 21: Epidemiology Summary (Deprivation Quintiles within Cambridgeshire & Peterborough CCG, QOF Prevalence Data 2013/14)
Quintile Age 65+ Age 85+ CHD Stroke Heart Failure Diabetes Hypertension Atrial Fibrillation Smoking Obesity
5 - Most Deprived 14.6% 1.9% 3.1% 1.5% 0.6% 6.8% 13.0% 1.2% 26.7% 11.0%
4 16.1% 2.2% 3.2% 1.5% 0.7% 6.1% 13.5% 1.5% 21.7% 10.2%
3 14.6% 2.0% 2.7% 1.3% 0.6% 5.0% 11.9% 1.4% 16.1% 7.6%
2 16.0% 2.1% 2.6% 1.4% 0.5% 4.7% 11.8% 1.5% 13.4% 6.6%
1 - Least Deprived 19.1% 2.6% 3.1% 1.6% 0.7% 5.1% 14.0% 1.8% 13.4% 7.8%
CCG 15.9% 2.1% 2.9% 1.5% 0.6% 5.6% 12.8% 1.5% 18.6% 8.7%
Source: 2013/14 Quality Outcomes Framework Data
Borderline & Peterborough practices comprise the majority (17/22, 77.3%) of practices in the most deprived quintile within the CCG. Within this quintile, prevalence is
significantly higher than the CCG for CHD and diabetes despite only 14.6% of population being aged 65 or older, 1.3% lower than the CCG. There are also statistically
significantly higher numbers of population that smoke and are obese in comparison to the CCG within these quintiles. Prevalence of CHD, stroke, heart failure, hypertension
and atrial fibrillation are also statistically significantly high in the least deprived quintile, although this may be in part due to having 19.1% of population aged 65 or older (vs
15.9% across the CCG).
27
Figure 22: Epidemiology Summary (LCGs, Hospital Admissions Data for Key CVD-Related Conditions (All Ages) 2014/15)
DSR per 100,000 DSR per 1,000,000
LCG Age 65+ Age 85+ CHD Heart Failure Stroke Angiography Revascularisation
BORDERLINE 16.2% 2.1% 568.2 147.3 197.0 2,544.3 1,821.0
CAM HEALTH 13.9% 2.5% 453.1 120.1 164.0 2,255.9 1,416.1
CATCH 15.0% 2.1% 419.8 124.4 159.0 2,115.8 1,309.7
HUNTS CARE PARTNERS 19.2% 2.4% 641.8 141.2 200.5 2,575.2 1,847.6
HUNTS HEALTH 16.2% 1.9% 645.1 142.8 177.8 2,280.4 2,015.9
ISLE OF ELY 18.0% 2.2% 593.7 119.8 191.7 2,616.6 1,881.6
PETERBOROUGH 12.7% 1.7% 556.4 141.0 204.5 2,452.0 1,937.6
WISBECH 19.8% 2.5% 708.9 217.3 253.4 2,031.6 1,973.0
CCG 15.9% 2.1% 551.2 138.7 187.5 2,362.8 1,714.9
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
Neither the Borderline nor Peterborough LCGs show any statistically significant variance with regards to admission rates for coronary heart disease, heart failure, stroke,
angiography or revascularisation. These data are directly age-standardised to account for differences in age among the population.
Figure 23: Epidemiology Summary (LCGs, Hospital Admissions Data for Key CVD-Related Conditions (U75 Only) 2014/15)
DSR per 100,000 DSR per 1,000,000
LCG Age <75 Age 75+ CHD Heart Failure Stroke Angiography Revascularisation
BORDERLINE 92.8% 7.2% 392.5 56.4 96.1 1,903.3 1,407.0
CAM HEALTH 92.9% 7.1% 327.0 48.8 101.6 1,829.4 1,134.6
CATCH 93.2% 6.8% 277.5 37.6 78.3 1,629.3 1,034.0
HUNTS CARE PARTNERS 91.7% 8.3% 436.5 56.0 85.5 1,907.1 1,435.1
HUNTS HEALTH 93.1% 6.9% 474.4 54.7 71.3 2,074.1 1,582.0
ISLE OF ELY 92.0% 8.0% 420.7 35.2 101.0 1,969.7 1,532.8
PETERBOROUGH 93.9% 6.1% 438.3 54.4 115.3 2,109.4 1,671.7
WISBECH 90.8% 9.2% 596.0 78.1 148.9 1,927.9 1,794.4
CCG 91.4% 8.6% 395.6 49.7 94.7 1,882.0 1,387.1
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
28
As with admissions for all ages, Borderline and Peterborough LCGs are both statistically similar to the CCG as a whole with regards to directly age-standardised admission
rates for coronary heart disease, heart failure, stroke, angiography and revascularisation.
Figure 24: Epidemiology Summary (Quintiles of Deprivation, Hospital Admissions Data for Key CVD-Related Conditions (All Ages) 2014/15)
DSR per 100,000 DSR per 1,000,000
Quintile Age 65+ Age 85+ CHD Heart Failure Stroke Angiography Revascularisation
5 - Most Deprived 14.6% 1.9% 612.9 147.5 219.2 2,309.2 1,982.3
4 16.1% 2.2% 628.6 185.7 196.4 2,667.2 1,929.6
3 14.6% 2.0% 555.2 203.1 189.0 2,282.4 1,759.6
2 16.0% 2.1% 505.8 158.7 172.5 2,366.7 1,549.6
1 - Least Deprived 19.1% 2.6% 445.3 121.2 158.0 2,193.2 1,325.7
CCG 15.9% 2.1% 527.3 147.0 187.5 2,362.8 1,714.9
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
Admissions are statistically significantly high with regards to CHD in the most deprived quintile and CHD and heart failure in the second most deprived quintile. In the least
deprived quintile, admissions are statistically significantly low for CHD, heart failure and revascularisation. This suggests a degree of correlation between economic
deprivation and the risk of admission for a CVD-related condition/procedure.
Figure 25: Epidemiology Summary (Quintiles of Deprivation, Hospital Admissions Data for Key CVD-Related Conditions (U75 Only) 2014/15)
DSR per 100,000 DSR per 1,000,000
Quintile Age <75 Age 75+ CHD Heart Failure Stroke Angiography Revascularisation
5 - Most Deprived 93.2% 6.8% 496.2 60.5 132.0 2,079.9 1,754.1
4 92.5% 7.5% 440.6 62.5 97.7 2,095.5 1,501.3
3 93.5% 6.5% 392.9 56.2 80.6 1,794.9 1,377.1
2 92.9% 7.1% 347.1 34.8 82.5 1,746.4 1,188.3
1 - Least Deprived 91.4% 8.6% 295.4 34.0 78.4 1,691.8 1,089.6
CCG 15.9% 2.1% 395.6 49.7 94.7 1,882.0 1,387.1
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
Within the most deprived quintile, under 75 hospital admissions for CHD, stroke and revascularisation are statistically significantly higher in comparison to the CCG.
2.2.1 Coronary Heart Disease
Figure 26: Coronary Heart Disease Prevalence 2013/14, Cambridgeshire & Peterborough CCG LCGs
LCG Persons Prevalence Lower Interval Upper Interval Patients Aged
65+ Patients Aged
85+
CATCH 5,338 2.4% 2.3% 2.4% 15.0% 2.1%
CAM HEALTH 2,067 2.4% 2.3% 2.5% 13.9% 2.5%
PETERBOROUGH 3,809 2.7% 2.6% 2.8% 12.7% 1.7%
BORDERLINE 3,255 3.0% 2.9% 3.1% 16.2% 2.1%
HUNTS HEALTH 2,121 3.1% 3.0% 3.2% 16.2% 1.9%
ISLE OF ELY 3,153 3.3% 3.2% 3.5% 18.0% 2.2%
HUNTS CARE PARTNERS 4,371 3.6% 3.5% 3.7% 19.2% 2.4%
WISBECH 1,862 3.9% 3.8% 4.1% 19.8% 2.5%
BORDERLINE & PETERBOROUGH LCGs 7,064 2.8% 2.8% 2.9% 14.3% 1.9%
ALL OTHER LCGs 18,912 2.9% 2.9% 3.0% 16.6% 2.2%
C&P CCG 25,976 2.9% 2.9% 2.9% 15.9% 2.1%
Source: 2013/14 Quality Outcomes Framework Data
Peterborough has a statistically significantly low prevalence of coronary heart disease in comparison to the CCG
(2.7% vs 2.9%), which may be partially as a result of having a younger population than the CCG generally; only 14.3%
of patients registered with Borderline/Peterborough practices are aged 65 or over, compared to 15.9% across the
CCG. The collective prevalence of Borderline & Peterborough LCGs is 2.8%, statistically similar to that of the CCG.
Figure 27: Coronary Heart Disease Prevalence 2013/14, Cambridgeshire & Peterborough CCG LCGs
Source: 2013/14 Quality Outcomes Framework Data
2.4% 2.4%
2.7%3.0% 3.1%
3.3%3.6%
3.9%
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%
4.5%
CA
TCH
CA
M H
EALT
H
PET
ERB
OR
OU
GH
BO
RD
ERLI
NE
HU
NTS
HEA
LTH
ISLE
OF
ELY
HU
NTS
CA
RE
PA
RTN
ERS
WIS
BEC
H
----- = CCG Value
Green = Statistically significantly low in comparison to CCG
Blue = No statistical significance in comparison to CCG
Red = Statistically significantly high in comparison to CCG
30
Figure 28: Coronary Heart Disease Prevalence 2013/14, Borderline & Peterborough vs All Other LCGs
Source: 2013/14 Quality Outcomes Framework Data
Figure 29: Coronary Heart Disease Prevalence 2013/14, Cambridgeshire & Peterborough CCG Quintiles of
Deprivation
Quintile Persons Prevalence Lower Interval Upper Interval Patients Aged
65+ Patients Aged
85+
5 – Most deprived 6,034 3.1% 3.0% 3.1% 14.6% 1.9%
4 5,764 3.2% 3.1% 3.2% 16.1% 2.2%
3 5,101 2.7% 2.6% 2.7% 14.6% 2.0%
2 4,443 2.6% 2.5% 2.7% 16.0% 2.1%
1 – Least Deprived 4,634 3.1% 3.0% 3.2% 19.1% 2.6%
C&P CCG 25,976 2.9% 2.9% 2.9% 15.9% 2.1%
Source: 2013/14 Quality Outcomes Framework Data
As noted above, practice populations within the Borderline & Peterborough LCGs comprise the majority of the most
deprived two quintiles within the LCG, both of which have statistically significantly high CHD prevalence. The least
deprived quintile is also statistically significantly high.
2.8%
2.9%
2.6%
2.7%
2.8%
2.9%
3.0%
Borderline & Peterborough LCGs All Other LCGs
31
Figure 30: Coronary Heart Disease Admissions (All Admission Types, All Ages) 2014/15, Cambridgeshire &
Peterborough CCG LCGs, Directly Age-Standardised Admission Rate per 100,000
Area Observed
Admissions DSR Lower Interval Upper Interval
CATCH 759 419.8 390.2 451.0
CAM HEALTH 294 453.1 401.9 509.0
PETERBOROUGH 562 556.4 510.6 605.1
BORDERLINE 546 568.2 521.1 618.3
ISLE OF ELY 528 593.7 543.9 646.9
HUNTS CARE PARTNERS 772 641.8 597.2 688.9
HUNTS HEALTH 392 645.1 582.3 712.9
WISBECH 335 708.9 634.7 789.3
BORDERLINE & PETERBOROUGH LCGs 1,108 562.8 529.8 597.3
ALL OTHER LCGs 3,080 546.6 527.3 566.3
C&P CCG 4,188 551.2 534.5 568.2
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
The age-standardised admission rate for 2014/15 for CHD is statistically similar to the CCG for both Borderline &
Peterborough LCGs.
Figure 31: Coronary Heart Disease Admissions (All Admission Types, All Ages) 2014/15, Cambridgeshire &
Peterborough Quintiles of Deprivation, Directly Age-Standardised Admission Rate per 100,000
Quintile Observed
Admissions DSR Lower Interval Upper Interval
5 – Most deprived 969 612.9 574.6 653.1
4 979 628.6 589.7 669.5
3 844 555.2 518.0 594.3
2 727 505.8 469.5 544.2
1 – Least Deprived 669 445.3 412.0 480.5
C&P CCG 4,188 551.2 534.5 568.2
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
The age-standardised admission rate for 2014/15 for CHD follows a trend of admissions reducing as economic
deprivation decreases, with statistically significantly high rates in the most deprived two quintiles and a significantly
low rate in the most affluent quintile.
Figure 32: Coronary Heart Disease Admissions (All Admission Types, Under 75 Only) 2014/15, Cambridgeshire &
Peterborough CCG LCGs, Directly Age-Standardised Admission Rate per 100,000
Area Observed
Admissions DSR Lower Interval Upper Interval
CATCH 470 277.5 252.8 304.0
CAM HEALTH 189 327.0 281.3 378.1
BORDERLINE 360 392.5 352.8 435.6
ISLE OF ELY 350 420.7 377.6 467.3
HUNTS CARE PARTNERS 493 436.5 398.7 476.9
PETERBOROUGH 412 438.3 396.2 483.5
HUNTS HEALTH 279 474.4 420.0 533.9
WISBECH 255 596.0 524.8 674.0
BORDERLINE & PETERBOROUGH LCGs 772 416.6 387.4 447.4
ALL OTHER LCGs 2,036 388.1 371.3 405.4
C&P CCG 2,808 395.6 381.0 410.6
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
32
Amongst under 75s, as with for all ages, age-standardised CHD admission rates show Borderline & Peterborough
LCGs to be similar to the CCG rate and, as shown in figure 33 below, rates fall in correlation with reduced levels of
relative deprivation.
Figure 33: Coronary Heart Disease Admissions (All Admission Types, Under 75 Only) 2014/15, Cambridgeshire &
Peterborough Quintiles of Deprivation, Directly Age-Standardised Admission Rate per 100,000
Quintile Observed
Admissions DSR Lower Interval Upper Interval
5 – Most deprived 727 496.2 460.5 533.9
4 628 440.6 406.7 476.6
3 573 392.9 361.1 426.7
2 468 347.1 316.2 380.2
1 – Least Deprived 412 295.4 267.4 325.6
C&P CCG 2,808 395.6 381.0 410.6
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
Figure 34: Coronary Heart Disease Admissions (Emergency Admissions Only, All Ages) 2014/15, Cambridgeshire &
Peterborough CCG LCGs, Directly Age-Standardised Admission Rate per 100,000
Area Observed
Admissions DSR Lower Interval Upper Interval
CATCH 367 198.6 178.7 220.2
CAM HEALTH 152 223.5 188.6 262.8
PETERBOROUGH 269 259.8 229.2 293.3
ISLE OF ELY 247 277.6 243.9 314.7
BORDERLINE 275 289.2 255.7 325.7
HUNTS CARE PARTNERS 348 289.8 260.0 322.0
HUNTS HEALTH 177 298.2 255.4 345.9
WISBECH 182 385.7 331.5 446.2
BORDERLINE & PETERBOROUGH LCGs 544 275.1 252.2 299.5
ALL OTHER LCGs 1,473 259.4 246.2 273.0
C&P CCG 2,017 263.6 252.2 275.4
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
The Borderline & Peterborough LCGs are both statistically similar to the CCG with regards to emergency admissions
attributable to CHD.
Figure 35: Coronary Heart Disease Admissions (Emergency Admissions Only, All Ages) 2014/15, Cambridgeshire &
Peterborough Quintiles of Deprivation, Directly Age-Standardised Admission Rate per 100,000
Quintile Observed
Admissions DSR Lower Interval Upper Interval
5 – Most deprived 498 311.1 284.2 339.9
4 480 305.7 278.8 334.4
3 399 262.8 237.4 290.1
2 330 227.5 203.5 253.6
1 – Least Deprived 310 204.9 182.6 229.1
C&P CCG 2,017 263.6 252.2 275.4
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
Emergency admission rates for CHD are highest in areas of economic deprivation and statistically significantly low in
the least deprived two quintiles.
33
Figure 36: Coronary Heart Disease Admissions (Emergency Admissions Only, Under 75 Only) 2014/15,
Cambridgeshire & Peterborough LCGs, Directly Age-Standardised Admission Rate per 100,000
Area Observed
Admissions DSR Lower Interval Upper Interval
CATCH 187 106.9 92.0 123.5
CAM HEALTH 82 135.7 107.3 169.2
HUNTS CARE PARTNERS 202 178.4 154.5 204.8
ISLE OF ELY 147 178.4 150.6 209.8
BORDERLINE 164 179.5 152.9 209.4
HUNTS HEALTH 106 179.6 146.8 217.5
PETERBOROUGH 185 191.9 164.8 222.2
WISBECH 128 301.4 251.2 358.5
BORDERLINE & PETERBOROUGH LCGs 349 186.6 167.3 207.5
ALL OTHER LCGs 852 160.9 150.2 172.1
C&P CCG 1,201 167.5 158.1 177.3
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
As with admissions for all ages, both Borderline & Peterborough LCGs are statistically similar to the CCG for under
75 CHD admissions.
Figure 37: Coronary Heart Disease Admissions (Emergency Admissions Only, All Ages) 2014/15, Cambridgeshire &
Peterborough CCG Quintiles, Directly Age-Standardised Admission Rate per 100,000
Quintile Observed
Admissions DSR Lower Interval Upper Interval
5 – Most deprived 344 231.4 207.4 257.5
4 268 186.7 164.9 210.5
3 248 169.9 149.2 192.6
2 191 139.7 120.5 161.1
1 – Least Deprived 150 106.9 90.4 125.6
C&P CCG 1,201 167.5 158.1 177.3
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
34
2.2.2 HEART FAILURE
Figure 38: Heart Failure Prevalence 2013/14, Cambridgeshire & Peterborough CCG LCGs
LCG Persons Prevalence Lower Interval Upper Interval Patients Aged
65+ Patients Aged
85+
CATCH 1,181 0.5% 0.5% 0.6% 15.0% 2.1%
PETERBOROUGH 795 0.6% 0.5% 0.6% 12.7% 1.7%
CAM HEALTH 540 0.6% 0.6% 0.7% 13.9% 2.5%
HUNTS HEALTH 433 0.6% 0.6% 0.7% 16.2% 1.9%
ISLE OF ELY 616 0.7% 0.6% 0.7% 18.0% 2.2%
BORDERLINE 720 0.7% 0.6% 0.7% 16.2% 2.1%
WISBECH 854 0.7% 0.7% 0.8% 19.8% 2.5%
HUNTS CARE PARTNERS 343 0.7% 0.7% 0.8% 19.2% 2.4%
BORDERLINE & PETERBOROUGH LCGs 1,515 0.6% 0.6% 0.6% 14.3% 1.9%
ALL OTHER LCGs 3,967 0.6% 0.6% 0.6% 16.6% 2.2%
C&P CCG 5,482 0.6% 0.6% 0.6% 15.9% 2.1%
Source: 2013/14 Quality Outcomes Framework Data
Borderline & Peterborough LCGs have a collective heart failure prevalence of 0.6%, statistically similar to that of the
CCG.
Figure 39: Heart Failure Prevalence 2013/14, Cambridgeshire & Peterborough CCG LCGs
Source: 2013/14 Quality Outcomes Framework Data
0.5%
0.6%
0.6%0.6% 0.7% 0.7%
0.7% 0.7%
0.0%
0.1%
0.2%
0.3%
0.4%
0.5%
0.6%
0.7%
0.8%
0.9%
CA
TCH
PET
ERB
OR
OU
GH
CA
M H
EALT
H
HU
NTS
HEA
LTH
ISLE
OF
ELY
BO
RD
ERLI
NE
WIS
BEC
H
HU
NTS
CA
RE
PA
RTN
ERS
----- = CCG Value
Green = Statistically significantly low in comparison to CCG
Blue = No statistical significance in comparison to CCG
Red = Statistically significantly high in comparison to CCG
35
Figure 40: Heart Failure Prevalence 2013/14, Borderline & Peterborough vs All Other LCGs
Source: 2013/14 Quality Outcomes Framework Data
Figure 41: Heart Failure Prevalence 2013/14, Cambridgeshire & Peterborough CCG Quintiles of Deprivation
Quintile Persons Prevalence Lower Interval Upper Interval Patients Aged
65+ Patients Aged
85+
5 – Most deprived 1,187 0.6% 0.6% 0.6% 14.6% 1.9%
4 1,218 0.7% 0.6% 0.7% 16.1% 2.2%
3 1,099 0.6% 0.5% 0.6% 14.6% 2.0%
2 922 0.5% 0.5% 0.6% 16.0% 2.1%
1 – Least Deprived 1,056 0.7% 0.7% 0.8% 19.1% 2.6%
CCG 5,482 0.6% 0.6% 0.6% 15.9% 2.1%
Source: 2013/14 Quality Outcomes Framework Data
Heart failure prevalence is statistically significantly high in the least socio-economically deprived quintile, however
this may as a result of 19.1% of the population within the quintile being aged 65 or older, compared to 15.9% across
the CCG as a whole.
0.6%
0.6%
0.5%
0.6%
0.7%
Borderline & Peterborough LCGs All Other LCGs
----- = CCG Value
Green = Statistically significantly low in comparison to CCG
Blue = No statistical significance in comparison to CCG
Red = Statistically significantly high in comparison to CCG
36
Figure 42: Heart Failure Admissions (All Admission Types, All Ages) 2014/15, Cambridgeshire & Peterborough CCG
LCGs, Directly Age-Standardised Admission Rate per 100,000
Area Observed
Admissions DSR Lower Interval Upper Interval
ISLE OF ELY 102 119.8 97.6 145.6
CAM HEALTH 83 120.1 95.1 149.5
CATCH 220 124.4 108.4 142.1
PETERBOROUGH 132 141.0 117.7 167.4
HUNTS CARE PARTNERS 167 141.2 120.5 164.4
HUNTS HEALTH 82 142.8 113.4 177.6
BORDERLINE 134 147.3 123.3 174.6
WISBECH 104 217.3 177.4 263.6
BORDERLINE & PETERBOROUGH LCGs 266 144.0 127.0 162.5
ALL OTHER LCGs 758 136.8 127.2 147.0
C&P CCG 1,024 138.7 130.3 147.5
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
The directly age-standardised admission rate as a result of heart failure is statistically significantly high in only one
LCG, Wisbech. As noted in figure 46 below, it is significantly high in the second most-deprived quintile but
significantly low in the least deprived quintiles.
Figure 43: Heart Failure Admissions (All Admission Types, All Ages) 2014/15, Cambridgeshire & Peterborough
Quintiles of Deprivation, Directly Age-Standardised Admission Rate per 100,000
Quintile Observed
Admissions DSR Lower Interval Upper Interval
5 – Most deprived 245 163.7 143.7 185.7
4 280 180.6 159.9 203.1
3 202 138.3 119.8 158.9
2 138 99.5 83.5 117.6
1 – Least Deprived 159 106.0 90.1 123.9
C&P CCG 1,024 138.7 130.3 147.5
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
All LCGs and quintiles of deprivation are statistically similar to the CCG overall with regards to under 75 admissions
for heart failure.
37
Figure 44: Heart Failure Admissions (All Admission Types, Under 75 Only) 2014/15, Cambridgeshire &
Peterborough CCG LCGs, Directly Age-Standardised Admission Rate per 100,000
Area Observed
Admissions DSR Lower Interval Upper Interval
ISLE OF ELY 29 35.2 23.5 50.7
CATCH 59 37.6 28.5 48.6
CAM HEALTH 26 48.8 31.7 71.8
PETERBOROUGH 47 54.4 39.7 72.7
HUNTS HEALTH 32 54.7 37.2 77.4
HUNTS CARE PARTNERS 63 56.0 43.0 71.7
BORDERLINE 48 56.4 41.5 75.0
WISBECH 33 78.1 53.6 109.7
BORDERLINE & PETERBOROUGH LCGs 95 55.5 44.7 68.0
ALL OTHER LCGs 242 47.7 41.8 54.1
C&P CCG 337 49.7 44.5 55.3
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
Figure 45: Heart Failure Admissions (All Admission Types, Under 75 Only) 2014/15, Cambridgeshire &
Peterborough Quintiles of Deprivation, Directly Age-Standardised Admission Rate per 100,000
Quintile Observed
Admissions DSR Lower Interval Upper Interval
5 – Most deprived 83 60.5 48.1 75.2
4 86 62.5 49.9 77.3
3 76 54.7 43.0 68.7
2 45 35.0 25.4 46.9
1 – Least Deprived 47 34.8 25.5 46.3
C&P CCG 337 49.7 44.5 55.3
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
2.2.3 STROKE
With an overall prevalence of 1.3%, Peterborough LCG is one of three LCGs to be statistically significantly better
than the CCG prevalence of 1.5% for Stroke. The Borderline LCG prevalence is 1.6%, statistically significantly high;
collectively the two LCGs have a prevalence of 1.4%. Data show evidence of correlation between stroke prevalence
and age, with the LGCs with statistically significantly higher prevalence of stroke also having a higher percentage of
registered residents aged 65+. Peterborough LCG has a prevalence 0.2% lower than the CCG but also 3.2% fewer
registered persons over 65 and 0.4% fewer persons over 85.
38
Figure 46: Stroke Prevalence 2013/14, Cambridgeshire & Peterborough CCG LCGs
LCG Number Prevalence LI UI 65+ % 85+
CATCH 2,813 1.2% 1.2% 1.3% 15.0% 2.1%
CAM HEALTH 1,122 1.3% 1.2% 1.4% 13.9% 2.5%
PETERBOROUGH 1,842 1.3% 1.3% 1.4% 12.7% 1.7%
ISLE OF ELY 1,415 1.5% 1.4% 1.6% 18.0% 2.2%
HUNTS HEALTH 1,039 1.5% 1.4% 1.6% 16.2% 1.9%
BORDERLINE 1,706 1.6% 1.5% 1.6% 16.2% 2.1%
HUNTS CARE PARTNERS 2,036 1.7% 1.6% 1.8% 19.2% 2.4%
WISBECH 968 2.0% 1.9% 2.2% 19.8% 2.5%
BORDERLINE & PETERBOROUGH LCGs 3,548 1.4% 1.4% 1.5% 14.3% 1.9%
ALL OTHER LCGs 9,393 1.5% 1.4% 1.5% 16.6% 2.2%
CCG 12,941 1.5% 1.4% 1.5% 15.9% 2.1%
Source: 2013/14 Quality Outcomes Framework Data
Figure 47: Stroke Prevalence 2013/14, Cambridgeshire & Peterborough CCG LCGs
Source: 2013/14 Quality Outcomes Framework Data
1.2% 1.3% 1.3% 1.5% 1.5% 1.6%1.7%
2.0%
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
CA
TCH
CA
M H
EALT
H
PET
ERB
OR
OU
GH
ISLE
OF
ELY
HU
NTS
HEA
LTH
BO
RD
ERLI
NE
HU
NTS
CA
RE
PA
RTN
ERS
WIS
BEC
H
----- = CCG Value
Green = Statistically significantly low in comparison to CCG
Blue = No statistical significance in comparison to CCG
Red = Statistically significantly high in comparison to CCG
39
Figure 48: Stroke Prevalence 2013/14, Borderline & Peterborough vs All Other LCGs
Source: 2013/14 Quality Outcomes Framework Data
Figure 49: Stroke Prevalence 2013/14, Cambridgeshire & Peterborough CCG Quintiles of Deprivation
Quintile Persons Prevalence Lower Interval Upper Interval Patients Aged
65+ Patients Aged
85+
5 – Most deprived 3,019 1.5% 1.5% 1.6% 14.6% 1.9%
4 2,720 1.5% 1.4% 1.5% 16.1% 2.2%
3 2,529 1.3% 1.3% 1.4% 14.6% 2.0%
2 2,329 1.4% 1.3% 1.4% 16.0% 2.1%
1 – Least Deprived 2,344 1.6% 1.5% 1.6% 19.1% 2.6%
CCG 12,941 1.5% 1.4% 1.5% 15.9% 2.1%
Source: 2013/14 Quality Outcomes Framework Data
Stroke prevalence is statistically significantly high in the least economically deprived quintile, potentially as a result
of a high proportion of older persons.
1.4%
1.5%
1.3%
1.4%
1.5%
Borderline & Peterborough LCGs All Other LCGs
----- = CCG Value
Green = Statistically significantly low in comparison to CCG
Blue = No statistical significance in comparison to CCG
Red = Statistically significantly high in comparison to CCG
40
Figure 50: Stroke Admissions (All Admission Types, All Ages) 2014/15, Cambridgeshire & Peterborough CCG LCGs,
Directly Age-Standardised Admission Rate per 100,000
Area Observed
Admissions DSR Lower Interval Upper Interval
CATCH 286 159.0 140.9 178.6
CAM HEALTH 113 164.0 134.6 197.8
HUNTS HEALTH 103 177.8 144.9 215.9
ISLE OF ELY 168 191.7 163.7 223.1
BORDERLINE 186 197.0 169.5 227.7
HUNTS CARE PARTNERS 238 200.5 175.7 227.7
PETERBOROUGH 206 204.5 177.1 234.9
WISBECH 120 253.4 209.9 303.3
Peterborough & Borderline LCGs 392 200.7 181.1 221.8
All Other LCGs 1,028 182.6 171.6 194.2
C&P CCG 1,420 187.5 177.8 197.6
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
The collective directly age-standardised admission rate for Stroke for Borderline & Peterborough LCGs stands at
200.7/100,000 which is statistically similar to the CCG rate of 187.5/100,000.
Figure 51: Stroke Admissions (All Admission Types, All Ages) 2014/15, Cambridgeshire & Peterborough Quintiles of
Deprivation, Directly Age-Standardised Admission Rate per 100,000
Quintile Observed
Admissions DSR Lower Interval Upper Interval
5 – Most deprived 344 219.2 196.5 243.9
4 309 196.4 175.0 219.7
3 282 189.0 167.4 212.6
2 250 172.5 151.7 195.4
1 – Least Deprived 235 158.0 138.3 179.6
C&P CCG 1,420 187.5 177.8 197.6
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
Although the DSR as a result of Stroke falls as economic affluence increases, no quintile is statistically significantly
different to the CCG admission rate of 187.5/100,000.
41
Figure 52: Stroke admissions 2014/15 by discharge destination
Discharge Destination # % Of Total
Usual place of residence unless listed below, for example, a private dwelling whether owner occupied or owned by Local Authority, housing association or other landlord. This includes
wardened accommodation but not residential accommodation. 872 57.1%
Not applicable 189 12.4%
Patient died or still birth 179 11.7%
NHS other hospital provider - ward for general Patients or the younger physically disabled 135 8.8%
NHS run Care Home 41 2.7%
Non-NHS (other than Local Authority) run Care Home 35 2.3%
Temporary place of residence when usually resident elsewhere (includes hotel, residential educational establishment)
23 1.5%
Non-NHS run hospital 21 1.4%
NHS other hospital provider - high security psychiatric accommodation 19 1.2%
NHS other hospital provider - ward for Patients who are mentally ill or have learning disabilities
7 0.5%
Other (Categories with 5 or fewer admissions) 7 0.5%
Total (includes admitted patients who are registered with General Practices outside C&P CCG 1528 100.0%
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
The patient was discharged to their normal place of residence in 57.1% (872/1528) of cases. Data from Peterborough
City Council Adult Social Care shows 22.1% (151/681) of assigned social care packages were necessitated by a
Stroke/Cerebral Vascular Accident (CVA) condition, with the overall annual cost amounting to £4.02 million.
Figure 53: Stroke Admissions (All Admission Types, Under 75 Only) 2014/15, Cambridgeshire & Peterborough CCG
LCGs, Directly Age-Standardised Admission Rate per 100,000
Area Observed
Admissions DSR Lower Interval Upper Interval
HUNTS HEALTH 42 71.3 51.2 96.6
CATCH 132 78.3 65.4 93.0
HUNTS CARE PARTNERS 96 85.5 69.2 104.5
BORDERLINE 87 96.1 76.8 118.7
ISLE OF ELY 83 101.0 80.3 125.2
CAM HEALTH 59 101.6 76.9 131.5
PETERBOROUGH 111 115.3 94.4 139.4
WISBECH 62 148.9 114.1 191.1
42
Area Observed
Admissions DSR Lower Interval Upper Interval
Borderline & Peterborough LCGs 198 106.0 91.5 122.0
All Other LCGs 474 90.5 82.5 99.1
C&P CCG 672 94.7 87.6 102.2
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
With regards to stroke admissions for patients aged under 75 years, both Peterborough & Borderline LCGs are
statistically similar to the CCG average.
Figure 54: Stroke Admissions (All Admission Types, Under 75 Only) 2014/15, Cambridgeshire & Peterborough
Quintiles of Deprivation, Directly Age-Standardised Admission Rate per 100,000
Quintile Observed
Admissions DSR Lower Interval Upper Interval
5 194 132.0 113.9 152.2
4 138 97.7 82.0 115.6
3 118 80.6 66.5 96.7
2 114 82.5 67.9 99.2
1 108 78.4 64.3 94.8
C&P CCG 672 94.7 87.6 102.2
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
Admissions are statistically significantly high in the most deprived quintile, at 132.0/100,000 versus a CCG rate of
94.7/100,000.
2.2.4 Hypertension
Figure 55: Hypertension Prevalence 2013/14, Cambridgeshire & Peterborough CCG LCGs
LCG Number Prevalence Lower Interval Upper Interval Patients Aged
65+ Patients Aged
85+
CAM HEALTH 9,236 10.7% 10.5% 10.9% 13.9% 2.5%
CATCH 24,505 10.9% 10.7% 11.0% 15.0% 2.1%
PETERBOROUGH 17,060 12.2% 12.0% 12.4% 12.7% 1.7%
ISLE OF ELY 12,735 13.5% 13.3% 13.7% 18.0% 2.2%
HUNTS HEALTH 9,754 14.3% 14.0% 14.6% 16.2% 1.9%
BORDERLINE 15,549 14.3% 14.1% 14.6% 16.2% 2.1%
HUNTS CARE PARTNERS 18,215 15.0% 14.8% 15.2% 19.2% 2.4%
WISBECH 7,160 15.1% 14.8% 15.5% 19.8% 2.5%
BORDERLINE & PETERBOROUGH LCGs 32,609 13.1% 13.0% 13.3% 14.3% 1.9%
ALL OTHER LCGs 81,605 12.7% 12.6% 12.8% 16.6% 2.2%
CCG 114,214 12.8% 12.7% 12.9% 15.9% 2.1%
Source: 2013/14 Quality Outcomes Framework Data
Peterborough LCG has a statistically significantly low prevalence of hypertension; however Borderline LCG’s
prevalence of 14.3% contributes towards a collective prevalence for the two LCGs of 13.1%, significantly higher than
the CCG prevalence of 12.8%.
43
Figure 56: Hypertension Prevalence 2013/14, Cambridgeshire & Peterborough CCG LCGs
Source: 2013/14 Quality Outcomes Framework Data
Figure 57: Hypertension Prevalence 2013/14, Borderline & Peterborough vs All Other LCGs
Source: 2013/14 Quality Outcomes Framework Data
10.7% 10.9%12.2%
13.5%14.3% 14.3%
15.0% 15.1%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
CA
M H
EALT
H
CA
TCH
PET
ERB
OR
OU
GH
ISLE
OF
ELY
HU
NTS
HEA
LTH
BO
RD
ERLI
NE
HU
NTS
CA
RE
PA
RTN
ERS
WIS
BEC
H13.1%
12.7%
12.2%
12.4%
12.6%
12.8%
13.0%
13.2%
13.4%
Borderline & Peterborough LCGs All Other LCGs
----- = CCG Value
Green = Statistically significantly low in comparison to CCG
Blue = No statistical significance in comparison to CCG
Red = Statistically significantly high in comparison to CCG
44
Figure 58: Hypertension Prevalence 2013/14, Cambridgeshire & Peterborough CCG Quintiles of Deprivation
Quintile Persons Prevalence Lower Interval Upper Interval Patients Aged
65+ Patients Aged
85+
5 – Most deprived 25,673 13.0% 12.9% 13.2% 14.6% 1.9%
4 24,636 13.5% 13.3% 13.6% 16.1% 2.2%
3 22,813 11.9% 11.8% 12.0% 14.6% 2.0%
2 20,203 11.8% 11.7% 12.0% 16.0% 2.1%
1 – Least Deprived 20,889 14.0% 13.8% 14.2% 19.1% 2.6%
CCG 114,214 12.8% 12.7% 12.9% 15.9% 2.1%
Source: 2013/14 Quality Outcomes Framework Data
Hypertension prevalence is significantly high in the least deprived quintile and the fourth quintile, both of which
have a higher percentage of patients aged 65+ and 85+ than the CCG collectively.
2.2.5 Angiography
Figure 59: Angiography Admissions (All Admission Types, All Ages) 2014/15, Cambridgeshire & Peterborough CCG
LCGs, Directly Age-Standardised Admission Rate per 1,000,000
Area Observed
Events DSR Lower Interval Upper Interval
WISBECH 95 2,031.6 1,642.4 2,485.0
CATCH 381 2,115.8 1,906.8 2,341.3
CAM HEALTH 143 2,255.9 1,895.6 2,663.8
HUNTS HEALTH 145 2,280.4 1,921.6 2,686.4
PETERBOROUGH 247 2,452.0 2,151.0 2,782.8
BORDERLINE 247 2,544.3 2,234.4 2,884.8
HUNTS CARE PARTNERS 312 2,575.2 2,296.4 2,878.5
ISLE OF ELY 233 2,616.6 2,289.6 2,977.1
Peterborough & Borderline LCGs 494 2,486.1 2,269.3 2,717.8
All Other LCGs 1,309 2,317.4 2,192.9 2,447.2
C&P CCG 1,803 2,362.8 2,254.2 2,475.2
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
The DSR for angiography admissions 2014/15 is calculated as rate per 1,000,000 rather than rate per 100,000 due to
relatively low numbers of operations. All LCGs are statistically similar to the CCG rate of 2,362.8.
----- = CCG Value
Green = Statistically significantly low in comparison to CCG
Blue = No statistical significance in comparison to CCG
Red = Statistically significantly high in comparison to CCG
45
Figure 60: Angiography Admissions (All Admission Types, All Ages) 2014/15, Cambridgeshire & Peterborough
Quintiles of Deprivation, Directly Age-Standardised Admission Rate per 1,000,000
Quintile Observed
Admissions DSR Lower Interval Upper Interval
5 – Most deprived 366 2,309.2 2,076.8 2,560.4
4 416 2,667.2 2,415.8 2,937.5
3 353 2,282.4 2,048.2 2,535.8
2 340 2,366.7 2,120.1 2,633.9
1 – Least Deprived 328 2,193.2 1,960.8 2,445.4
CCG 1,803 2,362.8 2,254.2 2,475.2
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
There is no statistical significance to note between rates of admission across the quintiles of deprivation in the CCG
compared to the collective CCG rate.
Figure 61: Angiography Admissions (All Admission Types, Under 75 Only) 2014/15, Cambridgeshire &
Peterborough CCG LCGs, Directly Age-Standardised Admission Rate per 1,000,000
Area Observed
Events DSR Lower Interval Upper Interval
CATCH 275 1,629.3 1,440.7 1,835.6
CAM HEALTH 106 1,829.4 1,491.6 2,219.6
BORDERLINE 176 1,903.3 1,630.8 2,208.0
HUNTS CARE PARTNERS 216 1,907.1 1,660.4 2,179.9
WISBECH 82 1,927.9 1,531.9 2,394.6
ISLE OF ELY 165 1,969.7 1,679.3 2,295.7
HUNTS HEALTH 124 2,074.1 1,723.0 2,475.3
PETERBOROUGH 199 2,109.4 1,821.8 2,429.0
Peterborough & Borderline LCGs 375 1,998.4 1,799.2 2,213.4
All Other LCGs 968 1,838.3 1,723.7 1,958.5
C&P CCG 1,343 1,882.0 1,782.1 1,986.1
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
As with the directly age-standardised rates for all ages, data for under 75 only angiography admissions shows no
statistical outliers among C&P CCGs in comparison to the CCG rate of 1,882.0/1,000,000.
Figure 62: Angiography Admissions (All Admission Types, Under 75 Only) 2014/15, Cambridgeshire &
Peterborough Quintiles of Deprivation, Directly Age-Standardised Admission Rate per 1,000,000
Quintile Observed
Admissions DSR Lower Interval Upper Interval
5 – Most deprived 306 2,079.9 1,851.6 2,328.4
4 300 2,095.5 1,863.9 2,347.8
3 265 1,794.9 1,583.6 2,026.5
2 237 1,746.4 1,529.8 1,984.9
1 – Least Deprived 235 1,691.8 1,481.1 1,924.0
CCG 1,343 1,882.0 1,782.1 1,986.1
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
46
Although observed admissions fall in line with economic deprivation declining, no quintiles of deprivation have
statistically significant DSRs in comparison to the CCG value.
2.2.6 Revascularisation
Figure 63: Revascularisation Admissions (All Admission Types, All Ages) 2014/15, Cambridgeshire & Peterborough
CCG LCGs, Directly Age-Standardised Admission Rate per 1,000,000
Area Observed
Events DSR Lower Interval Upper Interval
CATCH 237 1,309.7 1,147.0 1,488.8
CAM HEALTH 89 1,416.1 1,133.4 1,747.2
BORDERLINE 177 1,821.0 1,560.7 2,112.1
HUNTS CARE PARTNERS 223 1,847.6 1,612.2 2,107.7
ISLE OF ELY 168 1,881.6 1,606.4 2,190.3
PETERBOROUGH 196 1,937.6 1,671.0 2,234.1
WISBECH 94 1,973.0 1,593.5 2,415.6
HUNTS HEALTH 124 2,015.9 1,673.9 2,406.8
Peterborough & Borderline LCGs 373 1,884.4 1,696.0 2,087.8
All Other LCGs 935 1,655.8 1,550.8 1,766.0
C&P CCG 1,308 1,714.9 1,622.7 1,811.1
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
Admissions for revascularisation are statistically significantly low in the ‘CATCH’ LCG and similar to that of the CCG
for all other LCGs, however it should be noted that revascularisation rates will pertain to observed CVD/CHD
prevalence and therefore, although statistically significantly different, the DSR of the CATCH LCG should not be
interpreted as necessarily ‘better’ than the CCG DSR.
Figure 64: Revascularisation Admissions (All Admission Types, All Ages) 2014/15, Cambridgeshire & Peterborough
Quintiles of Deprivation, Directly Age-Standardised Admission Rate per 1,000,000
Quintile Observed
Admissions DSR Lower Interval Upper Interval
5 – Most deprived 315 1,982.3 1,767.7 2,215.7
4 301 1,929.6 1,716.8 2,161.4
3 269 1,759.6 1,553.6 1,985.1
2 224 1,549.6 1,352.1 1,767.6
1 – Least Deprived 199 1,325.7 1,146.8 1,524.5
CCG 1,308 1,714.9 1,622.7 1,811.1
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
Revascularisation admissions fall in line with declining economic deprivation, with the rate of 1,325.7/1,000,000
standing as statistically significantly low in comparison to the CCG rate of 1,714.9/1,000,000.
47
Figure 65: Revascularisation Admissions (All Admission Types, Under 75 Only) 2014/15, Cambridgeshire &
Peterborough CCG LCGs, Directly Age-Standardised Admission Rate per 1,000,000
Area Observed
Events DSR Lower Interval Upper Interval
CATCH 174 1,034.0 884.9 1,200.8
CAM HEALTH 65 1,134.6 871.9 1,450.7
BORDERLINE 129 1,407.0 1,173.2 1,673.5
HUNTS CARE PARTNERS 162 1,435.1 1,222.0 1,674.7
ISLE OF ELY 128 1,532.8 1,277.7 1,823.7
HUNTS HEALTH 93 1,582.0 1,274.8 1,940.5
PETERBOROUGH 157 1,671.7 1,415.3 1,960.4
WISBECH 78 1,794.4 1,417.4 2,240.5
Peterborough & Borderline LCGs 286 1,547.0 1,370.9 1,739.2
All Other LCGs 700 1,331.7 1,234.4 1,434.6
C&P CCG 986 1,387.1 1,301.4 1,477.0
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
As with admissions of all ages, the ‘CATCH’ LCG is statistically significantly low in comparison to the CCG for
revascularisation admissions in the under 75 only age range.
Figure 66: Revascularisation Admissions (All Admission Types, Under 75 Only) 2014/15, Cambridgeshire &
Peterborough Quintiles of Deprivation, Directly Age-Standardised Admission Rate per 1,000,000
Quintile Observed
Admissions DSR Lower Interval Upper Interval
5 – Most deprived 258 1,754.1 1,544.9 1,983.6
4 215 1,501.3 1,306.4 1,716.9
3 201 1,377.1 1,191.7 1,582.9
2 160 1,188.3 1,010.3 1,388.6
1 – Least Deprived 152 1,089.6 922.3 1,278.3
CCG 986 1,387.1 1,301.4 1,477.0
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
Amongst under 75s, admissions are statistically significantly high in comparison to the CCG in the most deprived
quintile and significantly low in the least deprived quintile.
48
3 Lifestyle Determinants
3.1 Risk Factors Associated with Cardiovascular Disease
A number of common risk factors are recognised as increasing the likelihood of individuals developing
atherosclerosis and consequently CVD. There are three broad groups.16 Fixed risk factors are by definition
unmodifiable, but are taken into account in calculating and advising people about their overall risk:
age;
gender
family history/genetic factors
ethnicity
Lifestyle/behavioural risk factors reflect an individual’s circumstances and choices, and can be changed for the better to reduce personal risk:
smoking
physical inactivity;
poor diet
obesity; and
harmful use of alcohol
‘Bodily’ or physiological risk factors reflect changes to body systems that are preventable or reversible in their early stages, but may require medical treatment to manage the risk:
hypertension/raised blood pressure;
raised cholesterol/disordered lipids;
impaired glucose tolerance/diabetes; and
chronic kidney disease (CKD).
Individuals will often have a number of these risk factors, and may also have more than one clinical manifestation
of CVD. For instance people with diabetes or CKD or who are smokers or suffer from hypertension are more likely
to have strokes, heart attacks, or develop heart failure. It is estimated that each additional risk factor present
doubles the previous overall risk for that individual.17 This multiplicative association of risk factors underpins the
need for an integrated approach to reducing risk both at population and individual level. It is also estimated that in
over 90% of cases, the risk of a first heart attack is related to one or more of nine potentially modifiable risk
factors18 - smoking, poor diet, insufficient physical activity, high blood pressure, obesity, diabetes, psychosocial
stress, alcohol consumption and high blood cholesterol.
3.2 Ethnicity as a risk factor contributing to CVD
British Heart Foundation statistics show that there is a disparity between ethnicities with regards to the prevalence
of cardiovascular disease and associated risk factors– for example, Black Caribbean, Indian, Pakistani and
Bangladeshi men have a considerably higher prevalence of diabetes than the general population and stroke
16 Department of Health: https://www.gov.uk/government/publications/cardiovascular-disease-outcomes-strategy-improving-outcomes-for-people-with-or-at-risk-of-cardiovascular-disease 17 Yusuf S et al; INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004;364:937-952 18 http://www.nice.org.uk/guidance/ph25/documents/prevention-of-cardiovascular-disease-draft-guidance2 p.5
49
incidence rates in the black ethnic group are higher than in the white ethnic group for both sexes.19 Although
identifying particular ethnic factors that influence cardiovascular disease is complicated (with a requirement to
factor in genetic makeup, cultural and social practices and risk factors such as obesity and diabetes), there is
evidence of inequalities between ethnicities with regards to access to treatment20 as well as behavioural factors
such as smoking, alcohol consumption, diet and physical activity.
Peterborough has a relatively high proportion of black & ethnic minority (BME) residents – in the 2011 national
census, 17.5% of residents identified as BME compared to 14.6% of respondents nationally.
Figure 70 ranks Peterborough’s 24 electoral wards by percentage of BME residents and includes statistics related
to cardiovascular disease for each ward. Data show that there is clear correlation between hospital admissions
from, and deaths as a result of, circulatory diseases and high percentages of BME ethnicities as a percentage of
overall population. However, there is also strong correlation between levels of income deprivation and the hospital
admission and mortality rates. Deprivation is associated with the wider determinants of cardiovascular disease-
higher levels of smoking and obesity, a less healthy diet, lower levels of physical activity, more stress and less
control in employment.
19 http://www.esrc.ac.uk/news-and-events/features-casestudies/features/14709/the-ethnicity-of-heart-disease.aspx 20 http://www.parliament.uk/documents/post/postpn276.pdf
50
Figure 67: Peterborough ward ethnicity & CVD-related metrics
Area Name
% Black & Minority Ethnic
Population (2011)
% living in income
deprived households
(2010)
Standardised Mortality
Ratio: Deaths from circulatory
diseases, all ages (2008-
2012)
Standardised Mortality
Ratio: Deaths from circulatory diseases, under 75
years (2008-2012)
Standardised Mortality
Ratio: Deaths from
coronary heart
disease, all ages (2008-
2012)
Standardised Mortality
Ratio: Deaths from
coronary heart
disease, under 75
years (2008-2012)
Standardised Mortality
Ratio: Deaths from
stroke, all ages (2008-
2012)
Standardised Admission
Ratio: Emergency
hospital admissions for coronary
heart disease
(2008/09-2012/13)
Standardised Admission
Ratio: Elective hospital
admissions for coronary
heart disease
(2008/09-2012/13)
Standardised Admission
Ratio: Emergency
hospital admissions for stroke (2008/09-2012/13)
Standardised Admission
Ratio: Emergency
hospital admissions
for myocardial infarction (2008/09-2012/13)
Central 58.2 25.5 116.2 172.1 152.2 229.9 86.1 160.9 166.0 145.2 115.4
Park 35.8 21.7 154.5 200.8 149.5 212.6 209.4 150.4 162.4 122.4 113.0
Ravensthorpe 30.8 25.4 138.7 224.5 185.9 262.0 68.7 146.9 149.7 116.8 115.5
West 29.5 10.5 130.6 86.5 121.3 62.3 164.9 92.6 112.1 107.4 71.3
East 26.8 25.3 123.8 181.2 132.8 188.9 79.2 139.0 149.3 113.0 105.0
North 23.0 26.5 95.8 137.4 127.8 161.5 76.1 135.8 152.2 107.3 63.4
Dogsthorpe 18.4 28.0 123.8 161.0 142.9 197.1 102.7 126.6 139.1 98.3 75.9
Bretton South 14.8 14.3 90.5 101.4 120.7 164.1 77.6 90.2 114.0 98.6 70.9
Orton with Hampton
14.0 10.3 88.2 68.2 87.1 51.0 66.7 96.6 159.1 102.1 81.2
Bretton North 12.4 23.3 106.1 123.9 108.7 114.5 98.1 115.5 134.2 88.3 99.2
Fletton and Woodston
11.5 17.3 121.9 149.6 140.9 167.2 81.7 117.3 148.4 119.8 93.3
Orton Longueville
10.1 24.0 145.0 166.6 141.1 178.6 150.3 137.7 164.0 98.3 92.9
Paston 9.6 25.7 93.5 134.0 91.9 134.4 80.9 111.1 121.6 84.1 101.3
Stanground East
8.3 13.1 71.4 79.3 67.1 53.6 70.3 105.7 152.7 105.0 92.2
Walton 8.2 15.6 93.7 108.3 111.3 123.5 76.9 104.3 125.0 95.1 81.4
Werrington North
7.4 11.2 78.5 84.3 85.9 85.5 77.5 109.0 137.9 79.2 94.4
Orton Waterville
7.2 10.3 76.8 96.0 72.9 63.5 64.5 91.9 122.7 84.6 78.5
Stanground Central
6.9 14.6 103.2 100.5 112.7 119.7 88.6 104.9 152.1 114.1 86.5
Eye and Thorney
5.0 11.7 118.1 100.5 142.6 85.8 104.4 91.5 138.3 99.9 73.3
Werrington South
4.9 10.1 104.2 93.4 90.0 89.7 115.0 92.9 125.6 71.8 83.4
Newborough 4.7 6.7 55.6 54.4 52.6 48.7 61.8 87.0 131.5 47.6 87.9
51
Area Name
% Black & Minority Ethnic
Population (2011)
% living in income
deprived households
(2010)
Standardised Mortality
Ratio: Deaths from circulatory
diseases, all ages (2008-
2012)
Standardised Mortality
Ratio: Deaths from circulatory diseases, under 75
years (2008-2012)
Standardised Mortality
Ratio: Deaths from
coronary heart
disease, all ages (2008-
2012)
Standardised Mortality
Ratio: Deaths from
coronary heart
disease, under 75
years (2008-2012)
Standardised Mortality
Ratio: Deaths from
stroke, all ages (2008-
2012)
Standardised Admission
Ratio: Emergency
hospital admissions for coronary
heart disease
(2008/09-2012/13)
Standardised Admission
Ratio: Elective hospital
admissions for coronary
heart disease
(2008/09-2012/13)
Standardised Admission
Ratio: Emergency
hospital admissions for stroke (2008/09-2012/13)
Standardised Admission
Ratio: Emergency
hospital admissions
for myocardial infarction (2008/09-2012/13)
Glinton and Wittering
2.8 5.3 83.8 69.6 77.4 34.0 48.1 95.1 135.8 89.4 88.5
Barnack 2.7 4.7 111.6 100.2 104.2 78.3 72.6 87.8 126.5 89.9 78.9
Northborough 2.3 5.7 100.1 60.5 123.1 81.2 62.7 116.9 167.6 95.0 115.1
Peterborough Unitary
Authority 17.5 17.8 110.5 122.3 117.6 125.8 101.1 114.3 140.8 101.4 89.9
Source: Local Health Profiles
Figure 68: Peterborough Hospitals Admissions 2014/15 – Ethnic Breakdown
Ethnicity Category All Admissions All CHD All Heart Failure All Stroke All Angiography All Revascularisation
British 72.2% 78.0% 76.7% 70.7% 81.5% 77.4%
Not Known 9.4% 11.6% 11.2% 9.7% 5.8% 15.8%
Not Stated 7.3% 3.5% 4.2% 10.9% 4.8% 1.5%
Any Other White Background 4.7% 1.8% 3.7% 3.8% 2.2% 0.4%
Pakistani 1.5% 1.4% 1.2% 1.4% 1.3% 1.1%
Indian 0.9% 1.0% 0.4% 0.6% 1.4% 1.2%
Any Other Ethnic Group 0.7% 0.6% 0.5% 0.4% 0.7% 0.6%
Any Other Asian Background 0.6% 0.4% 0.3% 0.5% 0.6% 0.3%
Irish 0.6% 0.6% 0.4% 0.7% 0.6% 0.6%
African 0.4% 0.0% 0.0% 0.1% 0.1% 0.0%
Any Other Mixed Background 0.3% 0.1% 0.2% 0.1% 0.1% 0.1%
Chinese 0.3% 0.2% 0.1% 0.1% 0.1% 0.2%
52
Ethnicity Category All Admissions All CHD All Heart Failure All Stroke All Angiography All Revascularisation
Any Other Black Background 0.2% 0.1% 0.1% 0.4% 0.2% 0.1%
Caribbean 0.2% 0.1% 0.3% 0.4% 0.1% 0.0%
Bangladeshi 0.2% 0.3% 0.9% 0.2% 0.5% 0.3%
White and Asian 0.2% 0.1% 0.0% 0.0% 0.2% 0.1%
White and Black Caribbean 0.2% 0.0% 0.1% 0.1% 0.1% 0.0%
White and Black African 0.1% 0.1% 0.0% 0.0% 0.0% 0.3%
Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset
Data show that 72.2% of patients admitted to Peterborough City Hospital in 2014/15 self-identified as British; this ethnic group accounted for
a 78.0% of admissions as a result of CHD, 76.7% of heart failure admissions, 81.5% of angiography procedures and 77.4% of revascularisation
procedures. 9.4% of all admissions had a ‘Not Known’ ethnicity status – this also applies to 11.6% of CHD admissions, 11.2% of heart failure
admissions, 9.7% of stroke admissions and 15.8% of revascularisation procedures. Caution should therefore be exercised in use of these data
as it is difficult to draw conclusions with regards to proportion of admissions attributable to ethnic groups when, incorporating ‘Not Known’
and ‘Not Stated’ status in ethnicity field, 16.7% of admissions do not provide the data required for analysis by ethnicity of admitted patient.
53
3.3 Smoking as a CVD risk factor
Reducing tobacco use is one of the most important actions that can be taken to improve health. Tobacco is addictive and harms the people that use it, those around them and communities. Smoking remains the leading cause of preventable death and disease in England, accounting for more preventable deaths than the following five preventable causes, combined. Over 81,400 deaths in England each year in those aged 35 years and over are caused by smoking. That equates to 18% of deaths in this age group. Smoking is also one of the most significant factors that has an impact on health inequalities and ill health, with an estimated 461,000 hospital admissions for people aged 35 years and older estimated to be attributable to smoking.21
The table below shows that tobacco smoking is the primary leading risk factor contributing to ‘Years of Life Lost’ in the United Kingdom. Figure 69: Leading Risk Factors, % of total Years of Life Lost, 2010 (United Kingdom)
Source: Yorkshire & Humber Public Health Observatory
21 BMA: http://bma.org.uk/working-for-change/improving-and-protecting-health/tobacco/smoking-statistics
54
However, by successfully stopping smoking, people can avoid smoking-related diseases and live longer, whatever their age22. The table below demonstrates the benefits in terms of life expectancy and associated overall health associated with stopping smoking:
Age at which stopped smoking Years of life gained
30 10
40 9
50 6
60 3
Source: HM Government ‘Healthy Lives, Healthy People: A Tobacco Control Plan for England’
The Government strategy, Healthy Lives, healthy people: A Tobacco Control Plan for England23 set out an assessment of what could be delivered through national action, supported and associated with locally driven comprehensive tobacco control practice. The plan’s ambition of reducing smoking prevalence among adults in England to 18.5% or less by the end of 2015 appears achievable with 2013 data showing national prevalence of 18.4%. Although the 2015 ASH report Smoking Still Kills advocates an ambition to reduce smoking in the adult population to 13% by 2020 and 9% by 2025.24
Smoking rates in Peterborough have been declining over recent years. In 2010 one in four (25.2%) adults in Peterborough smoked, while in 2013 this rate had declined to one in five (20.8%) adults smoking, a reduction of 4.4 percentage points. In comparison the England average rate has reduced 2.4 percentage points to 18.4% and the East of England average rate has reduced 2.1 percentage points to 17.5% over the same period.
Figure 70: Smoking prevalence among persons aged 18 years and over Trend 2010-2013 (%)
Source: Public Health Outcomes Framework Indicator 2.14
Smoking rates in Peterborough do however remain worse that the England and the East of England average rates as shown in figure 74.
22 UK Govt: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213757/dh_124960.pdf 23 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213757/dh_124960.pdf 24 http://www.ash.org.uk/files/documents/ASH_962.pdf
55
Figure 71: Smoking prevalence among persons aged 18 years and over 2013 – East of England (%)
Source: Public Health Outcomes Framework Indicator 2.14
There is a strong relationship between smoking and people suffering from mental health problems. People with longstanding anxiety, depression or another mental health condition are twice as likely to be smokers as those who do not have any mental health problems. Depression is two to three times more common in a range of cardiovascular diseases including cardiac disease, coronary artery disease, stroke, angina, congestive heart failure, or following a heart attack25. Rates of smoking increase with the severity of the mental health disorder, ranging from 25 per cent among people with eating disorders to 56 per cent among those with probable psychosis. Over the last 20 years, smoking prevalence has changed little in those with severe illness26. It has been estimated that 42% of overall tobacco consumption in England is by this group27.
There is also a strong relationship between smoking and occupation. Smoking prevalence is twice as high among people in routine and manual occupations compared to those in managerial and professional occupations. In Peterborough smoking prevalence among people in routine and manual occupations is 34%, the highest in the East of England. Prevalence has been consistently falling nationally over the period 2011-2013 but rose in Peterborough from 34.3% to 34.7% between 2012 and 2013.
Figure 72: Smoking prevalence among persons working in ‘routine and manual’ occupations 2013 (%)
Source: Public Health Outcomes Framework Indicator 2.14
25 http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/long-term-conditions-mental-health-cost-comorbidities-naylor-feb12.pdf 26 http://www.ash.org.uk/files/documents/ASH_962.pdf 27 http://www.natcen.ac.uk/media/21994/smoking-mental-health.pdf
56
Figure 73: Smoking prevalence among persons working in ‘routine and manual’ occupations Trend
2011-2013 (%)
Source: Public Health Outcomes Framework Indicator 2.14
Smoking status of residents registered with GP practices in 2013/14 demonstrates an association between high levels of deprivation and high rates of smoking. Of the eight registered GP practice populations with highest smoking rates in Peterborough and Borderline, six are in the most deprived 30% of the England population as defined by the 2010 Index of Multiple Deprivation.
Figure 74: Smoking Prevalence 2013/14, Cambridgeshire & Peterborough CCG LCGs
Source: 2013/14 Quality Outcomes Framework Data
Data show both the Borderline and Peterborough LCGs to have a statistically significantly high level
of smoking prevalence, with a collective prevalence of 22.9% vs 18.6% across the CCG collectively.
These data are not age-standardised so prevalence may be affected by the relatively young
population of Peterborough, due to smoking prevalence generally declining with age.
LCG Number Prevalence Lower Interval Upper Interval Patients Aged 65+
Patients Aged 85+
CATCH 26,247 13.7% 13.5% 13.9% 15.0% 2.1%
CAM HEALTH 11,677 15.8% 15.5% 16.1% 13.9% 2.5%
HUNTS CARE PARTNERS 18,478 18.2% 17.9% 18.5% 19.2% 2.4%
HUNTS HEALTH 10,255 18.2% 17.9% 18.6% 16.2% 1.9%
ISLE OF ELY 14,157 18.5% 18.2% 18.8% 18.0% 2.2%
BORDERLINE 17,395 19.7% 19.4% 20.0% 16.2% 2.1%
PETERBOROUGH 28,455 25.5% 25.2% 25.7% 12.7% 1.7%
WISBECH 10,586 26.7% 26.2% 27.2% 19.8% 2.5%
BORDERLINE & PETERBOROUGH LCGs 45,850 22.9% 22.7% 23.1% 14.3% 1.9%
ALL OTHER LCGs 91,400 17.0% 16.8% 17.1% 16.6% 2.2%
CCG 137,250 18.6% 18.5% 18.7% 15.9% 2.1%
57
Figure 75: Smoking Prevalence 2013/14, Cambridgeshire & Peterborough CCG LCGs
Source: 2013/14 Quality Outcomes Framework Data
Figure 76: Smoking Prevalence 2013/14, 16+, Cambridgeshire & Peterborough CCG LCGs
Source: 2013/14 Quality Outcomes Framework Data
13.7%15.8%
18.2% 18.2% 18.5%19.7%
25.5%26.7%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
CA
TCH
CA
M H
EALT
H
HU
NTS
CA
RE
PA
RTN
ERS
HU
NTS
HEA
LTH
ISLE
OF
ELY
BO
RD
ERLI
NE
PET
ERB
OR
OU
GH
WIS
BEC
H
22.9%
17.0%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
Borderline & Peterborough LCGs All Other LCGs
----- = CCG Value
Green = Statistically significantly low in comparison to CCG
Blue = No statistical significance in comparison to CCG
Red = Statistically significantly high in comparison to CCG
58
Figure 77: Smoking Prevalence 2013/14, Cambridgeshire & Peterborough CCG Quintiles of
Deprivation
Quintile Persons Prevalence LI UI 65+ % 85+
5 – Most deprived 42,577 26.7% 26.5% 27.0% 14.5% 1.9%
4 33,178 21.7% 21.4% 21.9% 16.2% 2.3%
3 26,243 16.1% 15.9% 16.3% 14.8% 2.0%
2 18,631 13.4% 13.2% 13.6% 16.2% 2.1%
1 – Least Deprived 16,621 13.4% 13.2% 13.6% 19.5% 2.6%
CCG 137,250 18.6% 18.5% 18.7% 14.5% 1.9%
Source: 2013/14 Quality Outcomes Framework Data
Smoking prevalence is significantly higher amongst the more deprived elements of the CCG
population, falling as deprivation decreases to a low of 13.4% in the two least deprived quintiles.
Addressing current levels of smoking prevalence in Peterborough will have a direct impact on the prevalence of cardiovascular disease. The further development of comprehensive tobacco control locally, including targeted action to reduce smoking prevalence among specific groups, should be considered.
Figure 78: NICE smoking and tobacco guidance
PH1 – Brief interventions and referral for smoking cessation
PH5 – Workplace interventions to promote smoking cessation
PH10 – Smoking cessation services
PH14 – Preventing the uptake of smoking by children and young people
PH15 - Identifying and supporting people most at risk of dying prematurely
PH23 – School based interventions to prevent smoking
PH39 – Smokeless tobacco cessation: South Asian communities
PH45 – Tobacco Harm reduction
PH48 – Smoking cessation in secondary care and tobacco guidance
Source: http://www.nice.org.uk/guidance/lifestyle-and-wellbeing/smoking-and-tobacco
----- = CCG Value
Green = Statistically significantly low in comparison to CCG
Blue = No statistical significance in comparison to CCG
Red = Statistically significantly high in comparison to CCG
59
3.4 Physical inactivity as a CVD Risk Factor
There is growing evidence that sedentary behaviours (e.g. sitting for long periods at work, for
travel, study and ‘screen time’) is independently and adversely linked to all-cause mortality,
cardiovascular deaths, type 2 diabetes, some cancers and depression.28 An increase in sedentary
behaviour can be associated with social, economic and cultural trends that have removed physical
activity from daily life, evidenced by a reduction in manual jobs and the continual use of technology
for work and leisure that requires people to sit for long periods.
Studies show that doing more than 150 minutes of moderate physical activity or 75 minutes of
vigorous physical activity reduces the risk of coronary heart disease by approximately 30%.29
Physical activity promotes cardiovascular health through regulating weight and the body’s use of
insulin, as well as providing health benefits relating to blood pressure, blood lipid levels, blood
glucose levels, blood clotting factors and the health of blood vessels.
Figure 79: The percentage of adults who are physically active in Peterborough (54.6%) is lower
than the East of England average (57.8%) and the England average (56.0%).
Area Physically active
% Physically inactive
%
Peterborough 54.6% 31.2%
East of England 57.8% 26.9%
England 56.0% 28.9%
Source: Sport England Local Sport Profiles 2014
Approximately eight deaths could be prevented annually if 25% more persons aged 40-79 in
Peterborough engaged in physical activity. The reduction in deaths could rise to 117 if 100% more
were involved.
Figure 80: Number of deaths that could be prevented by increasing levels of physical activity
among 40-79 year olds
Percentage more active Peterborough East of England England
25% 8 163 1,749
50% 45 1,394 13,438
75% 81 2,625 25,127
100% 117 3,856 36,815
Source: Sport England Local Sport Profiles 2014
28 ’Start active, stay active’- a report on physical activity and health from the four home countries’ Chief Medical Officers, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216370/dh_128210.pdf 29 ’Start active, stay active’- a report on physical activity and health from the four home countries’ Chief Medical Officers, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216370/dh_128210.pdf
60
The cost of physical inactivity in terms of expenditure on related ailments in Peterborough in
2009/10 financial year was estimated to be over £2.7 million. More than half of the estimated
expenditure (£1.4 million) was on coronary heart disease.
Figure 81: Health costs of physical inactivity, split by disease type, 2009/10
Disease category Peterborough East of England England
Coronary heart disease £1,463,791 £60,186,615 £491,095,943
Diabetes £787,339 £19,484,702 £190,660,420
Cerebrovascular disease e.g. stroke £267,574 £11,718,678 £134,359,285
Cancer lower GI e.g. bowel cancer £133,227 £5,853,928 £67,816,189
Breast Cancer £94,798 £5,755,887 £60,357,887
Total Cost £2,746,729 £102,999,810 £944,289,723
Source: Sport England Local Sport Profiles 2014
There is a clear correlation between health and where we live. A number of published studies have
provided evidence that our local environments can have a positive effect on individual health and
wellbeing. However, many aspects of cities and towns deter people from being physically active.
Lack of access to open and green spaces can be detrimental to people’s physical and mental health.
This is particularly evident within areas of deprivation that have access to green space. Within such
areas all-cause mortality rates of residents have been found to be significantly lower compared to
those of other residents in deprived areas with less access to green space.
Barriers to walking or cycling as part of everyday life also restrict and discourage people to from
becoming more physically active. The Campaign for Better Transport’s 2014 Car Dependency
Scorecard30 rated Peterborough as ‘the most car-dependent’ of 29 assessed cities.
Figure 82: Campaign for Better Transport 2014 Car Dependency Scorecard
Source: Campaign for Better Transport
30 http://www.bettertransport.org.uk/sites/default/files/pdfs/Car_Dep_Scorecard_2014_LOW_RES.pdf
61
Figure 83: NICE physical activity guidance
PH2 – Four commonly used methods to increase physical activity
PH8 – Physical activity and the environment
PH41 – Walking and cycling: local measures to promote walking and cycling as forms of travel and recreation
PH44 – Brief advice for adults in primary care
PH54 – Exercise referral schemes to promote physical activity
Source: http://www.nice.org.uk/guidance/lifestyle-and-wellbeing/physical-activity
3.5 Poor Diet as a CVD Risk Factor
Evidence shows that the risk of a new major cardiac event can be reduced up to 73% by consuming
a diet low in saturated fats and including substantial amounts of fresh fruit and vegetables31. Foods
that can contribute towards cardiovascular health include:
• Fresh fruits and vegetables – low intake of fresh fruit and vegetables accounts for about 20% of
cardiovascular disease worldwide, as they contain components that protect against heart disease
and stroke.
• Fish – in countries where fish consumption is high there is a reduced risk of death from all causes,
including cardiovascular mortality
• Nuts – eating nuts regularly is associated with decreased risk of coronary heart disease
• Wholegrain cereals – Unrefined whole grains contain folic acid, B vitamins and fibre, all of which
protect against heart disease.
• Soy – Evidence shows that soy has a beneficial effect on blood lipid levels and reduces cholesterol
levels.
Dietary factors that are known to damage cardiovascular health include:
• A diet high in trans fats (e.g. fast food, cakes) and saturated fats (e.g. cheese, butter) increases
levels of cholesterol and can contribute towards abnormal blood lipid levels, which have a strong
31 http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors/diet/
62
correlation with the risk of coronary artery disease.32 It is recommended that the average man
should eat no more than 30g of saturated fat per day and the average woman no more than 20g.
• Salt/Sodium – high consumption of sodium is linked to high blood pressure, a major risk factor for
cardiovascular disease. It has been estimated that a universal reduction in dietary intake of sodium
by approximately 1g of sodium per day (about 3g of salt) would lead to a 50% reduction in the
number of people needing treatment for hypertension, a 22% drop in the number of deaths from
strokes and a 16% fall in deaths from coronary heart disease.33
In 2013, the UK government introduced front-of-pack nutrition labelling to help consumers easily
assess the content of their food. Red colour coding means the food or drink is high in this nutrient
and should be consumed in moderation or avoided. Amber colour coding means the food or drink
has a relatively average amount of the nutrient and can be safely consumed on a regular basis.
Green colour coding means the food or drink is low in this nutrient and is therefore likely to
represent ‘the healthier choice’ within a diet.
Figure 84: UK front-of-pack nutrition labelling example
Government guidance suggests that people should consume at least 5 portions of fruit and
vegetables per day to maintain their health. The below table shows the percentage of residents
within each of Peterborough’s wards that self-reported as consuming at least 5 portions of fruit and
vegetables per day, as well as data pertaining to the number of emergency hospital admissions and
deaths within wards.
Data show a clear correlation between low levels of economic deprivation, high levels of healthy
eating and relatively low levels of emergency hospital admissions and deaths. Conversely, where
deprivation is relatively high, levels of healthy eating tend to be relatively low and hospital
admission rates are high.
32 http://www.nhs.uk/livewell/goodfood/pages/eat-less-saturated-fat.aspx 33 http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors/diet/
63
Figure 85: % of Healthy eating adults and associated emergency hospital admission/mortality
metrics
Within the table below, indirectly age-standardised rates are presented from emergency hospital
admissions for all causes and deaths from all causes. Indirect age-standardisation provides a
method through which the rate of observed events can be compared between two or more areas
(e.g. Peterborough City Council electoral wards compared to England) in the absence of age-specific
data that would be required for direct age standardisation. The rate for England is set at 100.0; a
local rate below 100.0 illustrates fewer observed events than would be expected based on values
for England, whereas conversely a rate above 100.0 shows a greater number of observed events
than would be expected in comparison to the rate for England.
Area % living in income
deprived households (2010)
% health eating adults (2006-2008)
Standardised Admission Ratio: Emergency hospital admissions for all causes
(2008/09-2012/13)
Standardised Mortality Ratio: Deaths from all
causes, all ages (2008-2012)
Barnack 4.7 37.2 88.8 80.0
Glinton and Wittering
5.3 36.1 85.8 81.1
Northborough 5.7 35.2 86.8 95.7
Newborough 6.7 29.6 76.7 75.1
Werrington South
10.1 28.9 85.7 104.7
Orton Waterville
10.3 32.7 86.2 73.5
Orton with Hampton
10.3 28.9 96.8 90.2
West 10.5 35.3 92.8 136.0
Werrington North
11.2 28.3 85.4 76.9
Eye and Thorney
11.7 28.4 94.3 125.5
Stanground East
13.1 26.4 93.9 80.5
Bretton South 14.3 32.0 95.0 83.0
Stanground Central
14.6 26.2 99.6 102.2
Walton 15.6 27.7 99.1 102.9
Fletton and Woodston
17.3 27.3 109.8 103.4
Park 21.7 30.0 119.3 150.9
Bretton North 23.3 23.6 111.9 96.3
Orton Longueville
24.0 24.8 118.3 131.2
East 25.3 26.6 114.4 108.1
Ravensthorpe 25.4 23.3 123.1 117.5
Central 25.5 28.2 127.5 105.9
Paston 25.7 23.9 107.2 95.2
North 26.5 23.4 117.4 95.1
Dogsthorpe 28.0 23.0 113.0 109.7
Peterborough Unitary
Authority 17.8 28.0 104.2 105.6
64
Area % living in income
deprived households (2010)
% health eating adults (2006-2008)
Standardised Admission Ratio: Emergency hospital admissions for all causes
(2008/09-2012/13)
Standardised Mortality Ratio: Deaths from all
causes, all ages (2008-2012)
Cambridgeshire &
Peterborough Clinical
Commissioning Group
10.6 31.6 86.8 91.9
England 14.7 28.7 100.0 100.0
Source: Local Health Profiles
Figure 86: NICE diet guidance
PH47 – Managing overweight and obesity in children and young people
PH53 - Managing overweight and obesity in adults – lifestyle weight management services
Source: http://www.nice.org.uk/guidance/lifestyle-and-wellbeing/diet--nutrition-and-obesity
3.6 Obesity as a CVD Risk Factor
Obesity is a term used to describe somebody who is very overweight, with a lot of body fat34. Being
obese can dramatically increase the risk of developing a range of serious diseases. Additionally,
moderate obesity (a BMI of 30-35) was found to reduce life expectancy by an average of three years,
while morbid obesity (a BMI of 40-50) reduces life expectancy by 8-10 years – a similar reduction in
life expectancy to that caused by a lifetime of smoking tobacco.35 NICE guidance recommends lower
thresholds of obesity for intervening to prevent ill health among adults from black, Asian and other
ethnic groups (with an increased risk of chronic conditions BMI≥ 23 kg/m² and a high risk of chronic
conditions BMI ≥27.5kg/m²).36
Obesity can lead to physical problems including type 2 diabetes, cardiovascular disease and
obstructive sleep apnoea as well as psychosocial risks such as low self-esteem and impaired quality
of life for both children and adults.37
34 http://www.nhs.uk/Conditions/Obesity/Pages/Introduction.aspx 35 http://www.noo.org.uk/NOO_about_obesity/obesity_and_health 36 http://publications.nice.or.uk/gb13 37 http://www.noo.org.uk/NOO_about_obesity/obesity_and_health/health_risk_child
65
Source: https://www.noo.org.uk/slide_sets
The most widely used method for classifying a person’s general health in relation to their weight is
body mass index (BMI). For adults, BMI is calculated as:
Weight in kilograms/height in metres/height in metres
For example, an adult weighing 70kg and 1.75 tall would calculate their BMI as:
70 / 1.75 / 1.75 = 22.9.
BMI is calculated differently for adults and children. For adults:
A BMI under 18.5 is considered underweight;
A BMI of 18.5 to 24.9 is considered a healthy weight;
A BMI of 25 to 29.9 is considered overweight;
A BMI of 30 to 39.9 is considered obese;
A BMI of 40 or above is considered morbidly obese.
The below chart provides a broad indication of healthy weight for height ranges for adults.
66
Figure 87: Healthy Weight/BMI Chart
Source: Diabetes UK
For children, BMI is interpreted by reference to a child’s BMI centile – how they compare in
relation to other children of the same age, height and sex.38
Public Health England predict that 70% of adults will be overweight or obese by the year 2034 39
- this would amount to approximately 170,000 people within Peterborough if Cambridgeshire
research group population growth projections prove accurate.
The most recent estimates released by Public Health England (based on the 2012 Active People
Survey) suggest the actual percentage of adults classified as obese in Peterborough to be 24.1%,
2.5% higher than the estimate for Cambridgeshire (21.6%). The Public Health Outcomes Framework
also includes an estimated percentage of adults classified as either overweight or obese; in
Peterborough, this figure is 65.5% whereas in Cambridgeshire it is 65.0%.
38 http://www.nhs.uk/Livewell/loseweight/Pages/BodyMassIndex.aspx#women 39 https://www.noo.org.uk/slide_sets
67
Area % of adults classified as obese
(Active People Survey, 2012)
% of adults with excess
weight (PHOF indicator 2.12),
2012
Peterborough 24.1% 65.5%
Cambridgeshire 21.6% 65.0%
Source: Active People Survey, Public Health England
Figure 88: Recorded Obesity Prevalence 2013/14, 16+, Cambridgeshire & Peterborough CCG LCGs
LCG Number Prevalence LI UI 65+ 85+
CATCH 11,443 6.1% 6.0% 6.2% 15.0% 2.1%
CAM HEALTH 4,457 6.1% 5.9% 6.3% 13.9% 2.5%
HUNTS HEALTH 5,150 9.3% 9.1% 9.6% 16.2% 1.9%
BORDERLINE 8,305 9.6% 9.4% 9.8% 16.2% 2.1%
ISLE OF ELY 7,469 9.7% 9.5% 9.9% 18.0% 2.2%
HUNTS CARE PARTNERS 9,981 10.0% 9.8% 10.2% 19.2% 2.4%
PETERBOROUGH 11,659 10.7% 10.5% 10.8% 12.7% 1.7%
WISBECH 4,720 12.1% 11.8% 12.4% 19.8% 2.5%
BORDERLINE & PETERBOROUGH LCGs 19,964 10.2% 10.0% 10.3% 14.3% 1.9%
ALL OTHER LCGs 43,220 8.1% 8.1% 8.2% 16.6% 2.2%
CCG 63,184 8.7% 8.6% 8.8% 15.9% 2.1%
Source: 2013/14 Quality Outcomes Framework Data
The prevalence of recorded obesity across the CCG is 8.7%. Both Borderline & Peterborough LCGs
have prevalence statistically significantly higher than the CCG, with the combined prevalence of the
two LCGs standing at 10.2% (19,964 people).
Figure 89: Recorded Obesity Prevalence 2013/14, 16+, Cambridgeshire & Peterborough CCG LCGs
Source: 2013/14 Quality Outcomes Framework Data
6.1% 6.1%
9.3% 9.6% 9.7% 10.0% 10.7%12.1%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
CA
TCH
CA
M H
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H
HU
NTS
HEA
LTH
BO
RD
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ISLE
OF
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HU
NTS
CA
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PA
RTN
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PET
ERB
OR
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WIS
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68
Figure 90: Recorded Obesity Prevalence 2013/14, 16+, Cambridgeshire & Peterborough CCG LCGs
The combined prevalence of obesity amongst all LCGs other than Borderline & Peterborough is
statistically significantly below that of the CCG (8.1% vs 8.7%). Prevalence in Borderline &
Peterborough LCGs is statistically significantly higher at 10.2%.
Source: 2013/14 Quality Outcomes Framework Data
Figure 91: Recorded Obesity Prevalence 2013/14, Cambridgeshire & Peterborough CCG Quintiles
of Deprivation
Quintile Persons Prevalence LI UI 65+ % 85+
5 – Most deprived 17,189 11.0% 10.8% 11.2% 14.6% 1.9%
4 15,328 10.2% 10.0% 10.3% 16.1% 2.2%
3 12,144 7.6% 7.4% 7.7% 14.6% 2.0%
2 9,076 6.6% 6.4% 6.7% 16.0% 2.1%
1 – Least Deprived 9,447 7.8% 7.6% 7.9% 19.1% 2.6%
CCG 63,184 8.7% 8.6% 8.8% 15.9% 2.1%
Source: 2013/14 Quality Outcomes Framework Data
10.2%
8.1%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
Borderline & Peterborough LCGs All Other LCGs
----- = CCG Value
Green = Statistically significantly low in comparison to CCG
Blue = No statistical significance in comparison to CCG
Red = Statistically significantly high in comparison to CCG
----- = CCG Value
Green = Statistically significantly low in comparison to CCG
Blue = No statistical significance in comparison to CCG
Red = Statistically significantly high in comparison to CCG
69
3.7 Harmful use of alcohol as a CVD Risk Factor
People who consume alcohol in excessive amounts place themselves at a substantial risk of
damaging their health, which in turn places a higher financial burden on the local
healthcare economy. The NHS recommends that men should not exceed 3-4 units of
alcohol a day and women not more than 2-3units a day.40 There are approximately 2 units
of alcohol in a regular strength (ABV 3.6%) beer, 3 units in a large glass of wine (ABV 12%)
and 1 unit in a standard 25ml shot of spirits (ABV 40%).
Figure 95 below shows that Peterborough City Council’s directly age standardised rate of
hospital admissions for alcohol-related cardiovascular disease (all persons) has been
statistically significantly higher than the England rate for the six consecutive years spanning
2008/09 – 2013/14. The Unitary Authority rate has, however, remained relatively
consistent over the past there years, during which time the England rate has increased.
Figure 92: Alcohol Related Cardiovascular Disease Hospital Admissions, All Persons
2008/09 – 2013/14 (Directly Age-Standardised Rate per 100,000)41
Source: Local Alcohol Profiles for England
40 http://www.nhs.uk/Livewell/alcohol/Pages/alcohol-units.aspx 41 http://www.lape.org.uk/
0
200
400
600
800
1,000
1,200
1,400
2008/09 2009/10 2010/11 2011/12 2012/13 2013/14
Peterborough UA Cambridgeshire & Peterborough CCG England
70
Admissions
Period Peterborough UA Cambridgeshire & Peterborough CCG
England
2008/09 1,026 928 759
2009/10 1,172 1,021 855
2010/11 1,249 1,089 958
2011/12 1,168 1,047 988
2012/13 1,172 1,049 997
2013/14 1,168 1,085 1,049
Source: Local Alcohol Profiles for England
Figure 93 shows that Peterborough’s admissions rate for all persons and for males is
statistically significantly high for each year between 2008/09 and 2013/14. For both all
persons and for males only, the Peterborough rate has remained relatively similar for each
of the past three years, during which time the rate for England has risen.
Figure 93: Alcohol Related Cardiovascular Disease Hospital Admissions, Males, 2008/09 –
2013/14 (Directly Age-Standardised Rate per 100,000)
Source: Local Alcohol Profiles for England
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
2,000
2008/09 2009/10 2010/11 2011/12 2012/13 2013/14
Peterborough UA Cambridgeshire & Peterborough CCG England
71
Admissions
Period Peterborough UA Cambridgeshire & Peterborough CCG
England
2008/09 1,548 1,382 1,114
2009/10 1,721 1,503 1,252
2010/11 1,864 1,623 1,399
2011/12 1,724 1,547 1,444
2012/13 1,715 1,553 1,457
2013/14 1,703 1,616 1,524
Source: Local Alcohol Profiles for England
The rate for females is statistically significantly high in Peterborough for each year between
2008/09 and 2013/14. Within the CCG overall, the rate was statistically significantly high
for the three years 2008/09 – 2010/11 but has been similar to that of England for the most
recent three years for which data are available. The admission rate is, however, much
lower for females than for males.
Figure 94: Alcohol Related Cardiovascular Disease Hospital Admissions, Females, 2008/09
– 2013/14 (Directly Age-Standardised Rate per 100,000)
Source: Local Alcohol Profiles for England
0
100
200
300
400
500
600
700
800
900
2008/09 2009/10 2010/11 2011/12 2012/13 2013/14
Peterborough UA Cambridgeshire & Peterborough CCG England
72
Admissions
Period Peterborough UA Cambridgeshire & Peterborough CCG
England
2008/09 638 569 488
2009/10 747 639 549
2010/11 768 662 617
2011/12 725 643 634
2012/13 744 636 636
2013/14 734 647 673
Source: Local Alcohol Profiles for England
Figure 95: NICE alcohol guidance
PH24 - Alcohol-use disorders: preventing harmful drinking
Source: http://www.nice.org.uk/guidance/lifestyle-and-wellbeing/alcohol
3.8 Diabetes as a CVD risk factor
Diabetes occurs when the body doesn’t produce, or respond to, the hormone insulin which maintains blood glucose. There are 3.2 million people diagnosed with diabetes in the UK and an estimated 630,000 people who have the condition, but don’t know it.42
There are two main types of diabetes: Type 1 diabetes and Type 2 diabetes. In Type 1 diabetes, the cells that produce insulin are damaged by the body’s immune system. This usually develop before the age of 40, requires insulin injections and accounts for about 10% of diabetes. Type 2 diabetes accounts for about 90% of cases and is caused when the body doesn’t produce enough insulin or the insulin produced doesn’t work effectively. It is treated with diet and exercise and often progresses to need drugs or insulin. It is more common with increasing age and in people who are overweight or obese-including a rising number of young people.
Ethnicity is a factor in the development of diabetes with South Asians having a 50% higher lifetime risk of Type 2 diabetes than white Europeans and in often develops at a younger age and at a lower level of obesity.
Deprived people are 2.5 times more likely to have diabetes on average, at any given age, mostly as deprivation is associated with higher levels of obesity and physical inactivity. The risk in people with a mental illness is also 2-3 times higher than in those without; this is thought to be due to differences in diet and physical activity and also a side effects of drugs which can promote weight gain and affect glucose metabolism.
73
There is a strong correlation between cardiovascular disease (CVD) and diabetes. Heart diseases and stroke are the number one causes of death and disability among people with type 2 diabetes. At least 65 percent of people with diabetes die from some form of heart disease or stroke. Adults with diabetes are two to four times more likely to have heart disease or a stroke than adults without diabetes. The American Heart Association considers diabetes to be one of the seven major controllable risk factors for cardiovascular disease.
People with diabetes, particularly type 2 diabetes, often have the following conditions that contribute to their risk for developing cardiovascular disease.
High blood pressure (hypertension);
Abnormal cholesterol and high triglycerides;
Obesity;
Lack of physical activity/ sedentary lifestyles;
Poorly controlled blood sugars (too high) or out of normal range which damages small blood vessels;
Smoking; Insulin Resistance.
Figure 96: Public Health Outcomes Framework – East of England Diabetes Profile
Source: Public Health England, East of England Diabetes Profile
74
Figure 97: Diabetes Prevalence 2013/14, Cambridgeshire & Peterborough CCG LCGs
LCG Number Prevalence LI UI 65+ % 85+
CATCH 7,366 4.0% 3.9% 4.1% 15.0% 2.1%
CAM HEALTH 3,060 4.3% 4.1% 4.4% 13.9% 2.5%
HUNTS HEALTH 3,142 5.8% 5.6% 6.0% 16.2% 1.9%
BORDERLINE 5,313 6.2% 6.1% 6.4% 16.2% 2.1%
PETERBOROUGH 6,931 6.4% 6.3% 6.6% 12.7% 1.7%
ISLE OF ELY 4,937 6.5% 6.3% 6.7% 18.0% 2.2%
HUNTS CARE PARTNERS 6,440 6.6% 6.4% 6.7% 19.2% 2.4%
WISBECH 2,813 7.3% 7.0% 7.6% 19.8% 2.5%
BORDERLINE & PETERBOROUGH LCGs 12,244 6.3% 6.2% 6.5% 14.3% 1.9%
ALL OTHER LCGs 27,758 5.3% 5.2% 5.4% 16.6% 2.2%
CCG 40,002 5.6% 5.5% 5.6% 15.9% 2.1%
Source: 2013/14 Quality Outcomes Framework Data
Both Borderline & Peterborough LCGs have statistically significantly high prevalence of diabetes;
collectively the prevalence for the two LCGs is 6.3% vs 5.6% across the LCG as a whole.
Figure 98: Diabetes Prevalence 2013/14, Cambridgeshire & Peterborough CCG LCGs
Source: 2013/14 Quality Outcomes Framework Data
4.0% 4.3%
5.8%6.2% 6.4% 6.5% 6.6%
7.3%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
CA
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OR
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OF
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HU
NTS
CA
RE
PA
RTN
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WIS
BEC
H
----- = CCG Value
Green = Statistically significantly low in comparison to CCG
Blue = No statistical significance in comparison to CCG
Red = Statistically significantly high in comparison to CCG
75
Figure 99: Diabetes Prevalence 2013/14, Borderline & Peterborough vs All Other LCGs
Source: 2013/14 Quality Outcomes Framework Data
3.9 Modifiable Risk Factors - Population Level Interventions
These are interventions also focusing on modifiable risk factors but at population-level
which could lead to further substantial reduction in cardiovascular disorders. These can be
achieved in a number of ways but must be supported by national and/or local policies and
legislation. The table below summarises NICE guidance Prevention of Cardiovascular Disease
(PH25) https://www.nice.org.uk/guidance/ph25 recommendations for policy.
Figure 100: NICE guidance Prevention of Cardiovascular Disease (PH25)
Issue Summary of rationale Policy Goal
Salt High levels of salt in the diet are
linked with high blood pressure
which, in turn, can lead to stroke
and coronary heart disease. High
levels of salt in processed food have
a major impact on the total amount
consumed by the population.
To reduce population-level consumption of salt.
Saturated Fats Reducing general consumption of
saturated fat is crucial to preventing
CVD.
To reduce population-level consumption of saturated fats including the continued promotion of semi-skimmed milk for children aged over 2 years.
6.3%
5.3%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
Borderline & Peterboruogh LCGs All Other LCGs
----- = CCG Value
Green = Statistically significantly low in comparison to CCG
Blue = No statistical significance in comparison to CCG
Red = Statistically significantly high in comparison to CCG
76
Trans fats Industrially-produced trans fatty
acids (IPTFAs) constitute a significant
health hazard.
Ensure all groups in the population
are protected from the harmful
effects of IPTFAs. This includes
establishing guidelines for local
authorities to monitor
independently IPTFA levels in the
restaurant, fast-food and home food
trades using existing statutory
powers (in relation to trading
standards or environmental health).
Marketing and
promotions aimed
at children and
young people
Eating and drinking patterns get
established at an early age so
measures to protect children from
the dangers of a poor diet should be
given serious consideration.
Ensure children and young people
under 16 are protected from all
forms of marketing, advertising and
promotions (including product
placements) which encourage an
unhealthy diet.
Commercial
Interests
If deaths and illnesses associated
with CVD are to be reduced, it is
important that food and drink
manufacturers, retailers, caterers,
producers and growers, along with
associated organisations, deliver
goods that underpin this goal.
Ensure dealings between government, government agencies and the commercial sector are conducted in a transparent manner that supports public health objectives.
Product labelling Clear labelling which describes the
content of food and drink products
is important because it helps
consumers to make informed
choices. It may also be an important
means of encouraging
manufacturers and retailers to
reformulate processed foods high in
saturated fats, salt and added
sugars.
Evidence shows that simple traffic
light labelling consistently works
better than more complex schemes
and should be encouraged.
Health impact
assessment
Policies in a wide variety of areas
can have a positive or negative
impact on CVD risk factors and
frequently the consequences are
unintended. The Cabinet Office has
indicated that, where relevant,
government departments should
assess the impact of policies on the
health of the population.
Use a variety of methods to assess
the potential impact (positive and
negative) that all local policies and
plans may have on rates of CVD and
related chronic diseases.
Take account of any potential impact
on health inequalities.
Physically active
travel
Travel offers an important
opportunity to help people become
more physically active. However,
Ensure guidance for local transport plans supports physically active travel. This can be achieved by
77
inactive modes of transport have
increasingly dominated in recent
years.
allocating a percentage of the integrated block allocation fund to schemes which support walking and cycling as modes of transport. Create an environment and incentives which promote physical activity, including physically active travel to and at work.
Consider and address factors which
discourage physical activity,
including physically active travel to
and at work. An example of the
latter is subsidised parking.
Public sector
catering guidelines
Public sector organisations are
important providers of food and
drink to large sections of the
population. It is estimated that they
provide around one in three meals
eaten outside the home. Hence, an
effective way to reduce the risk of
CVD would be to improve the
nutritional quality of the food and
drink they provide.
Ensure publicly funded food and drink provision contributes to a healthy, balanced diet and the prevention of CVD. Ensure public sector catering practice offers a good example of what can be done to promote a healthy, balanced diet.
Take-aways and
other food outlets
Food from take-aways and other
outlets (the 'informal eating out
sector') comprises a significant part
of many people's diet. Local
planning authorities have powers to
control fast food outlets.
Encourage local planning authorities to restrict planning permission for take-aways and other food retail outlets in specific areas (for example,within walking distance of schools). Help them implement existing planning policy guidance in line with public health objectives.
Monitoring CVD is responsible for around 33%
of the observed gap in life
expectancy among people living in
areas with the worst health and
deprivation indicators compared
with those living elsewhere in
England.
Independent monitoring, using a full
range of available data, is vital when
assessing the need for additional
measures to address such health
inequalities, including those related
to CVD.
Use available data to assess the need
for additional measures to address
health inequalities related to CVD.
78
4 Services for Cardiovascular Disease
4.1 Health Checks in Primary Care
Everyone aged 40-74 who is does not have a pre-existing condition is eligible for an NHS Health
Check every five years to identify those with risk factors for cardiovascular and kidney disease and
diabetes. Older people, aged over 65 years, are provided with information on the signs and
symptoms of dementia and on local services.
Figure 101: Observed Number of People Invited for an NHS Health Check Q1 2013/14 – Q3
2014/1543
Source: Public Health Outcomes Framework Indicator 2.22iii
22,462 people have now been invited for an NHS Health Check in Peterborough; 45.8% of the
eligible population. This figure is statistically significantly better than the percentage observed in
England overall which stands at 33.1%.
However, the proportion taking up the tests remains disappointing. Only 10,769 eligible people in
Peterborough took up an NHS Health Check in 2014/5, 47.9% of the total of invites (22,462). This
number is statistically similar to England; in the previous six periods of measurement, Peterborough
has been statistically significantly worse than England with regards to converting invitations in to
Health Checks.
Figure 102: Outcome of NHS Heath Checks, 2013-1444
43 http://fingertips.phe.org.uk/profile/nhs-health-check-detailed
44 Tackling Inequalities in Coronary Heart Disease programme update 3, May 2014
79
4.2 Hospital Services – Quality Standards & National Audit Data
The majority of Peterborough residents with cardiovascular conditions are admitted to
Peterborough and Stamford Hospitals NHS Foundation Trust. The hospital participates in the
national audits of treatments for heart disease and stroke.
However, patients with acute chest pain are taken to Papworth Hospital, the specialist cardiac
hospital. Peterborough doesn’t offer emergency treatment to restore the blood flow in the coronary
arteries and there is some evidence that specialist centres, with high numbers of cases, achieve
better outcomes for patients.
4.2.1 Coronary heart disease (MINAP)
MINAP, the Myocardial Ischaemia National Audit Project, analyses data from ambulance and
hospital services on the process and outcomes of care to inform the public, clinicians and
commissioners on the quality of local care by publishing an annual report.
Heart attack or myocardial infarction is part of a spectrum of conditions know as acute coronary
syndrome. The term includes both ST-elevation myocardial infarction (STEMI- named for the ECG
changes seen ) where emergency re-perfusion of the coronary arteries with primary percutaneous
In 2013/14, Peterborough planned to undertake health checks on 6,059
registered patients aged 40-74. All 25 GP practices participated in the
programme with individual targets supported by clinical coaching and
Public Health events across all communities.
The programme has achieved 99.7% of the target (6042 completed checks
against a target of 6059). This is 12% increase on the number of completed
health checks compared to the 2012/13 programme.
Based on national and regional statistics Peterborough city council is 22nd
out 151 LAs and second across Eastern LAs. This is an excellent effort from
all GP practices working in partnership with the local authority to reduce
the prevalence of chronic disease.
Specific outcomes for Peterborough include:
777 patients assessed with a CVD risk of more than 20% (10 year
risk of developing a chronic disease.
164 Hypertensive patients identified (high blood pressure)
54 Diabetics diagnosed
495 patients referred to weight management programmes
1840 patients received dementia awareness advice
2003 patients received Alcohol Audit C assessment
557 patient referred to physical activity programme
471 patients prescribed statins to lower cholesterol
80
intervention (PCI) or thrombolytic drugs is indicated in eligible patients; and non-ST-elevation
myocardial infarction (nSTEMI) which is more common and requires different treatment.
The vast majority of patients (99.8%) with STEMI admitted to Papworth, (not just Peterborough
residents) received primary PCI in 2013-14 (1) and 30 day mortality unadjusted rates were below the
national average (6.3% vs 7.2% in primary PCI capable centres, 2011-14). (1)
Data for non-STEMI patients is more likely to be incomplete, particularly if they are not admitted to a
cardiac ward. In Peterborough, as in England, 94% were seen by a cardiologist or a member of their
team. Of those admitted to Peterborough hospital, all who were eligible were referred for
angiography with increasing numbers receiving this during their admission.
81
Figure 103: Primary PCI in hospitals in England, Wales and Belfast (extract of local data)
Source: MINAP National Clinical Audit 2014
82
Use of secondary prevention medication after the acute admission is proven to improve outcomes for patients with either STEMI or n-STEMI by reducing
the risk of a further heart attack or complications such as heart failure. NICE Clinical Guidance 48 supports the use of combinations of drugs in all eligible
patients who have had a heart attack. The audit also collects information on the percentage of patients with an acute coronary syndrome and eligible for
each secondary prevention medication who are discharged on that treatment. (Patients are not included if they die, are transferred to another hospital, are
not eligible for a medication or decline treatment)
Figure 104: Secondary prevention medication eligibility, 2012/13 and 2013/14 (extract of local data)
Source: MINAP National Clinical Audit 2014
83
4.2.2. Stroke (SSNAP)
The Sentinel Stroke National Audit Programme (SSNAP) aims to improve the quality of stroke care by
auditing stroke services against evidence based standards, and national and local benchmarks.
There are six domains for acute stroke care, each scored into five bands. The total organisational
score is obtained by calculating the average of the 6 domain scores, which are divided into bands A-
E, with A as the highest performance band. These results reflect the stroke service audit data of July
2104.
Figure 105: The six domains of stroke services organisation, SNAPP, 2014
Source: Sentinel Stroke National Audit Programme (SNAPP), RCP, regional results, 2014
Local hospitals, including Peterborough and Stamford Hospitals NHS Foundation Trust participate in
the audit. Peterborough City Hospital provided acute stroke care, including thrombolysis available
24/7 for eligible patients, a 36 bed stroke unit with access to a range of specialist staff and prompt
access to investigate and initiate treatment in high risk transient ischaemic attacks (TIA).
84
Figure 106: Stroke national acute organisational audit, east of England, 2014
Source: Sentinel Stroke National Audit Programme (SNAPP), RCP, Regional Results 2014
85
4.2.3 Tackling Coronary Heart Disease inequalities programme Recognising the challenge in inequalities in coronary heart disease, the Peterborough and Borderline
LCGs instigated a programme of work to improve population outcomes. The programme had four
areas of activity:
Smoking cessation
Health checks
Cardiac rehabilitation
Primary care and prevention.
Physiological/metabolic risk factors are generally managed in primary care with support from hospital services and clinicians. It was not possible to include information on the management of high blood pressure, hypercholesterolaemia, atrial fibrillation etc. or these services in this JSNA although some data is included in the quality and outcomes framework.
Following Peterborough City Council prioritising cardiovascular disease, the programme is reviewing
its remit and with a view to including the detection and management of atrial fibrillation, a risk
factor for strokes and transient ischaemic attacks. Across Cambridgeshire and Peterborough CCG,
the East Midlands Strategic Clinical Network model suggests that 348 strokes and 115 deaths per
year could be prevented by optimum management of atrial fibrillation compared to the 134 strokes
and 44 deaths per year prevented by current management.
Figure 107: Tackling Health Inequalities in Coronary Heart Disease 2015/16
Source: Tackling Inequalities in Coronary Heart Disease Board, 2015
86
Service Gaps
Further work is needed to better understand the range of services for prevention, treatment,
rehabilitation and continuing support for people with CVD across sectors and to map pathways of
care against quality standards and needs.
Consideration of equity and inequalities in access and outcome should be central to this work.
The views of users –and those who don’t take up services, such as the offer of an Health Check-and an understanding of barriers to accessing services particularly for BME and deprived communities should be considered.
The process of engagement through the CVD JSNA steering group and workshops is central to developing this programme of work.
5. Evidence of Effectiveness
Available evidence on what works in CVD prevention is based on reviews carried out by the National
Institute for Health and Clinical Excellence (NICE). Findings From these reviews have been used in
developing guidance documents currently utilized in the development of intervention programmes
in the UK. Recommended interventions are either at individual or population level.
5.1 Individual Level Interventions
These are interventions focussing on modifiable (CVD) risk factors and aim at changing an
individual's behaviour. They are supported by a range of existing NICE guidance listed in figure 108.
Figure 108: NICE guidance CVD prevention individual level interventions
Risk Factor
Rationale NICE guidance
Alcohol
Excessive alcohol can cause
abnormal heart rhythms, high
blood pressure, damage to the
heart muscle and lead to a
stroke.
Alcohol-use disorders: preventing
harmful drinking. NICE public health
guidance 24 (2010).
Physical
Activity
Lack of regular exercise
increases the risk for
developing high blood
pressure, high cholesterol
Promoting physical activity for children
and young people. NICE public health
guidance 17 (2009).
87
levels, high stress levels and
being overweight. All of which
are risk factors for CVD.
Promoting physical activity in the
workplace. NICE public health guidance
13 (2008).
Physical activity and the environment.
NICE public health guidance 8 (2008).
Four commonly used methods to
increase physical activity. NICE public
health guidance 2 (2006).
Smoking
Smoking and other tobacco use
are significant risk factors for
CVD. The toxins (poisons) in
tobacco can damage and
narrow coronary arteries,
making affected persons more
vulnerable to coronary heart
disease.
Preventing the uptake of smoking by
children and young people. NICE public
health guidance 14 (2008).
Smoking cessation services. NICE public
health guidance 10 (2008).
Workplace interventions to promote
smoking cessation. NICE public health
guidance 5 (2007).
Brief interventions and referral for
smoking cessation in primary care and
other settings. NICE public health
guidance 1 (2006).
Obesity
Being overweight or obese
increases the risk of developing
diabetes and high blood
pressure.
Maternal and child nutrition. NICE public
health guidance 11 (2008).
Obesity: the prevention, identification,
assessment and management of
overweight and obesity in adults and
children. NICE clinical guideline 43
(2006).
Obesity in
BME groups
The prevalence of conditions
such as Type 2 diabetes , CHD
and stroke is up to 6 times
higher (and they occur at a
younger age) among BME
groups.
Lifestyle interventions
targeting sedentary lifestyles
Body mass index thresholds for
intervening to prevent ill health among
black, Asian and other minority ethnic
groups 2014
http://www.publications.nice.org/lgb13
88
and weight have reduced the
incidence of diabetes by 50% in
high risk individuals.
BMI thresholds recommended
as a trigger to intervene to
prevent ill health among adults
from black, Asian and other
ethnic groups :
Increased risk chronic
conditions BMI 23
kg/m2
High risk of chronic
conditions BMI
27.5KG/m2
Hypertension
High blood pressure
(hypertension) can damage
artery walls and increase the
risk of developing a blood clot
and eventually a stroke.
Usually a normal blood
pressure reading should be
below 130/80mmHg.
Hypertension: Clinical management of
primary hypertension in adults. NICE
clinical guideline 127 (2011).
Health
Checks
Local authorities and their
partners should encourage
people to have NHS health
checks and support them to
change their behaviour to
reduce their risk factors.
NHS health checks
should be offered to
each eligible person
aged 40-75 once every
Encouraging people to have NHS Health
Checks and supporting them to reduce
risk factors [LBG15] 2014
https://www.nice.org.uk/advice/lgb15
89
5 year, with recall every
5 year if still eligible;
People having a health
check should be told
their cardiovascular risk
score and other results;
And provided with
individually tailored
advice which will
motivate them and
support any necessary
lifestyle changes to help
them manage risk.
Identifying
and
supporting
people most
at risk of
dying
prematurely
Aims to support the
identification and provision of
services to people who are
disadvantaged and most at risk
of dying early from heart
disease. The risk of dying early
can be reduced by providing
services to help people stop
smoking and the treatment of
high cholesterol and other
conditions which increase the
risk of heart disease.
GPs and other NHS staff
and local authorities
should set up systems
to identify people who
are disadvantaged and
Identifying and supporting people most
at risk of dying prematurely [PH15] 2008
https://www.nice.org.uk/guidance/ph15
90
at high risk of heart
disease.
NHS organisations and
the local authority
should work together
to provide flexible
services to improve the
health of these people;
The NHS and local
authorities should
ensure that services
aiming to improve the
health of people who
are disadvantaged are
coordinated and that
there are enough
people trained to run
them.
91
5.2 Population Level Interventions
These are interventions also focusing on modifiable risk factors but at population-level
which could lead to further substantial reduction in cardiovascular disorders. These can be
achieved in a number of ways but must be supported by national and/or local policies and
legislation. Figure 108 summarises recommendations for local action by commissioners and
providers of public health services. They are based on extensive and consistent evidence
compiled by NICE.45
Figure 109: NICE guidance CVD prevention - population level interventions
Issue
National Strategy
Recommended Local Action for
commissioners and providers of
public health services
Salt
High levels of salt in the diet are
linked with high blood pressure
which, in turn, can lead to stroke
and coronary heart disease. High
levels of salt in processed food
have a major impact on the total
amount consumed by the
population. The government
food standards agency is working
with the food industry to reduce
salt in everyday foods.
Ensure all food procured by, and
provided for, people working in the
public sector and all food provided for
people who use public services: is low
in salt and saturated fats, is
nutritionally balanced and varied, in
line with recommendations made in
the 'eat well plate.' 46
Saturated
Fats
Reducing general consumption of
saturated fat is crucial to
preventing CVD. The government
food standards agency is working
with consumers and food
industry to reduce the
population's intake.
Ensure all food procured by, and
provided for, people working in the
public sector and all food provided for
people who use public services: is low
in saturated fats and is nutritionally
balanced and varied, in line with
recommendations made in the 'eat
well plate.'
45 NICE: Prevention of cardiovascular disease: https://www.nice.org.uk/guidance/ph25 46 Department of Health: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/340869/2014-250_-_eatwell_plate_Final_version_2014.pdf
92
Issue
National Strategy
Recommended Local Action for
commissioners and providers of
public health services
Trans fats
Industrially-produced trans fatty
acids (IPTFAs) constitute a
significant health hazard. The
government food standards
agency is working with
manufacturers and caterers to
ensure reduction in the amount
of IPTFAs in their products.
Ensure all food procured by, and
provided for, people working in the
public sector and all food provided for
people who use public services does
not contain industrially produced trans
fatty acids (IPTFAs).
Marketing
and
promotions
aimed at
children and
young
people
Eating and drinking patterns get
established at an early age so
measures to protect children
from the dangers of a poor diet
should be given serious
consideration. Current
advertising restrictions have
reduced the number of
advertisements for foods high in
fat, salt or sugar during television
programmes made for children
and young people.
Encourage venues frequented by
children and young people and
supported by public money to resist
sponsorship or product placement
from companies associated with foods
high in fat, sugar or salt. (This includes
fun parks and museums).
Commercial
Interests
Dealings between government,
government agencies and the
commercial sector should be
conducted in a transparent
manner that supports public
health objectives and is in line
with best practice. (This includes
full disclosure of interests).
Encourage best practice for all
meetings, including lobbying, between
the food and drink industry and
government (and government
agencies). This includes full disclosure
of interests by all parties. It also
involves a requirement that
information provided by the food and
93
Issue
National Strategy
Recommended Local Action for
commissioners and providers of
public health services
drink, catering and agriculture
industries is available for the general
public and is auditable.
Product
labelling
Clear labelling which describes
the content of food and drink
products is important because it
helps consumers to make
informed choices. It may also be
an important means of
encouraging manufacturers and
retailers to reformulate
processed foods high in
saturated fats, salt and added
sugars. Evidence shows that
simple traffic light labelling
consistently works better than
more complex schemes.
Encourage local food and drink
manufacturers and retailers to adopt
traffic light labelling of their products
Health
impact
assessment
Policies in a wide variety of areas
can have a positive or negative
impact on CVD risk factors and
frequently the consequences are
unintended. The Cabinet Office
has indicated that, where
relevant, government
departments should assess the
impact of policies on the health
of the population.
Use a variety of methods to assess the
potential impact (positive and
negative) that all local policies and
plans may have on rates of CVD and
related chronic diseases.
Take account of any potential impact
on health inequalities.
Physically
active travel
Travel offers an important
opportunity to help people
Ensure the physical environment
encourages people to be physically
94
Issue
National Strategy
Recommended Local Action for
commissioners and providers of
public health services
become more physically active.
However, inactive modes of
transport have increasingly
dominated in recent years. In
some areas in England, schemes
are in place to encourage people
to opt for more physically active
forms of travel such as walking
and cycling.
active. This includes prioritising the
needs of pedestrians and cyclists over
motorists when developing or
redeveloping highways. It also includes
developing and implementing public
sector workplace travel plans that
incorporate physical activity.
Encourage and support employers in
other sectors to do the same.
Public sector
catering
guidelines
Public sector organisations are
important providers of food and
drink to large sections of the
population. It is estimated that
they provide around one in three
meals eaten outside the home.
Hence, an effective way to
reduce the risk of CVD would be
to improve the nutritional quality
of the food and drink they
provide.
When public money is used to procure
food and drink in venues outside the
direct control of the public sector,
ensure those venues provide a range
of affordable healthier options
(including from vending machines).
Ideally, the healthier options should be
cheaper than the less healthy
alternatives.
Encourage venues frequented by
children and young people and
supported by public money to resist
sponsorship or product placement
from companies associated with foods
high in fat, sugar or salt. (This includes
fun parks and museums).
Take-aways
and other
food outlets
Food from take-aways and other
outlets (the 'informal eating out
sector') comprises a significant
part of many people's diet. Local
Use bye-laws to regulate the opening
hours of take-aways and other food
outlets, particularly those near schools
that specialise in foods high in fat, salt
or sugar.
95
Issue
National Strategy
Recommended Local Action for
commissioners and providers of
public health services
planning authorities have powers
to control fast food outlets.
Use existing powers to set limits for
the number of take-aways and other
food outlets in a given area. Directives
should specify the distance from
schools and the maximum number
that can be located in certain areas.
Help owners and managers of take-
aways and other food outlets to
improve the nutritional quality of the
food they provide.
Ensure the links between nutrition and
health are an integral part of training
for catering managers
Monitoring
CVD is responsible for around
33% of the observed gap in life
expectancy among people living
in areas with the worst health
and deprivation indicators
compared with those living
elsewhere in England.
Independent monitoring, using a
full range of available data, is
vital when assessing the need for
additional measures to address
such health inequalities,
including those related to CVD.
Use available data to assess the need
for additional measures to address
health inequalities related to CVD
96
5.3 Clinical Guidance & Quality Standards
Figure 110: NICE guidance -Clinical guidance; and quality standards
Issue Summary of rationale
and recommendations
Guidance
Atrial Fibrillation
(AF)
AF is the most common
heart irregularity and
prevalence increases
with age. It is a risk
significant risk factor for
strokes.
Personalised packages of
care should be offered to
those in AF to include
consideration of
Anticoagulants
Drugs or cardio-
version to
correct heart
rhythm
Those with a
CHA2 DS2-VASC2
score of 2 or
above should be
offered
anticoagulation
with a NOVAC,
taking risk of
bleeding into
account
Do not offer
aspirin
monotherapy
solely for stroke
prevention.
Atrial fibrillation: the management of
atrial fibrillation [CG180]
http://www.nice.org.uk/guidance/cg180
-
Acute coronary
events
Makes recommendations
on referral, assessment,
Chest pain of recent onset: assessment
and diagnosis of recent onset chest pain
97
diagnosis, investigation
and management.
and discomfort of suspected cardiac
origin [CG95] 2010
Unstable angina
and STEMI
Guidance on the
investigation,
management and
assessment of risk and
prevention of future
events in angina and
non-ST segment
elevation myocardial
infraction.
Unstable angina and STEMI [CG 94] 2010
https://www.nice.org.uk/guidance/cg95
Myocardial
infarction with ST-
segment elevation
Guidance on assessment
& investigation (coronary
angiography) for
immediate reperfusion
by percutaneous
coronary intervention
[PCI] within 120 minutes
or fibrinolysis within 12
hours of presentation.
Myocardial infarction with ST-segment
elevation: the acute management of
myocardial infarction with ST segment
elevation [CG 167] 2013
https://www.nice.org.uk/guidance/cg167
Myocardial
infarction -
secondary
prevention
Recommends cardiac
rehabilitation (with an
exercise component )
and lifestyle changes,
psychological support
and medication following
an MI.
MI-secondary prevention: secondary
prevention in primary and secondary
care for patients following a myocardial
infarction, 2013
Chronic Heart
Failure
Recommends evidence –
based management and
treatment for people
with chronic heart
failure, including offering
a group based exercise
programme as part of
the cardiac rehabilitation
programme and planning
for end of life care.
Chronic heart failure: management
chronic heart failure in adults in primary
and secondary care [CG108] 2010
https://www.nice.org.uk/guidance/cg108
NICE Clinical knowledge summaries,
Heart Failure-chronic, revised May 2015
http://cks.nice.org.uk/heart-failure-
chronic#!changes
98
Stroke and TIA –
initial
management
Stroke is preventable and
treatable. Half of the
people living with a
stroke need assistance
with activities of
everyday living.
In a TIA (transient
ischaemic attack,
symptoms resolve within
24 hours.
A screening test
such as FAST
(the Face, arm,
speech test)
should be used
outside
hospital;
People who
have had a TIA
should be
assessed for
stroke risk with
a validated
scoring system
such as ABCD2
and referred for
specialist
assessment and
prevention
People with
acute stroke
should be cared
for in specialist
acute stoke
units; receive
urgent brain
imaging and be
assessed for
thrombolysis
with alteplase
Stroke: diagnosis and acute management
of stroke and TIA [CG 68]
99
and anti-
platelet drugs.
Stroke –
rehabilitation
Makes recommendations
on organising health and
social care for people
needing rehabilitation
after a stroke
Initially in a
dedicated stroke
inpatient unit
From a specialist
stroke team in
the community
Offering early
supported
discharge
6 month and then
annual reviews
Strength, fitness,
speech and
language training;
assessment of
cognitive and
visual
impairment;
depression;
return to work
and long term
health and social
support.
Stroke rehabilitation: long term
rehabilitation after stroke [CG 162]
https://www.nice.org.uk/guidance/cg162
Stroke services-
quality standard
Services should be
commissioned from and
coordinated across
agencies.
An integrated approach
to service provision is
fundamental to high
quality care.
Stroke quality standard[QS2] 2010
https://www.nice.org.uk/guidance/qs2
100
11 quality statements
including:
1.ambulance staff to
screen those with
neurological
symptoms with a
validated tool for
stroke and TIA and
transfer to stroke unit
within 1 hour
2. acute stroke
patients to receive
brain imaging within 1
hour of arrival ;
3. admit to a
specialist stroke unit
assess for
thrombolysis
4. screen for
swallowing reflex
within 4 hours
5. assessment and
management by a
specialist stroke team
6. inpatient
rehabilitation on a
specialist stroke unit
101
5.4 Effective CVD Prevention Programmes
Figure 111: Effective CVD Prevention Programmes
NICE recommends the following six components for effective CVD prevention programmes.47
1. Good practice principles
Programmes should comprise intense and multicomponent interventions that address
identified risk factors.
They should be sustainable for a minimum of five years and should be allocated adequate
resources.
2. Preparation
Programme leads should gain a good understanding of local CVD prevalence, existing risk
factors and ongoing interventions.
3. Programme development
Programmes should adopt a population based approach underpinned by a proven
theoretical model.
Programmes should link with other existing interventions e.g. NHS Health Checks.
Programmes should take account of existing NICE guidance.
4. Resources
Ensure programmes last a minimum of 5 years and are allocated adequate financial and
human resources.
5. Leadership
Identify senior figures in the local community and request them to act as champions for
CVD prevention.
6. Evaluation
Ensure evaluation is built in and results are freely available and are shared with partner
organisations.
47 NICE: Prevention of cardiovascular disease: https://www.nice.org.uk/guidance/ph25