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The Indicator Guide

Health Profiles 2009

Health Profiles 2009  The Indicator Guide 2

Contents
Section 1: Introduction
Section 2: Our communities
1. Deprivation indicator 6
2. Children in poverty indicator 12
3. Statutory homelessness indicator 18
4. GCSE achieved (5A*–C inc. Eng and Maths) indicator 24
5. Violent Crime indicator 31
6. Carbon emissions indicator 38
Section 3: Children’s and young people’s health
7. Smoking in pregnancy indicator 44
8. Breast feeding initiation indicator 52
9. Physically active children indicator 61
10. Obese children indicator 68
11. Children’s tooth decay (at age 5) indicator 77
12. Teenage pregnancy (under 18) indicator 86
Section 4: Adults’ health and lifestyle
13. Adults who smoke indicator 94
14. Binge drinking adults indicator 108
15. Health eating adults indicator 124
16. Physically active adults indicator 141
17. Obese adults indicator 148
Section 5: Disease and poor health
18. Over 65s ‘not in good health’ indicator 165
19. Incapacity benefits for mental illness indicator 172
20. Hospital stays for alcohol related harm indicator 179
21. Drug misuse indicator 185
22. People diagnosed with diabetes indicator 190
23. New cases of tuberculosis indicator 198
24. Hip fracture in over-65s indicator 203
Section 6: Life expectancy and causes of death
25. Excess winter deaths indicator 212
26. Life expectancy – male indicator 221
27. Life expectancy – female indicator 227
28. Infant deaths indicator 233
29. Deaths from smoking indicator 238
30. Early deaths: heart disease and stroke indicator 248
31. Early deaths: cancer indicator 253
32. Road injuries and deaths indicator 258
Section 7: Charts and trend graphs
33. Deprivation chart 266
34. Life expectancy by deprivation quintile chart 271
35. Trend 1: all age, all cause mortality 276
36. Trend 2: early deaths from heart disease and stroke 281
37. Trend 3: early deaths from cancer 286
38. Health inequalities: ethnicity chart 291

Health Profiles 2009  The Indicator Guide 3

Section 1:
Introduction

Health Profiles 2009  The Indicator Guide 4

Introduction

The Health Profiles are created using national indicators which are selected to give a snapshot of the
health in local authority areas. The metadata for the 32 indicators that have been selected for Health
Profiles 2009 are presented within five domains:

1. Our communities
2. Children’s and young people’s health
3. Adults’ health and lifestyle
4. Disease and poor health
5. Life expectancy and causes of death

The metadata for the charts and trend graphs within the central pages of the Heath Profiles 2009 are
also presented.

The Indicator Guide provides detailed information about each of these indicators. This includes a
summary table with 10 key pieces of basic information about the indicator such as:

• What is being measured?
• Why is it being measured?
• How is the indicator defined?

and a further three sections with more detailed information:

• The indicator description
• The indicator specification
• The indicator technical methods

Health Profiles 2009  The Indicator Guide 5

Section 2:
Our communities

(This is the population estimate used in the construction of the IMD 2007 – see Table 2) 5. or statistical process figure compared to the England value. these dimensions are weighted and an overall deprivation score is given. What is being measured? Level of deprivation of a population in an area. 9. It actually defined? is underpinned by separate dimensions of deprivation. Where does the data DCLG website: http://www. DEPRIVATION INDICATOR Basic Information 1. Why is it being measured? The differences in deprivation between areas are a major determinant of health inequality in the United Kingdom. all ages in the relevant population (otherwise known as the ‘at risk’ population). 10. How accurate and All indicators included in the IMD 2007 are considered to be complete will the data be? accurate and complete.gov. When does it measure it? Based on various indicators. control to test the meaning of the data and the variation they show? Table 1 – Indicator Description Information Pg 4 Health Summary – Indicator No. Will It measure absolute Proportion based on a composite indicator. based on the 95% confidence intervals of the tests. significance England average. 3. mostly using 2005 data. It is based on an average warnings/problems? score of an area and it can’t be assumed to represent all individuals in that area. as measured by the percentage of people in that area living in the most deprived fifth of areas in England.uk/communities/ actually come from? neighbourhoodrenewal/deprivation/deprivation07/ 8. 2. How is this indicator IMD 2007 is a model of measuring deprivation in an area.Health Profiles 2009  The Indicator Guide 6 Section 2: Our communities 1. Are particular The data point is green or red when the figure in a local authority tests needed such as is statistically significantly better or worse respectively than the standardisation. Who does it measure? All persons. numbers or proportions? 7.communities. some aspects of deprivation are not to be included in the indices. 1 component Subject category/ Our Communities domain(s) Indicator name (* Deprivation Indicator title in health profile) PHO with lead Yorkshire and Humber responsibility . Are there any caveats/ The indicators are based on mainly 2005. This may have a larger effect in some areas than others. due to data being incomplete or not available. 6. 4. Although very comprehensive.

communities.pdf •D  epartment of Health. 2007 http://www. www. London Boroughs Timeliness Indicator is not regularly updated. Rationale: The difference in deprivation between areas is a major determinant of Public Health health inequality in the United Kingdom. London: TSO. Department of Health. (The relevant population is the population estimate used in the construction of the IMD 2007) Geography Local Authority: Counties. Rationale: Level of deprivation of a population in an area. by measuring the What this indicator percentage of the population living in the most deprived quintile of purports to measure neighbourhoods in England. For instance. the definition is not completely consistent due to changes in some of the indicators used.gov.uk/assetRoot/04/05/57/83/04055783.uk/assetRoot/04/01/93/62/04019362. self-reported long standing illness are all correlated with deprivation.gov.uk/ Department for Communities and Local Government The New Performance Framework for Local Authorities & Local Authority Partnerships: Single Set of National Indicators Department for Communities and Local Government. 1998. Metropolitan County Districts. •D  epartment of Health.gov.Health Profiles 2009  The Indicator Guide 7 Section 2: Our communities Date of PHO dataset Feb 2009 creation Indicator definition % of the relevant population in this area living in the 20% most deprived areas in England.gov. The NHS Plan. Policy relevance London: TSO. Unitary Authorities. 2000.uk/corporate/ .hm- treasury. 2003.pdf •H  M Treasury 2007 PBR CSR: Public service agreements: http://www. Tackling Health Inequalities: A Programme for Action. Rationale: Purpose To monitor and help reduce health inequalities. all cause mortality. smoking prevalence. health inequalities are likely to decrease also. behind the inclusion of the indicator Rationale: •A  cheson D. www. Published in December 2007 as an update for IMD 2004. County Districts.dh. Report of the Independent Inquiry into Inequalities in Health. Importance Many studies and analyses have demonstrated the association of increasingly poor health with increasing deprivation. If deprivation inequalities decrease.dh.

for example if the data is incomplete or not collected. If the interval includes the national value. In Health Profiles 2009 this is 95%. . for example. the interval can be used to test whether the value is statistically significantly different to the national.Health Profiles 2009  The Indicator Guide 8 Section 2: Our communities Interpretation: What An indicator value worse than average (red circle in health summary chart) a high/low level of represents a statistically significant worse level of deprivation for that local indicator value means authority when compared to the national value. This means that there is no best quartile range shown on the spine chart for this indicator as all local authorities in the best quartile are at 0%. The confidence intervals have also been used to make comparisons against the national value. The wider the confidence interval the greater is the uncertainty in the estimate. and so we say that there is a 95% probability that the interval covers the true value. Confidence intervals are given with a stated probability level. This may have a larger effect in some areas than others. uncertainty also arises from random differences between the sample and the population itself. Confidence intervals quantify the uncertainty in this estimate and. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. due to bias and Although very comprehensive some aspects of deprivation will not be confounding included in the indices. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. under these conditions. describe how much different the point estimate could have been if the underlying conditions stayed the same. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. In the case of indicators based on a sample of the population. Confidence Intervals: A confidence interval is a range of values that is normally used to describe Definition and purpose the uncertainty around a point estimate of a quantity. due to type of measurement method Interpretation: It is based on an average score of an area and it can’t be assumed to Potential for error represent all individuals in that area. the difference is statistically significant and the value is shown on the health summary chart with a red or green symbol depending on whether it is worse or better than the national value respectively. the difference is not statistically significant and the value is shown on the health summary chart with an amber symbol. Interpretation: The indicators are based on mainly 2005 data and this is therefore at least Potential for error 4 years out of date. Note: more than a quarter of local authorities have no areas that fall within the most deprived 20% of areas in England and therefore have a value of 0% for this indicator. generally speaking. The use of 95% is arbitrary but is conventional practice in medicine and public health. If the interval does not include the national value. but chance had led to a different set of data. a mortality rate. These occurrences result in random fluctuations in the indicator value between different areas and time periods. An indicator value better than average (green circle in health summary chart) represents a statistically significant better level of deprivation for that local authority when compared to the national value.

Denominator: source Office for National Statistics (ONS) and Department of Communities and Local Government (DCLG). http://www. The figures have been adjusted from the ONS mid-year estimate to exclude the prison population in order to fit the definition of ‘at risk’.uk/communities/ geographies available neighbourhoodrenewal/deprivation/deprivation07/ for this indicator from other providers Dimensions of IMD 2007 individual domains are available at Lower Super Output Area inequality: subgroup level and this measure could be derived for them.uk/communities/neighbourhoodrenewal/ source URL deprivation/deprivation07/ Data extraction: date Data extracted from source as at: February 2009 Numerator: definition Number of the relevant population living in the most deprived quintile in England based on the IMD 2007 score. analyses of this gov. (The relevant population is the population estimate used in the construction of the IMD 2007).communities. The figures have been subject to disclosure control. Numerator: source Department of Communities and Local Government Denominator: Denominator data – ‘at risk’ mid-2005 population estimates (elsewhere definition referred to as the ‘relevant’ population).communities. Data quality: Accuracy Criteria for inclusion of indicators to IMD 2004 and IMD 2007 included: and completeness • Up-to-date • Statistically robust • Available for the whole of England at a small level in a consistent form .Health Profiles 2009  The Indicator Guide 9 Section 2: Our communities Table 2 – Indicator Specification Indicator definition: Deprivation Variable Indicator definition: Percentage of the relevant population in this area living in the 20% most Statistic deprived areas in England. (The relevant population is the population estimate used in the construction of the IMD 2007) Indicator definition: Persons Gender Indicator definition: All ages age group Indicator definition: 2005 period Indicator definition: Percentage of population scale Geography: Lower Super Output Area http://www.gov.uk/communities/neighbourhoodrenewal/deprivation/deprivation07/ dataset available from other providers Data extraction: Department of Communities and Local Government website Source Data extraction: http://www.communities.gov.

Health Profiles 2009  The Indicator Guide 10 Section 2: Our communities Table 3 – Indicator Technical Methods Numerator: The score was derived by YHPHO from the Indices of Deprivation 2007 extraction Numerator: The number of relevant population in the worst quintile of deprivation was aggregation/ aggregated from Lower Super Output Area to Local Authority level. Denominator data Census data and mid-year estimates are known to be deficient in their caveats estimates of: • Non-white populations • Full-time students • Men aged 20–39 • People living in nursing homes etc • Rough sleepers • Inner-city populations • Households of multiple occupation • Migrants Methods used to The relevant population in the worst quintile of deprivation was aggregated calculate indicator from Lower Super Output Area to Local Authority level. (The relevant population is the population estimate used in the construction of the IMD 2007) Small Populations: Excluded at district level but included at regional and national level. Numerator data Deprivation level is based on the average for the area. not all individuals in the caveats area will be deprived. allocation (The relevant population is the population estimate used in the construction of the IMD 2007). and divided by the value total for the Local Authority. How Isles of Scilly and City of London populations have been dealt with Disclosure Control Every effort has been made by the DCLG and ONS to ensure that data does not allow the disclosure of confidential information. .

17:857-72. Wilson EB. the interval becomes n/(n+z2) to 1. First calculate the estimated proportions of subjects with (p) and without (q) some feature of interest from a sample of size n. When r = n so that p = 1. B = z z 2 + 4rq . proportion with feature of interest = p = r/n proportion without feature of interest = q = 1 . r and hence p are both zero. where z is the appropriate value. Stat Med 1998. z1-α/2. When there are no observed events. and C=2(n+z2). calculate the three quantities A = 2r + z2. . J Am Stat Assoc 1927. 209-212 Newcombe. from the standard Normal distribution. Two-sided confidence intervals for the single proportion: comparison of seven methods. Second. 22. RG. Then the confidence interval for the population proportion is given by (A-B)/C to (A+B)/C This method has the considerable advantage that it can be used for any data. and the recommended confidence interval simplifies to 0 to z2/(n+z2).p where r is the observed number of subjects with the feature of interest.Health Profiles 2009  The Indicator Guide 11 Section 2: Our communities Confidence The 95% confidence intervals are calculated with the method described Intervals by Wilson and by Newcombe which is a good approximation of the exact calculation method method.

Why is it being measured? Growing up in poverty damages children’s health and well-being. Are particular The data point is green or red when the figure in a local authority tests needed such as is statistically significantly better or worse respectively than the standardisation. significance England average. CHILDREN IN POVERTY INDICATOR Basic Information 1. When does it measure it? Based on 2005 data. 9. 2 component Subject category/ Our Communities domain(s) . A small number of claimants whose details are held clerically are excluded. Who does it measure? Children under 16 years in the relevant population (otherwise known as the ‘at risk’ population). Comprehensive validation checks are undertaken. 5.Health Profiles 2009  The Indicator Guide 12 Section 2: Our communities 2. 6.communities. Measuring the proportion of children under 16 years living in families receiving means-tested benefits. (This is the population estimate used in the construction of the IMD 2007 – see Table 2). Local authority denominator derived by aggregating LSOA-level relevant child population estimates.uk/communities/neighbourhoodrenewal/ deprivation/deprivation07/ 8. Where does the data Department of Communities and Local Government and ONS http:// actually come from? www. What is being measured? Children in Poverty 2. or statistical process figure compared to the England value.gov. control to test the meaning of the data and the variation they show? Table 1 – Indicator Description Information Pg 4 Health Summary – Indicator No. Will It measure absolute Proportions numbers or proportions? 7. How is this indicator Income Deprivation Affecting Children Index: part of Indices of actually defined? Deprivation 2007 – Income deprivation domain. How accurate and The data are of very high quality as they are drawn from a 100% complete will the data be? scan of administrative records and as a result are not subject to any sampling error. Are there any caveats/ Rounding error is liable to occur in the process of aggregating from warnings/problems? LSOAs to Local Authorities. adversely affecting their future health and life chances as adults. 10. 4. these are based on ONS experimental statistics. 3. based on the 95% confidence intervals of the tests.

Rationale: Growing up in poverty damages children’s health and well-being. London Boroughs Timeliness Indicator is not regularly updated. under-16 years (2005). Eradicating child poverty is now a national policy target. childhood obesity. is important. especially early childhood. Unitary Authorities. By international standards the comparative picture of child poverty in the UK has been poor. This is used as a proxy for the widely-used HBAI (Households Below Average Income) indicator. the definition is not completely consistent due to changes in some of the indicators used. Rationale: Child poverty operationalised as children living in families reliant on means- What this indicator tested benefits and those in receipt of Working Tax Credit and/or Child Tax purports to Credit with an equivalised income below 60 percent of the national median measure before housing costs. Metropolitan County Districts. In other countries experiencing similar demographic changes and economic pressures to the UK. infant mortality. low birth weight. adversely Public Health affecting their future health and life chances as adults. A considerable body of evidence links adverse childhood circumstances to poor child health outcomes and future adult ill health. low educational attainment. school exclusions. (part of Indices of Deprivation 2007 – Income deprivation domain) Geography England. mental ill health. Published in December 2007 as an update for ID 2004. Rationale: Purpose To monitor and help reduce health inequalities. Adverse outcomes include higher rates of: fatal accidents. Ensuring a good Importance environment in childhood.Health Profiles 2009  The Indicator Guide 13 Section 2: Our communities Indicator name Income Deprivation Affecting Children Index (*Children in Poverty) (*Indicator title in health profile) PHO with lead Yorkshire and Humber responsibility Date of PHO Feb 2009 dataset creation Indicator definition Prevalence of children living in families receiving means-tested benefits. poor dental health. behind the inclusion of the indicator Rationale: Opportunity for All Policy relevance Every Child Matters Children’s National Service Framework . which is not available at local authority level. teenage pregnancy some infections. child mortality. GOR. International variation in child poverty levels shows that child poverty is not inevitable. County Districts. children have been protected from escalating child poverty by social policy favouring progressive taxation and higher spending on social protection for children. Local Authority: Counties. substance misuse.

Others may be living in income due to type of deprivation but may not be entitled to claim. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. under these conditions. Confidence intervals are given with a stated probability level. the difference is statistically significant and the value is shown on the health summary chart with a red or green symbol depending on whether it is worse or better than the national value respectively. value means An indicator value better than average (green circle in health summary chart) represents a statistically significant better rate of child poverty for that local authority when compared to the national value. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. Interpretation: Benefits claims are an imperfect measure of income deprivation because some Potential for error eligible families do not claim their entitlement. uncertainty also arises from random differences between the sample and the population itself. a mortality and purpose rate. Confidence intervals quantify the uncertainty in this estimate and. In the case of indicators based on a sample of the population. The confidence intervals have also been used to make comparisons against the national value. The wider the confidence interval the greater is the uncertainty in the estimate. for example. generally speaking. The use of 95% is arbitrary but is conventional practice in medicine and public health. and so we say that there is a 95% probability that the interval covers the true value. These occurrences result in random fluctuations in the indicator value between different areas and time periods. the difference is not statistically significant and the value is shown on the health summary chart with an amber symbol. and may be over-represented in certain areas. but chance had led to a different set of data. due to bias and confounding Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. describe how much different the point estimate could have been if the underlying conditions stayed the same. measurement method Interpretation: Some groups are known to have a low propensity to claim the benefits to Potential for error which they are entitled. .Health Profiles 2009  The Indicator Guide 14 Section 2: Our communities Interpretation: An indicator value worse than average (red circle in health summary chart) What a high/low represents a statistically significant worse rate of child poverty for that local level of indicator authority when compared to the national value. In Health Profiles 2009 this is 95%. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. If the interval does not include the national value. If the interval includes the national value. the interval can be used to test whether the value is statistically significantly different to the national.

gov.gov.gov.Health Profiles 2009  The Indicator Guide 15 Section 2: Our communities Table 2 – Indicator Specification Indicator definition: Children living in families receiving means-tested benefits Variable Indicator definition: Percentage of relevant resident population.communities. Those counted as living in poverty are relevant children under 16 living in families receiving Income Support or Jobseekers Allowance (Income Based). or in families receiving Working Families Tax Credit/Child Tax Credit whose equivalised income is below 60% of median before housing costs.uk/communities/neighbourhoodrenewal/ source URL deprivation/deprivation07/ Data extraction: Data extracted from source as at: February 2009. This count was then aggregated from LSOA to LA level. The number of such children was calculated by multiplying this proportion by the total number of children in the LSOA.communities. Statistic (This is the population estimate used in the construction of the IMD 2007) Indicator definition: Persons Gender Indicator definition: Under 16 years age group Indicator definition: 2005 period Indicator definition: Percentage of child population scale Geography: Lower Super Output Area http://www.uk/communities/ geographies neighbourhoodrenewal/ deprivation/deprivation07/ available for this indicator from other providers Dimensions None. (The relevant population is the population estimate used in the construction if the IMD 2007) Numerator: source The proportion of relevant children living in poverty by LSOA can be found at http://www. date Numerator: The published data consists of the percentage of relevant children in the LSOA definition who are living in poverty.communities. of inequality: subgroup analyses of this dataset available from other providers Data extraction: Department of Communities and Local Government and ONS Source Data extraction: http://www.uk/communities/neighbourhoodrenewal/ deprivation/deprivation07/ (The relevant population is the population estimate used in the construction if the IMD 2007) .

Denominator: http://www.communities. aggregation / allocation Numerator data Rounding error is liable to occur in the process of aggregating from LSOAs to caveats Local Authorities. consistency and completeness of the data.uk/communities/neighbourhoodrenewal/ source deprivation/deprivation07/ Data quality: The data are of very high quality as they are drawn from a 100% scan of Accuracy and administrative records and as a result are not subject to any sampling error. . The value quotient was expressed as a percentage. Table 3 – Indicator Technical Methods Numerator: Download from DCLG website and aggregation from LSOA to LA level. The figures have been subject to disclosure control. Denominator data Local authority denominator derived by aggregating LSOA-level child caveats population estimates. Additional checks were undertaken by the University of Oxford to verify the quality of the data. extraction Numerator: The set of benefits is such that only one can be claimed at a time. these are based on ONS experimental statistics Methods used to The numerator and denominator were derived as explained above and a calculate indicator population weighted average of LSOAs was calculated for each LA.Health Profiles 2009  The Indicator Guide 16 Section 2: Our communities Denominator: Denominator data – ‘at risk’ mid-2005 population estimates (age under 16) definition (elsewhere referred to as the ‘relevant’ population). How Isles of Scilly and City of London populations have been dealt with Disclosure Control Every effort has been made by the DWP to ensure that data do not allow the disclosure of confidential information. Comprehensive validation checks are undertaken by the DWP Information Centre to assess the accuracy. The figures have been adjusted from the ONS mid-year estimate to exclude the prison population in order to fit the definition of ‘at risk’. completeness A small number of claimants whose details are held clerically are excluded.gov. reliability. Small Populations: Excluded at district level but included at regional and national level.

the interval becomes n/(n+z2) to 1. proportion with feature of interest = p = r/n proportion without feature of interest = q = 1 . When there are no observed events. and the recommended confidence interval simplifies to 0 to z2/(n+z2). 209-212 Newcombe. calculate the three quantities A = 2r + z2. where z is the appropriate value. r and hence p are both zero. Two-sided confidence intervals for the single proportion: comparison of seven methods. from the standard Normal distribution. RG. B = z z 2 + 4rq . z1-α/2. . When r = n so that p = 1. and C=2(n+z2). J Am Stat Assoc 1927.Health Profiles 2009  The Indicator Guide 17 Section 2: Our communities Confidence The 95% confidence intervals are calculated with the method described Intervals by Wilson and by Newcombe which is a good approximation of the exact calculation method method. 22.17:857-72. Then the confidence interval for the population proportion is given by (A-B)/C to (A+B)/C This method has the considerable advantage that it can be used for any data. Stat Med 1998. Second.p where r is the observed number of subjects with the feature of interest. First calculate the estimated proportions of subjects with (p) and without (q) some feature of interest from a sample of size n. Wilson EB.

8. When does it measure it? Reported quarterly and updated every year. Statutorily homeless households contain some of the most vulnerable members of society. 3. 4. Will It measure absolute numbers or Proportions: number of statutorily homeless proportions? households per thousand estimated total households. Missing data is considered to be zeros. or a local authority is statistically significantly better statistical process control to test the or worse respectively than the England average. significance tests. Why is it being measured? Homelessness is associated with severe poverty and is a social determinant of health. The total number of households is an estimated figure. Who does it measure? All persons. Are there any caveats/warnings/ Data only count ‘statutory homeless’ so does not problems? include the intentionally homeless or those who are not in priority need categories. all ages. 10. Are particular tests needed such as The data point is green or red when the figure in standardisation. crude rate per 1000 estimated households. 2007 to 2008. Tackling homelessness requires joint working across health and social care services. all persons. Where does the data actually come Collection and collation from the Housing Strategy from? Statistical Appendix via the Department for Communities and Local Government. 2. HSSA and P1E guidance notes provide universal definitions. Data is also validated manually by the DCLG. What is being measured? Estimates of homelessness amongst the most needy and vulnerable groups. How accurate and complete will the data A built-in-validation system allows each LA to check be? data accuracy. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. Table 1 – Indicator Description Information Pg 4 Health Summary – Indicator 3 component Subject category/ Our Communities domain(s) Indicator name Homelessness (*Statutory homelessness) (*Indicator title in health profile) .Health Profiles 2009  The Indicator Guide 18 Section 2: Our communities 3. 5. all ages.1 HOMELESSNESS INDICATOR Basic Information 1. 9. 6. How is this indicator actually defined? Statutory homeless households. 7.

gov. The statutory homeless statistics suggest that 62% of officially accepted homeless households include dependent children or an expectant mother. particularly amongst the most vulnerable behind the and needy groups in society. Rationale: Purpose To reduce the level of homelessness. value means An indicator value better than average (green circle in health summary chart) represents a statistically significant better level of statutory homelessness for that local authority when compared to the national value. all ages. Homelessness is associated with adverse health. inclusion of the indicator Rationale: The Department for Communities and Local Government (DCLG) has Policy relevance published a strategy document. Unitary Authorities. and therefore a low indicator value should not mean that public health action is not needed.000 estimated total households. ‘Sustainable Communities: Settled Homes: Changing Lives’ which sets out the Government’s plans on reducing homelessness with the aim of halving the number of homeless households in temporary accommodation by 2010. County Districts. To be deemed statutorily homeless a household must have become unintentionally homeless and must be considered to be in priority need. crude rate per 1. particularly for children. education and Importance social outcomes. Local Authority: Counties. GOR. however it should be noted that quarterly statistics are published on the Department for Communities and Local Government website: www. London Boroughs Timeliness The Housing Strategy Statistical Appendix (HSSA) is updated annually.Health Profiles 2009  The Indicator Guide 19 Section 2: Our communities PHO with lead NEPHO responsibility Date of PHO February 2009 dataset creation Indicator definition Statutory homeless households. statutorily homeless households contain some of the most vulnerable and needy members of our communities. Interpretation: An indicator value worse than average (red circle in health summary chart) What a high/low represents a statistically significant worse level of statutory homelessness for level of indicator that local authority when compared to the national value.communities. Metropolitan County Districts. . As such. health and social care and the voluntary sector. However no amount of homelessness is acceptable. 2007 to 2008. persons Geography England. Preventing and tackling homelessness requires sustained and joined-up interventions by central and local government.uk Rationale: Estimates of homelessness amongst the most needy and vulnerable groups in What this indicator society purports to measure Rationale: Homelessness is associated with severe poverty and is a social determinant Public Health of health.

The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. and/or a desire not to rely on state support.Health Profiles 2009  The Indicator Guide 20 Section 2: Our communities Interpretation: The statistic necessarily only measures the incidence of official homelessness. Therefore. Rough sleepers are also not included. . This statistic does not include households that have become unintentionally homeless but are not considered to be in priority need or households that have become intentionally homeless. the measure is an underestimate of the extent of homelessness. Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. describe how much different the point estimate could have been if the underlying conditions stayed the same. In the case of indicators based on a sample of the population. Confidence intervals quantify the uncertainty in this estimate and. Edited by: Jonathan Bradshaw. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. but chance had led to a different set of data. The use of 95% is arbitrary but is conventional practice in medicine and public health. Interpretation: Potential confounding factors associated with the homelessness statistic Potential for error include: housing affordability. the difference is not statistically significant and the value is shown on the health summary chart with a white symbol. 2001. the difference is statistically significant and the value is shown on the health summary chart with a red or amber symbol depending on whether it is worse or better than the national value respectively. the interval can be used to test whether the value is statistically significantly different to the national. housing capacity. generally speaking. If the interval includes the national value. uncertainty also arises from random differences between the sample and the population itself. a correct method or misplaced belief that they will not qualify for assistance. a mortality and purpose rate. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. These occurrences result in random fluctuations in the indicator value between different areas and time periods. and so we say that there is a 95% probability that the interval covers the true value. Reasons may include a lack of knowledge of the legislation. variation in local authority due to bias and methods of collection and collation of housing and homelessness statistics. confounding local variation in demand for housing. Confidence intervals are given with a stated probability level. In Health Profiles 2009 this is 95%. The confidence intervals have also been used to make comparisons against the national value. See: Poverty: the outcomes for children. The wider is the confidence interval the greater is the uncertainty in the estimate. under these conditions. for example. If the interval does not include the national value. both of those populations who would qualify for assistance and for the larger number of people who fall outside of the legislation. Potential for error The number of households who are homeless but do not apply to the local due to type of authority and are therefore not considered under Housing Act legislation is not measurement known. ESRC.

Denominator: Total estimated households at 30th June 2008.communities.000 total estimated households definition: Statistic Indicator Persons definition: Gender Indicator All ages definition: age group Indicator 1 April 2007 to 31 March 2008 definition: period Indicator Per 1.uk/documents/housing/xls/hssa08sectioneh.000 total estimated households definition: scale Geography: No other geographies available from other providers. for which the local authority accepts responsibility for securing accommodation under part VII of the Housing Act 1996 or part III of the Housing Act 1985.Section F source (Household Numbers) DCLG.gov.communities. of inequality: subgroup analyses of this dataset available from other providers Data extraction: Department for Communities and Local Government Source Data extraction: http://www. geographies available for this indicator from other providers Dimensions Data relating to the ethnicity of households is collected as part of the HSSA. Numerator: source Department for Community and Local Government. unintentionally homeless definition and in priority need.xls source URL http://www.gov.uk/documents/housing/xls/hssa08sectione. definition Denominator: 2007/2008 Housing Strategy Statistical Appendix (HSSA) . .Health Profiles 2009  The Indicator Guide 21 Section 2: Our communities Table 2 – Indicator Specification Indicator Statutory homeless households definition: Variable Indicator Crude rate per 1.xls Data extraction: Data extracted from source as at: 3 February 2009 date Numerator: Count of households (2007/2008) who are eligible.

Regional or National level. losing their previous accommodation through their own action such as not paying rent or a mortgage. the following must be satisfied: caveats • They are homeless. A built-in-validation system allows each LA to check completeness the accuracy of the data (see detailed on the ‘Validation’ section). nor own any property. be evicted. • They must have a local connection (lived or worked in the area. caveats . or vulnerable. 6% of total entries are missing. as well as some older white men. validation checks are carried out manually. Or they can also be classed as ‘potentially homeless’ if they are about to lose their dwelling.e. aggregation / allocation Numerator data To be classified as statutorily homeless. within 28 days. • They are in priority need i. Again. of different ethnic groups. for financial management purposes. had dependent children in them (aged under 16 years) or are an older person household. These include the ‘single homeless’. or are not in a priority need categories. in the larger cities.Health Profiles 2009  The Indicator Guide 22 Section 2: Our communities Data quality: Each LA checks the data prior to sending it to the Housing Statistics Accuracy and Department of the DCLG. each LA has to maintain accurate and up-to-date information on homelessness. At LA level. This is due to incomplete returns and methods used to safeguard the confidentiality of the data (see ‘Disclosure Control’ Section).e. those to whom no duty is owed either because they are deemed intentionally homeless. they are not legal tenants of any property. Figures registered as missing values at LA level have not been estimated and have therefore been considered to be zeros when aggregating to a higher level. The HSSA and P1E guidance notes help to provide LAs with universal definitions. Denominator data This is an estimated total number of households at the 30th June 2008. Once the data has been submitted to the DCLG. By contrast the ‘non-statutory’ homeless are. • The homeless household must not be intentionally homeless i. There has been no imputation at LA. family in the area. have a care responsibility or need care from relatives in the area). extraction Numerator: Counts had already been allocated to local authorities. Table 3 – Indicator Technical Methods Numerator: Simple download. many of whom are now young people of both sexes and.e. defined as those without any right to access secure accommodation for that night i.

z1-α/2. Wilson EB. calculate the three quantities A = 2r + z2. and the recommended confidence interval simplifies to 0 to z2/(n+z2). When r = n so that p = 1. 209-212 Newcombe. Second. Small Populations: Isles of Scilly and City of London have been included in regional and England How Isles of Scilly numerators and denominators. Then the confidence interval for the population proportion is given by (A-B)/C to (A+B)/C This method has the considerable advantage that it can be used for any data. r and hence p are both zero. Stat Med 1998. where z is the appropriate value.17:857-72. RG. B = z z 2 + 4rq . Isles of Scilly have been included in the and City of London numerator and denominator for the County of Cornwall. First calculate the estimated proportions of subjects with (p) and without (q) some feature of interest from a sample of size n. Two-sided confidence intervals for the single proportion: comparison of seven methods. sums of counts may not equal related totals.Health Profiles 2009  The Indicator Guide 23 Section 2: Our communities Methods used to Number of households deemed to be statutorily homeless during the calculate indicator period April 2007 to March 2008. proportion with feature of interest = p = r/n proportion without feature of interest = q = 1 . divided by the estimated total number of value households as at 30th June 2008.p where r is the observed number of subjects with the feature of interest. 22. J Am Stat Assoc 1927. populations have been dealt with Disclosure Control Data have been suppressed in this dataset to protect both the confidentiality of individual information and the potential statistical instability caused by low counts. and C=2(n+z2). from the standard Normal distribution. . Confidence The 95% confidence intervals are calculated with the method described Intervals by Wilson and by Newcombe which is a good approximation of the exact calculation method method. As a consequence. multiplied by 1000. the interval becomes n/(n+z2) to 1. When there are no observed events.

Are there any caveats/warnings/ Data for Regions and Counties are aggregated problems? on the basis of the schools’ administrating Local Education Authorities. Will it measure absolute numbers or Proportions. persons. . 8. percentage of pupils at end of Key Stage 4 in schools maintained by the Local Education Authority. Metropolitan County Districts (MCD). or a local authority is statistically significantly better statistical process control to test the or worse respectively than the England average. These are related to health and health inequalities. Unitary Authorities (UA) and London Boroughs (LB) are aggregated on the basis of Neighbourhood Renewal areas based on the geographic location of the school and not the location of the pupil’s residence. Where does the data actually come Collection and collation by the Department for from? Children. Who does it measure? Pupils at the end of Key Stage 4 in maintained schools. How accurate and complete will the data This indicator only contains data for LEA maintained be? schools. which in turn influences income. percentage of pupils. 6. Schools and Families (DCSF). Data for County Districts.Health Profiles 2009  The Indicator Guide 24 Section 2: Our communities 4. 9. Educational qualifications are a determinant of an individual’s labour market position. housing and other material resources. Why is it being measured? Educational attainment is influenced by both the quality of education children receive and their family’s socio-economic circumstances. What is being measured? GCSE achievement 2. at the end of the academic year 2007-08. Are particular tests needed such as The data point is green or red when the figure in standardisation. GCSE ACHIEVEMENT INDICATOR Basic Information 1. 3. significance tests. therefore it excludes pupils educated in private schools. 5. 10. 4. proportions? 7. How is this indicator actually defined? Pupils achieving 5 or more GCSEs at grades A*-C (including English and Maths) or equivalent. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. When does it measure it? This indicator is published annually.

housing and other material resources. These are related to health and health inequalities. GOR. health profile) PHO with lead LHO responsibility Date of PHO Feb 2009 dataset creation Indicator definition Pupils achieving 5 or more GCSEs. of pupils at the end (*Indicator title in of Key Stage 4 (*GCSE achieved 5A*–C inc. Timeliness Annual. County Districts.4. persons. including maths and English. Rationale: Purpose This indicator relates to the Department for Children. including maths and English. at grades A*–C or equivalent. rising to 25% by 2006 and 30% by 2008. Rationale: This indicator is the DCSF PSA 10 target. The data is suitable for time trend analysis. Next data is expected at the end of January 2010. at the end of academic year 2007–2008. which in turn influences income. Best Value Performance Indicator 38 Opportunity for all – Children and young people – Indicator 6 . London Boroughs. percentage of pupils at end of Key Stage 4 in schools maintained by the Local Education Authority.Health Profiles 2009  The Indicator Guide 25 Section 2: Our communities TABLE 1 – INDICATOR DESCRIPTION Information Pg 4 Health summary – Indicator No 4 component Subject category/ Our Communities domain(s) Indicator name GCSE and equivalent results. Eng & Maths). Metropolitan County Districts. Rationale: This indicator measures the level of GCSE achievement in the area. 60% of those aged 16 achieve the equivalent of 5 GCSEs at grades A* to C. Schools and Families behind the (DCSF) Public Service Agreement (PSA) target 10 which is to raise standards in inclusion of the schools and colleges so that: indicator By 2008. Unitary Authorities. and in all schools at least 20% of pupils to achieve this standard by 2004. Policy relevance Others include: Tackling health inequalities: A programme for action – Education. Geography England. Local Authority: Counties. Importance Educational qualifications are a determinant of an individual’s labour market position. What this indicator purports to measure Rationale: Educational attainment is influenced by both the quality of education children Public Health receive and their family socio-economic circumstances. and Strategic Health Authorities for the South East. Local basket of inequalities indicators – Indicator 3. This indicator now uses the same definition as No 75 in the National Indicator Set.

University of Leeds. It should also be noted that the figure relates to the location of the school within a local authority area rather than the home residence of the pupils who attend the school. the socio-economic circumstances of families in the area or other factors known to influence achievement. Some schools may show improvement in educational attainment through changing the type of qualifications being taken. Interpretation: There are issues of equivalence of GCSE and other qualifications such as Potential for error NVQs. information is not available on the area of residence of pupils in independent schools and which local education authority would be responsible for them. regardless of where the pupils live. School of Education. currently counts equally with one who has a bare measurement pass in an Intermediate GNVQ course in IT (being equivalent to 4 passes) and method a GCSE grade C in any other subject. See: Nuffield Review of 14-19 Education and Training Working Paper 4 (based on Discussion Paper given at Working Day I. For example a pupil with English.pdf Interpretation: The statistic measures GCSE attainment in LEA maintained schools and Potential for error therefore does not include attainment for children who are educated in private due to bias and schools. Estimating the likely impact of private education and pupils travelling to schools outside their resident local authorities is problematic. this can mean up to 40% of resident pupils being educated privately or travelling to state schools in other boroughs. 17 Dec 2003) CONTINUITY AND DISCONTINUITY IN THE ‘14-19 CURRICULUM’ Jeremy Higham.e.nuffield14-19review. . The annual schools’ census collects information on pupils educated in independent schools. Mathematics. Available from: http://www. Post-14 Research Group. A low indicator value (red circle in health summary chart) represents a statistically significant lower level of educational attainment for that local authority when compared to the national value. this should prompt investigation as to the causes which may be related to quality of educational services. approximately 7% of children in England.Health Profiles 2009  The Indicator Guide 26 Section 2: Our communities Interpretation: A high indicator value (green circle in health summary chart) represents a What a high/low statistically significant higher level of educational attainment for that local level of indicator authority when compared to the England national value. Double Science and due to type of German with top grades.uk/files/documents12-1. more children achieving at least 5 GCSEs or equivalent not same children achieving more GCSEs). For some inner-London boroughs. Where educational attainment is not satisfactory. However.org. Areas have different densities of independent schools. The statistic also does confounding not take into account where pupils live. An increase in this value means indicator indicates that education achievement has increased relative to the number of pupils (i.

In the case of indicators based on a sample of the population. generally speaking. Confidence intervals quantify the uncertainty in this estimate and. In Health Profiles 2009 this is 95%. Statistic Indicator Persons definition: Gender Indicator End of key stage 4 (The term is defined in the Education Act 2002 as “the period definition: beginning at the same time as the school year in which the majority of pupils in his age group class attain the age of fifteen and ending at the same time as the school year in which the majority of pupils in his class cease to be of compulsory school age”) . the difference is not statistically significant and the value is shown on the health summary chart with a white symbol. including maths and English. under these conditions.Health Profiles 2009  The Indicator Guide 27 Section 2: Our communities Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. These occurrences result in random fluctuations in the indicator value between different areas and time periods. but chance had led to a different set of data. Confidence intervals are given with a stated probability level. The wider the confidence interval. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. at grades A*–C or definition: equivalent Variable Indicator Percentage of pupils at end of Key Stage 4 in schools maintained by the Local definition: Education Authority. If the interval includes the national value. uncertainty also arises from random differences between the sample and the population itself. TABLE 2 – INDICATOR SPECIFICATION Indicator Pupils achieving 5 or more GCSEs. describe how much different the point estimate could have been if the underlying conditions stayed the same. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. the greater the uncertainty in the estimate. the interval can be used to test whether the value is statistically significantly different to the national. The confidence intervals have also been used to make comparisons against the national value. The use of 95% is arbitrary but is conventional practice in medicine and public health. the difference is statistically significant and the value is shown on the health summary chart with a red or amber symbol depending on whether it is worse or better than the national value respectively. for example. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. a mortality and purpose rate. If the interval does not include the national value. and so we say that there is a 95% probability that the interval covers the true value.

dcsf.gov.gov.xls Data Department for Children.Health Profiles 2009  The Indicator Guide 28 Section 2: Our communities Indicator At the end of the academic year 2007–2008 definition: period Indicator definition: scale Geography: Neighbourhood renewal area.dcsf. at grades A*–C or equivalent in schools maintained by the Local Education Authority.dcsf.uk/rsgateway/DB/SFR/s000826/GCSE_performance_by_FSM_ band.gov.dcsf.uk/rsgateway/DB/SFR/s000826/SFR02_2009_SFRTables.uk/rsgateway/DB/SFR/s000822/SFR322008-KS4FinalNITables_ Amended300109.xls source URL Data Data extracted from source as at Feb 2009 extraction: date Numerator: Number of pupils at the end of key stage 4 at the end of the academic year 2007/08 definition achieving 5 or more GCSEs.dcsf.gov.xls Also available by free school meal status: http://www.gov.uk/rsgateway/DB/SFR/s000826/SFR02_2009_AdditionalTables_ Amended030309-2.xls Also available by ethnic group: http://www. including maths and English. from other and for urban/rural areas: providers http://www. The numerator will include achievements by these pupils in previous academic years.dcsf.gov.uk/performancetables/ available for this indicator from other providers Dimensions GCSE achievement: of inequality: subgroup Available by school type and admission’s basis: analyses of http://www.xls this dataset available Also available by sex (boys and girls) and for areas classified by level of deprivation. . Schools and Families (DCSF) tables 18 and 20 for 2007/08 extraction: Source Data http://www.uk/rsgateway/DB/SFR/s000826/SFR02_2009_AdditionalTables_ extraction: Amended160109. Numerators are not published by DCSF and therefore this number is estimated based on published percentage achievement and the total number pupils at the end of Key Stage 4. Local Education Authority (LEA) geographies http://www.

Regions and Counties are based on Table 18. Metropolitan County Districts. None of the data are based on the postcode of the pupils. Northumberland. where denominator data could be aggregated to the new geographies. Data for County Districts.uk/rsgateway/DB/SFR/s000826/SFR02_2009_AdditionalTables_ Amended160109. Metropolitan County Districts (MCD). Shropshire and Wiltshire). Published results are also not available for the two Strategic Health Authorities in the South East: South Central and South East Coast. Regions and Counties are based on Table 18. . Results for the other new UAs were taken from published data for local authorities (Bedford) or counties (County Durham. and Cornwall).Health Profiles 2009  The Indicator Guide 29 Section 2: Our communities Numerator: DCSF tables 18 and 20 for 2006/07 Performance data at: source http://www. did not correspond with existing geographies (Cheshire East.xls Data for England. Table 3 – Indicator Technical Methods Numerator: extraction Simple download from DCSF website Numerator: aggregation/ Data for Regions and Counties are aggregated on the basis of allocation the schools’ administrating Local Education Authorities. Data for County Districts. Data for County Districts. Numerator data can be approximated from published percentages for local authorities and be aggregated to the new geographies to allow the calculation of percentages. Denominator: Number of pupils at the end of Key Stage 4 at the end of the academic year 2007/08 definition in schools maintained by the Local Education Authority. Unitary Authorities and London Boroughs are based on Table 20. Denominator: DCSF tables 18 and 20 for 2007/08 Performance data at: source http://www.dcsf.gov. Central Bedfordshire. For these areas data were derived from Table 20. Wiltshire and Cornwall) which are taken from Table 18. Cheshire West and Cheshire. Unitary Authorities (UA) and London Boroughs (LB) are aggregated on the basis of Neighbourhood Renewal areas (geographic location of the school). introduced in April 2009. Metropolitan County Districts (MCD). Unitary Authorities (UA) and London Boroughs (LB) are aggregated on the basis of Neighbourhood Renewal areas (geographic location of the school). with the exception of new UAs formed in April 2009 (County Durham.dcsf. Data for some new Unitary Authorities. Data for County Districts. Unitary Authorities and London Boroughs are based on Table 20. Data quality: County. Data for Regions and Counties are aggregated on the basis of the schools’ administrating Local Education Authorities. Government Office Region and England Total (Maintained sector) figures are Accuracy and adjusted for pupils recently arrived from overseas.gov. Metropolitan County Districts. Shropshire. Northumberland. completeness This indicator only contains data for LEA maintained schools.uk/rsgateway/DB/SFR/s000826/SFR02_2009_AdditionalTables_ Amended160109.xls Data for England.

and pupil numbers for MCD. multiplied by 100. The Isles of Scilly is included in the England and South West Region totals. Disclosure Control Usage and dissemination of data is subject to Crown copyright. None of the data is based on the post code of the pupils. grade A*–C. 2000. Small Populations: How Isles Data for Cornwall excludes the Isles of Scilly. 2nd ed. In Altman. Excludes pupils educated in private schools Denominator data caveats None of the data is based on the post code of the pupils. Proportions and their differences. there are no numbers less than 3 in this dataset.Health Profiles 2009  The Indicator Guide 30 Section 2: Our communities Numerator data caveats The numerator values for local authorities and Regions will not add up to the total for England as the numerator is estimated. Statistics with Confidence. Confidence Intervals Confidence intervals have been calculated using the calculation method ‘recommended’ formula for a confidence interval of a proportion as described by Newcombe RG and Altman DG. DG et al (eds). Therefore pupil of Scilly and City of London numbers for County Districts will not add up to the data for populations have been dealt Counties as a whole. UA. LB and with Counties combined do not add up to the total for England. including maths and indicator value English. divided by the number of pupils at the end of Key Stage 4. however. . Data are suppressed if there are fewer than 3 pupils in that particular authority. BMJ Books. Excludes pupils educated in private schools Methods used to calculate The number of pupils achieving 5 GCSEs.

Will It measure absolute numbers or Proportion: Crude rate per 1. Are there any caveats/warnings/ This indicator only includes violent offences which problems? are reported to the police. or a local authority is statistically significantly better statistical process control to test the or worse respectively than the England average.000 population. all ages. persons. How is this indicator actually defined? Recorded violence against the person offences. Table 1 – Indicator Description Information Pg 4 Health Summary – Indicator No 5 component Subject category/ Our communities domain(s) Indicator name Violent crime (*Indicator title in health profile) PHO with lead South West Public Health Observatory responsibility Date of PHO November 2008 (revised February 2009 for Local Authorities as at April 2009) dataset creation Indicator definition Recorded violence against the person offences. crude rate per 1.Health Profiles 2009  The Indicator Guide 31 Section 2: Our communities 5. 4. significance tests. How accurate and complete will the data Coverage is complete.000 population. 6. GOR. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. 10. be? 9. Metropolitan County Districts. Unitary Authorities. all ages. 2007/08. persons Geography England. Where does the data actually come Home Office. proportions? 7. VIOLENT CRIME INDICATOR Basic Information 1. Local Authority: Counties. 2007/08. Who does it measure? All persons. 5. London Boroughs . from? 8. crude rate per 1. County Districts. It is susceptible to changes in police crime reporting procedures. 2.000 population. Are particular tests needed such as The data point is green or red when the figure in standardisation. all ages. What is being measured? Recorded crimes of violence against the person. When does it measure it? Continually reported and data is published annually. Why is it being measured? To help target policing and crime prevention resources and to reduce the incidence of violent crime. 3.

fphm. Interpretation: This indicator omits violent offences which are not reported to the police. or as a result of policing practice. This indicator specifically measures recorded ‘violence against the person’. org.uk/resources/AtoZ/bs_alcohol_violence. value means A low indicator value (green circle in health summary chart) represents a statistically significant lower rate of reported violent crime when compared to the England value.gov.uk/pdf/lhs/crime.Health Profiles 2009  The Indicator Guide 32 Section 2: Our communities Timeliness The indicator presented in Health Profiles is routinely updated annually. Lower Crime” http://www.org.pdf Importance and in the NACRO report “Better Health. It is Potential for error susceptible to changes in police crime reporting procedures.pdf) but it is likely that crime is a determinant and a consequence of health.londonshealth. Some victims of crime may suffer psychological distress and subsequent mental health problems. In 2002 the spending review included targets to reduce crime and the fear of crime and to reduce the gap between those Crime and Disorder Reduction Partnerships experiencing the highest crime and other areas. inclusion of the indicator Rationale: Targets included in the Treasury’s Spending Review provide the basis for policy Policy relevance priorities. However. Crime and fear of crime can also alter people’s lifestyles and impact on their physical and psychological health Collectively. the largest component of total ‘violent crime’ (which also includes robbery and sexual offences). it should be noted that high values reflect higher numbers of crimes recorded by the police.uk/data/resources/nacro-2004120264. The converse is true for low values of the indicator. Rationale: Purpose To help target policing and crime prevention resources and to reduce the behind the incidence of violent crime. these consequences represent a burden to the healthcare services. Interpretation: A high indicator value (red circle in health summary chart) represents a What a high/low statistically significant higher rate of reported violent crime when compared to level of indicator the England average value. This may be a result of higher underlying incidence of violent offences. Research undertaken by the Home Office and a number of other organisations suggests that there is a relationship between violent crime and alcohol http:// www. due to type of measurement method .nacro.pdf Violent crime may result in temporary or permanent disability and in some cases death. a greater proportion of incidents being reported to the police. Rationale: Level of reported violence against the person offences in an area What this indicator purports to measure Rationale: The links between crime and health are complex (as outlined in the London Public Health Health Commission report http://www.

In the case of indicators based on a sample of the population. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. for example. but chance had led to a different set of data. The use of 95% is arbitrary but is conventional practice in medicine and public health. and so we say that there is a 95% probability that the interval covers the true value. These occurrences result in random fluctuations in the indicator value between different areas and time periods. Confidence intervals quantify the uncertainty in this estimate and. Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. the higher the level of policing. the difference is not statistically significant and the value is shown on the health summary chart with an amber symbol. a mortality and purpose rate.Health Profiles 2009  The Indicator Guide 33 Section 2: Our communities Interpretation: The level and intensity of police service provision will affect rates of recorded Potential for error violent crime offences. If the interval includes the national value. i. describe how much different the point estimate could have been if the underlying conditions stayed the same. the difference is statistically significant and the value is shown on the health summary chart with a red or green symbol depending on whether it is worse or better than the national value respectively. The wider is the confidence interval the greater is the uncertainty in the estimate. Confidence intervals are given with a stated probability level. The confidence intervals have also been used to make comparisons against the national value.e. generally speaking. Table 2 – Indicator Specification Indicator definition: Recorded violence against the person offences Variable Indicator definition: Crude rate Statistic Indicator definition: Persons Gender Indicator definition: age All ages group Indicator definition: period Numerator financial years 2007/08. Denominator mid-2006 . If the interval does not include the national value. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. Caution needs to be taken when confounding considering crime rates in areas with low resident populations in which violent crimes are carried out by non-residents. uncertainty also arises from random differences between the sample and the population itself. the interval can be used to test whether the value is statistically significantly different to the national. In Health Profiles 2009 this is 95%. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. under these conditions. the more likely it is due to bias and that recorded crime figures will be elevated.

Durham. assault on a constable. Numerator: definition Annual count of recorded ‘violence against the person’ offences in the respective financial years.Health Profiles 2009  The Indicator Guide 34 Section 2: Our communities Indicator definition: scale Per 1. child destruction. Where new Unitary Authorities that have been created as part of the April 2009 boundary changes are exactly co-terminous with pre-existing counties (Cornwall. Unitary Authorities.gov. cruelty to and neglect of children. the numerator data have been drawn from the relevant county figures. Numerator data have been used exactly as published in the Home Office supplied data. London Boroughs from other providers Annual rates and numerators available for these geographies from www. manslaughter. Violence against the person comprises the following offences: Murder. Please note that a similar approach has been applied to the denominator data (see Denominator: Definition for more information).homeoffice. procuring illegal abortion. the concealment of birth offence is no longer included in the Violence Against The Person group. Local Authority: Counties. disqualified or uninsured). This is a change for the 2007/08 data from the previous year. endangering life at sea. racially or religiously aggravated common assault.homeoffice. causing death by driving (unlicensed. numerator data have been aggregated from the relevant published figures for the constituent districts. possession of weapons. threat or conspiracy to murder. causing or allowing death of a child or vulnerable person. Where the new Unitary Authorities represent only a part of the existing counties. endangering a railway passenger. racially or religiously aggravated other wounding.uk Dimensions of inequality: None available. wounding or other acts endangering life. Shropshire and Wiltshire) . abandoning child under two years. GOR. common assault. available for this indicator Metropolitan County Districts. subgroup analyses of this dataset available from other providers Data extraction: Source Home Office Data extraction: source http://www. child abduction. Northumberland. Numerator: source Home Office . harassment. Please see the following for more details: http://www.homeoffice. infanticide. County Districts. causing death by aggravated vehicle taking. attempted murder.gov. other wounding.000 population Geography: geographies England.pdf Please note that for the 2007/08 data.uk/rds/crimeew0708. as it has been moved to Miscellaneous Other Offences.gov.uk/rds/pdfs07/countviolence07. racially or religiously aggravated harassment. causing death by dangerous or careless driving.html URL Data extraction: date Data extracted from source as at: 04/11/2008.

org.uk/output/Page107. collecting and collating offence data. Please also see the Numerator Data Caveats section for related information. use the Home Office supplied data as published. except for newly created post-April 2009 Unitary Authorities. the relevant county population has been used in these calculations. – Please note that the Home Office published statistics use mid-2006 population estimates as their denominator. the recorded number of violence against the person offences increased by 23% in 2002/03. (http://www.asp).crimestatistics. with 68% of these being officially recorded as a crime.homeoffice.Health Profiles 2009  The Indicator Guide 35 Section 2: Our communities Denominator: definition 2001 Census based mid-year population estimate for the mid-point year (2006).uk/rds/pdfs06/ hosb1206. Data are based on the latest revisions of ONS mid-year population estimates for the respective year. Shropshire and Wiltshire). The data that have been entered into the Health Profiles tool. homeoffice. the National Crime Recording Standard (NCRS) was introduced to ensure greater consistency between forces in recording crime. rounded to the nearest 1.gov.pdf) suggests that about 45% of violent crimes are reported to the police. supplied as part of the Home Office’s data. completeness Historically there have been differences between police forces in procedures for recording. Home Office research (http://www. Please note that a similar approach has been applied to the numerator data (see Numerator: Definition for more information). As a result of the introduction of the NCRS.gov. Cheshire West & Chester. For new Unitary Authorities which are exactly co- terminous with pre-existing county boundaries (Cornwall.uk/rds/countrules. Northumberland. The Home Office provides specific counting rules regarding the counting and classification of violence against the person offences recorded by Police Forces in England and Wales (http://www. Bedford and Central Bedfordshire). an aggregate of the populations for the constituent districts has been used for calculation purposes. Denominator: source Home Office data.html).000. For new Unitary Authorities which comprise only a part of the pre-existing county boundaries (Cheshire East. Durham. and the calculated confidence intervals. Data quality: Accuracy and Coverage is complete. In April 2002. .

and City of London figures have been incorporated into populations have totals for London GOR and England.html. See Numerator Definition section for change in counting rules. allocation Numerator data These data exclude figures from British Transport Police and crimes committed caveats at airports within the jurisdictions of Greater Manchester. Metropolitan and Kent police force areas. however. The BCS is an annual survey which asks respondents about their experience of crime during the previous twelve months.homeoffice. Because of survey size limitations. The document is at http://www. The numerator was then divided by the denominator. the Home Office balance these recorded crime figures with the results of the British Crime Survey (BCS).uk/rds/crimeew0708. been dealt with .Health Profiles 2009  The Indicator Guide 36 Section 2: Our communities Table 3 – Indicator Technical Methods Numerator: Downloaded from www. and should be read alongside this metadata document for a full understanding of the issues. including visiting and or migratory persons. as presented here. counting or even policing methods. the denominator should reflect all people at risk of violent crime in the caveats area. The use of resident population as a denominator is a proxy measure for population exposure and is consistent with how this indicator is presented elsewhere.gov. In their annual reports entitled “Crime in England and Wales”.gov. irrespective of whether it was reported to the police. presents a thorough picture of the challenges around crime statistics. The latest annual report. South West and City of London GOR and England. is susceptible to fluctuations brought about by changes in recording. in particular how the recorded crime and BCS data may diverge and why. it is not possible to use the BCS data at the geographical level required by the Health Profiles. Methods used to Calculation of the numerator: Calculated as an annual of the number of the calculate indicator offences reported in 2007/08. Recorded crime. The very nature of crime statistics make analysing the data effectively particularly challenging. This data is not available and resident data has been used as a proxy. the resulting value was then multiplied by 1000 to give a crude rate per 1000 population.uk extraction Numerator: Area where offence took place allocated by police using records with attached aggregation/ postcodes. “Crime in England and Wales 2007/08”. Small Populations: Data for the Isles of Scilly and City of London have not been included How Isles of Scilly individually. This enables BCS data to be more resilient to changes in recording or policing.homeoffice. Isles of Scilly is included in the totals for Cornwall. Denominator count: Mid-2006 population value estimates (all ages). Denominator data Ideally.

2d is the (100*a/2)th   100* (1-α) percentage point for a chi-squared distribution with 2d degrees of freedom and χ²(1-α/2). Confidence The 95% confidence intervals for crude rate of violence against the person Intervals offences were constructed by assuming a Poisson distribution for the number calculation method of offences occurring in a specific period of time. 2(d+1) 2 UL = 22 UL = where LL and UL are the lower and upper2100*(1-a) per cent confidence limits and d denotes the number of observed events (e. χ2 α/2. 2(d+1) 2 χ 1.2d th percentage point for a chi-squared distribution on 2(d+1) degrees of freedom. deaths) per unit of time exposed. (100*(1-α/2))th (100*(1-α/2))th (100*(1-α/2))th . 100* (1-α) violent offences.α2 .α . The lower and upper limits for this confidence interval were then obtained using the following formulae relating the chi-square and Poisson distributions: χ α . 2d 2 22 LL = 2 χ 1. χ² a/2.2(d+1) is the (100*(1-a 2 a/2)) χ α/2. 2d 2 LL = χ 2α . (100*α/2)th χ2 (1-α/2). Confidence intervals for (100*(1-α/2))th weighted sums of Poisson parameters.2(d+1) Dobson AJ. Statistics in Medicine 1991.10:457-462. serious injuries.Health Profiles 2009  The Indicator Guide 37 Section 2: Our communities Disclosure Control Not applicable as no counts less than 5. Kuulasmaa K.g.2d th The confidence limits for the (100*α/2) rates were then obtained by dividing the upper and lower limits for the counts by the person time exposed. Scherer J.2(d+1) Reference: χ2 (1-α/2). Eberle E.

all ages. 4. Are particular tests needed such as Confidence intervals have not been constructed for standardisation. 6 component Subject category/ Our Communities domain(s) Indicator name (* Carbon emissions Indicator title in health profile) . proportions? 7. 6. Will It measure absolute numbers or Proportions: CO2 emissions per capita. 3. 9. This indicator allows local authorities to monitor the effectiveness of their efforts to reduce carbon dioxide emissions. Who does it measure? All Persons. What is being measured? Total end user CO2 emissions per capita (tonnes of CO2 per resident) 2. or this indicator. When does it measure it? Annually. CARBON EMISSIONS INDICATOR Basic Information 1. 5. Why is it being measured? Carbon dioxide emission is one of the main contributors to greenhouse gases which cause global warming. significance tests. Where does the data actually come AEA Energy & Environment for the Department for from? Environment Food and Rural Affairs (Defra) 8. The data are based upon LA CO2 estimates produced by AEA technology on behalf of Defra. Are there any caveats/warnings/ Analysis carried out by AEA Energy and Environment problems? has confirmed that the data available for the construction of this local area Climate Change Indicator are sufficiently robust with relatively low levels of uncertainty.Health Profiles 2009  The Indicator Guide 38 Section 2: Our communities 6. 2006. statistical process control to test the meaning of the data and the variation they show? Table 1 – Indicator Description Information Page 4 Health Summary Indicator No. 10. How accurate and complete will the data The indicator relies on centrally produced statistics to be? measure end user CO2 emissions in the Local Area. Some sectors of CO2 emissions have been excluded from the estimates as they could not be easily aggregated to local or regional levels. How is this indicator actually defined? Indicator 186: Per capita CO2 emissions in the local authority area.

Global warming is of the greatest public health importance and Importance according to the worst predictions could result in millions of deaths across the world as a result of many changes including reduced capacity to produce food.g. Rationale: This indicator purports to measure the contribution of each locality to Carbon What this indicator dioxide emissions. London Boroughs Timeliness Annual. The figures for 2007 will be available in Autumn 2009. flooding by sea of low lying lands and increased frequency of extreme weather events. Local Authority: Counties. . Metropolitan County Districts. carbon dioxide emissions cannot inclusion of the be reduced unless each area accepts its responsibility to reduce emissions indicator and does not simply assume that their contribution does not matter because someone else will make a reduction. Arguments can be made for other exclusions. for electricity use) • Diesel railways • Land Use.Health Profiles 2009  The Indicator Guide 39 Section 2: Our communities PHO with lead WMPHO responsibility Date of PHO 23/02/2009 dataset creation Indicator definition Local and Regional CO2 Emissions Estimates for 2006 for the UK per capita Geography England. The data are based upon LA CO2 estimates produced by AEA technology on behalf of Defra. e. and where real change at the local level will be captured. whose emissions are indirectly included via the end user estimates. these are emissions that LAs can be least expected to be responsible for. and Forestry In effect. It is expected that further improvements to the underlying data and methodology will be made in this dataset which will improve the level of accuracy in certain sectors. Unitary Authorities. These National Statistics estimate all emissions in an area and have been modified slightly for this indicator to exclude certain emissions of the following components: • Motorways • EU Emissions Trading Scheme sites (except energy suppliers. Land Use Change. but a line has to be drawn somewhere that results in an indicator that is fair in terms of authority actions actually effecting change in the indicator. Rationale: Carbon dioxide is a major contributor to green house gases which cause global Public Health warming. power stations in the scheme. It is based on estimates of activities resulting in carbon purports to dioxide production (chiefly energy use). Rationale: Purpose While the contribution of each single local authority area to carbon dioxide behind the is a miniscule fraction of the global total. The carbon dioxide resulting from measure energy production is allocated not to the place where the energy is produced but to the place where the energy is used (eg carbon dioxide produced by a power station is allocated to the places using the electricity produced not to the place where the power station is located). Defra consulted with LAs during development of the indicator for LAA purposes. The indicator is one of those included in the National Indicator Set that can be used to monitor Local Area Agreements. County Districts.g. e. Rationale: As explained in the previous section reducing carbon dioxide emissions require Policy relevance everyone to make an effort thinking globally but acting locally. This indicator allows each local authority and others to assess how successful their efforts to reduce carbon dioxide emissions have been. GOR.

Interpretation: The indicator relies on accurately attributing emissions from energy use and Potential for error emissions related to energy supply to the local level. In terms of comparability. • Methodological improvements. • Implementation of improved formal quality assurance procedures. These include: • Re-classification of BERR Local Authority energy statistics as National Statistics. This gives users greater confidence in the confounding estimates. and is no due to bias and longer considered “experimental”. Some sectors of CO2 emissions have been excluded from the estimates as they could not be easily aggregated to local or regional levels. Interpretation: Unlike the 2005 Local Authority emissions estimates published last year. Intervals: Definition and purpose Table 2 – Indicator Specification Indicator CO2 emissions per capita definition: Variable Indicator Tonnes of CO2 emissions per resident. a range of quality criteria set out by the UK Statistics Authority had to be met. To achieve this. definition: Statistic Indicator Persons definition: Gender Indicator All ages definition: age group Indicator 2006 calendar year definition: period Indicator Tonnes per resident definition: scale . a consistent time series has now been produced by re-calculating the 2005 estimates to reflect the methodological changes used in calculating the 2006 estimates. level of indicator A low indicator value represents a lower level of CO2 emissions per capita for value means that local authority. and • Reduced uncertainty in the accuracy of some of the data inputs. This involves an iterative due to type of approach to estimate emissions to the end user. as energy producers will measurement use energy from other producers and therefore also be consumers of energy method themselves.Health Profiles 2009  The Indicator Guide 40 Section 2: Our communities Interpretation: A high indicator value represents a higher level of CO2 emissions per capita for What a high/low that local authority. Confidence Confidence intervals have not been constructed for this indicator. there have been in particular. key improvements to the accuracy and comparability of the data. Potential for error this dataset has now been classified as full National Statistics. In order to obtain this classification.

Health Profiles 2009  The Indicator Guide 41 Section 2: Our communities Geography: The original indicator is for the UK. Land Use. 08459 33 55 77 Data extraction: http://www. London SW1P 3JR. Denominator: Mid Year 2006 population estimates. Road Transport (excluding Motorways . e. and Forestry) Numerator: source Local gas.g. definition Domestic. . 17 Smith Square. for electricity use) Diesel railways. and is no completeness longer considered “experimental”.defra. so also includes Wales. In terms of comparability. Accuracy and this dataset has now been classified as full National Statistics. Complete dataset available from http://www.uk/ available for this environment/statistics/globatmos/download/regionalrpt/local-regionalco2- indicator from ni186indicator.uk/). In order to obtain this classification.gov. and • Reduced uncertainty in the accuracy of some of the data inputs.gov.xls other providers Dimensions None available of inequality: subgroup analyses of this dataset available from other providers Data extraction: Local government performance framework Source NI 186 – Per capita CO2 emissions in the LA area Environment Statistics Service.g. National Statistics definition Denominator: Included in NI186 dataset though they have used National Statistics 2006 mid source year population estimates. Area 5F Ergon House. built up of Industry and Commercial.defra.EU Emissions Trading Scheme sites (except energy suppliers. These include: • Re-classification of BERR Local Authority energy statistics as National Statistics. This gives users greater confidence in the estimates. • Methodological improvements. whose emissions are indirectly included via the end user estimates. e. power stations in the scheme. Data quality: Unlike the 2005 Local Authority emissions estimates published last year. there have been in particular. electricity and road transport fuel consumption estimates are published by BERR for 2005 (see http://www. Scotland and geographies Northern Ireland.berr. • Implementation of improved formal quality assurance procedures.htm source URL Data extraction: 5th February 2009 date Numerator: Total ktonnes of CO2 emissions.gov. Department for Environment. a consistent time series has now been produced by re-calculating the 2005 estimates to reflect the methodological changes used in calculating the 2006 estimates. key improvements to the accuracy and comparability of the data. a range of quality criteria set out by the UK Statistics Authority had to be met. Food and Rural Affairs. To achieve this. Land Use Change.uk/environment/localgovindicators/ni186.

” Numerator data caveats Data from some areas of CO2 emissions are excluded from the calculations due to the fact that the figures are not available disaggregated to required levels.Health Profiles 2009  The Indicator Guide 42 Section 2: Our communities Table 3 – Indicator Technical Methods Numerator: extraction Download from Department for Environment Food and Rural Affairs (Defra) website Numerator: aggregation AEA Energy & Environment produce the data on behalf of the /allocation Department for Environment Food and Rural Affairs (Defra). divided by the calculate indicator value population rounded to the nearest thousand. London populations have been dealt with Disclosure Control Copyright of data and/or information presented or attached in this document may not reside solely with this Department. They give the following description of the process that they use: “This dataset provides a spatial disaggregation of the national CO2 inventory on an End User basis in which emissions from the production and processing of fuels (including electricity) are reallocated to users of these fuels to reflect the total emissions relating to that fuel use. This is in contrast to ‘at source’ emissions in which all emissions are attributed to the sector that emits them directly. calculation method . Small Populations: How Scilly Isles and City of London has been included at LA level and included Isles of Scilly and City of at County. Denominator data Population figures are rounded to the nearest thousand and taken from caveats the 2006 mid year population estimates Methods used to The total of CO2 emissions in ktonnes per area.gov. Please contact us or see guidance on copyright at: http://www. The method used follows as closely as possible that used for the End User emissions calculated as part of the NAEI and reported by Defra at the national level. Region and National levels.defra.uk/environment/ statistics/help. The End User basis for reporting emissions has been chosen for this dataset because it fully accounts for the emissions from energy use at the local level and does not penalise local areas for emissions from the production of energy which is then ‘exported’ to other areas.htm Confidence Intervals Not applicable.

Health Profiles 2009  The Indicator Guide 43 Section 3: Children’s and young people’s health .

The county. How is this indicator actually defined? The percentage of women giving birth in 2007/08 who are current smokers at the time of delivery out of all maternities where smoking in pregnancy status is recorded. Where does the data actually come Care Quality Commission. therefore if these LAs are not truly representative of the areas they are being aggregated to. significance tests. Encouraging pregnant women to stop smoking during pregnancy may also help them kick the habit for good. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. SMOKING IN PREGNANCY INDICATOR Basic Information 1. 7. 10. and thus provide health benefits for the mother. GOR. Why is it being measured? Smoking in pregnancy has well known detrimental effects for the growth and development of the baby. Who does it measure? Women giving birth in 2007/08 whose smoking in pregnancy status is recorded. or a local authority is statistically significantly better statistical process control to test the or worse respectively than the England average. The data is originally recorded at PCT level which has been converted to LA level using birth weighting. Are particular tests needed such as The data point is green or red when the figure in standardisation. When does it measure it? Financial year 2007/08. 6. 5. How accurate and complete will the data 93% of LAs have less than or equal to 5% mothers be? with unknown smoking status and were therefore deemed as having valid prevalence estimates to be included in the Health Profiles 2009. 4. it would result in a biased estimate for aggregated areas. SHA and England prevalences were calculated from the LAs with valid data. from? 8. . Are there any caveats/warnings/ The indicator is based on the mother’s response and problems? is therefore susceptible to responder bias. What is being measured? Smoking in pregnancy 2. 9.Health Profiles 2009  The Indicator Guide 44 Section 3: Children’s and young people’s health 7. If there are several LAs within one PCT they will all have the same prevalence. Will It measure absolute numbers or Proportions: Number of women who smoke in proportions? pregnancy per 100 maternities where smoking status is recorded. thereby masking any variation in prevalence which may exist within that PCT. 3.

Rationale: This indicator was judged to be a valid and an important measure of Policy relevance public health and was therefore included in the ‘children’s and young people’s health’ domain of the profiles. An indicator value worse than average (red circle in health summary chart) represents statistically significantly more women smoking during pregnancy for that local authority when compared to the national value. domain(s) Indicator name (* Smoking in pregnancy Indicator title in health profile) PHO with lead ERPHO responsibility Date of PHO dataset 11.01. is intended to contribute to the national target to reduce the gap in mortality between “routine and manual” groups and the population as a whole by 2010. Geography The data is available at the PCT level this has been converted into the appropriate areas for Health Profiles Timeliness The data is released on a quarterly basis. Rationale: Women were asked at the time of delivery whether they currently What this indicator smoke. Encouraging pregnant women to stop smoking during pregnancy may also help them kick the habit for good. It is also included in PCT Local Delivery Plans (LDP). . and thus provide health benefits for the mother. Due to the negative connotations surrounding smoking during purports to measure pregnancy.2009 creation Indicator definition The percentage of women giving birth in 2007/08 who are current smokers at the time of delivery out of all maternities where smoking in pregnancy status is recorded. the indicator To highlight LAs with high smoking in pregnancy prevalence to encourage intervention. the NHS Priorities and Planning Framework 2003–06 target to deliver a one percentage point reduction per year in the proportion of women continuing to smoke throughout pregnancy. Interpretation: Potential It is based on the mother’s response and is therefore susceptible to for error due to type of responder bias. Rationale: Smoking in pregnancy has well-known detrimental effects for the growth Public Health Importance and development of the baby. this may be more susceptible to responder bias. focussing especially on smokers from disadvantaged groups. particularly as there is a stigma attached to smoking measurement method during pregnancy. Interpretation: What An indicator value better than average (green circle in health summary a high/low level of chart) represents statistically significantly fewer women smoking during indicator value means pregnancy for that local authority when compared to the national value.Health Profiles 2009  The Indicator Guide 45 Section 3: Children’s and young people’s health Table 1 – Indicator Description Information component Page 4 Spine Chart – Indicator 7 Subject category/ Children’s and young people’s health. Rationale: Purpose To encourage women to quit smoking when pregnant and hopefully as a behind the inclusion of consequence of this to quit smoking permanently.

This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. If the interval includes the national value. The use of 95% is arbitrary but is conventional practice in medicine and public health. the difference is not statistically significant and the value is shown on the health summary chart with an amber symbol.Health Profiles 2009  The Indicator Guide 46 Section 3: Children’s and young people’s health Interpretation: Potential As mentioned above. Confidence intervals quantify the uncertainty in this estimate and. The calculation of county. Achieving good coverage minimises opportunity for non response bias. In the case of indicators based on a sample of the population. and so we say that there is a 95% probability that the interval covers the true value. under these conditions. for example. the difference is statistically significant and the value is shown on the health summary chart with a red or green symbol depending on whether it is worse or better than the national value respectively. Confidence Intervals: A confidence interval is a range of values that is normally used to Definition and purpose describe the uncertainty around a point estimate of a quantity. . describe how much different the point estimate could have been if the underlying conditions stayed the same. They may therefore not be truly representative of the whole area if those LAs with invalid data have different prevalences compared with those LAs with valid data. These occurrences result in random fluctuations in the indicator value between different areas and time periods. The wider the confidence interval the greater the uncertainty in the estimate. In Health Profiles this is 95%. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. When viewing amalgamated areas it should be taken into consideration that they may be subject to non response bias. uncertainty also arises from random differences between the sample and the population itself. a mortality rate. the interval can be used to test whether the value is statistically significantly different to the national. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. which confounding would make the estimates of smoking in pregnancy more likely to be an underestimate of the actual figure. region. The confidence intervals have also been used to make comparisons against the national value. If the interval does not include the national value. but chance had led to a different set of data. generally speaking. it is likely to be susceptible to responder bias if for error due to bias and some mothers are reluctant to admit to smoking in pregnancy. All PCTs that returned data had at least 95% coverage which was the cut off for inclusion. Confidence intervals are given with a stated probability level. and the overall regional and England prevalences are only estimates. SHA and England prevalence is based on only those LAs which returned data.

the two percentages will not be identical unless there is 100% data coverage (see supporting indicator). Indicator Percentage definition: Statistic Indicator Female definition: Gender Indicator n/a definition: age group Indicator Financial year 2007/08 definition: period Indicator Percentage definition: scale Geography: PCT (commissioning PCT) geographies available for this indicator from other providers Dimensions n/a of inequality: subgroup analyses of this dataset available from other providers Data extraction: Care Quality Commission. This means where you have LAs that are identical to PCTs.uk/publications. The number of births by LA-PCT was extracted from the ONS 2007 birth file. In the health profiles only maternities with smoking in pregnancy status recorded is used as the denominator. Data extraction: Received the CQC (formerly Health Care Commission) spreadsheet on date 16/10/2008 Numerator: Number of women known to smoke in pregnancy definition Numerator: source Care Quality Commission . where as all maternities are used as the denominator for the prevalence of smoking in pregnancy at PCT level calculated by the CQC.cqc. Where there is not 100% data coverage the health profiles percentage will be higher than the CQC percentage due to the smaller denominator in the former. which is sent to PHOs.org.cfm?fde_id=1255 The denominator is different from that used by the CQC. Source Data extraction: Most of the data is available on the CQC website: source URL http://www.Health Profiles 2009  The Indicator Guide 47 Section 3: Children’s and young people’s health Table 2 – Indicator Specification Indicator The percentage of women giving birth in 2007/08 who are current smokers at definition: Variable the time of delivery out of all maternities where smoking in pregnancy status is recorded.

East Midlands. The regional and SHA values for North West. it would result in a biased estimate for aggregated areas.Health Profiles 2009  The Indicator Guide 48 Section 3: Children’s and young people’s health Denominator: Number of maternities where smoking in pregnancy status is recorded definition Denominator: Care Quality Commission source Data quality: The CQC data is based on commissioning PCT for the financial year 2007/08 Accuracy and and not PCT of residence. and therefore the number of maternities is slightly completeness different from the ONS number of births in 2007 based on residence. The regional and SHA data in the health profiles have been calculated by summing the LAs. South East (South East Coast SHA and South Central SHA) and South West differ slightly from those produced from summing the CQC PCT data. . If there are several LAs within one PCT they will all have the same prevalence. SHA and England prevalences are calculated from LAs which returned data. thereby masking any variation in prevalence which may exist within that PCT. Yorkshire and Humber. due to how PCTs that straddle SHAs were dealt with. There are estimated prevalence data for 93% of LAs. GOR. As the county. if these LAs are not truly representative of the areas they are being aggregated to. The data is originally recorded at PCT level which has been converted to LA level using birth weighting.

PCT ORDER BY OSCTY. COUNT(*) FROM D_births_96_07 LEFT JOIN HES.dbo. This was carried out in SQL using the syntax: SELECT OSCTY. The file was then loaded into Access to calculate the LA numerator. Expressed as an equation the numerator is calculated as follows: Smoking in pregnancy MumsLA = ∑ n/N * Smoking in pregnancy MumsPCT Smoking in pregnancy MumsLA = Estimated number of mothers known to smoke in pregnancy in the LA n= number of births in the LA-PCT overlapping block N = Number of births in the PCT .A_NationalPostcodes_feb08. There were no PCTs with >5% unknown smoking in pregnancy status to exclude but 7 PCTs did not return data (DNRs) and were therefore excluded from the analysis in Excel. An LA may overlap several PCTs so this has to be summed at the end. Weights based on births were used in order to convert the PCT data into LA data. to give the number of births in every LA-PCT overlapping block in 2007 by resident LA.DOBchild) = 2007 and (GOR = ‘A’ or GOR = ‘B’or GOR = ‘D’or GOR = ‘E’or GOR = ‘F’or GOR = ‘G’or GOR = ‘H’or GOR = ‘J’or GOR = ‘K’) GROUP BY OSCTY. OSLAUA. Births by resident LA and PCT were extracted from the ONS 2007 birth file.[Mat Pcode] = HES.[PCD2] WHERE [SB Ind] <> ‘1’ and year(D_Births_96_07. PCT To calculate the numerator we need to know the proportion of the LA-PCT overlap of each PCT and then multiply this proportion by the “Actual number of women known to smoke in pregnancy” in the PCT.dbo. PCT.A_NationalPostcodes_Feb08 ON D_births_96_07. OSLAUA. OSLAUA.Health Profiles 2009  The Indicator Guide 49 Section 3: Children’s and young people’s health Table 3 – Indicator Technical Methods Numerator and The numerator denominator: extraction The numerator is converted from the PCT level numerator: “Actual number of women known to smoke in pregnancy (LDPR)”.

in aggregation/ Access. This is expressed in the following formula: ∑LA-PCT number of births/LA total number of births. To find out where this is the case. SHA and England level using a allocation look-up table and pivot table in Excel. we worked out the LA-PCT birth overlap in each LA then summed this for the LA we had a prevalence estimate for. The Denominator The denominator is calculated in the same way as the numerator. The valid data is then loaded into Access and the denominator is calculated in the same way as the numerator using the same method of weighting and the formula: MaternitiesLA = ∑ n/N * MaternitiesPCT MaternitiesLA = Estimated number of maternities of known status for smoking in pregnancy in the LA n= number of births in the LA-PCT overlapping block N = number of births in the PCT MaternitiesPCT = number of maternities of known status for smoking in pregnancy in the PCT The denominator along with the numerator is then exported to Excel to complete the analysis. Data was aggregated to county. . and therefore those LAs entirely made up of PCTs who did not return data will not have an estimate. At PCT level the “number of maternities with smoking in pregnancy status known” is calculated in Excel (“actual number of maternities” – “number of maternities with status unknown”). However if they are made up of several PCTs and only one of which has valid data they will have a numerator and denominator based on this one PCT. so we need to select this out. region. Numerator: Data was aggregated up to LA level using the method described above.Health Profiles 2009  The Indicator Guide 50 Section 3: Children’s and young people’s health Smoking in pregnancy MumsPCT = Number of mothers known to smoke in pregnancy in the PCT Before the data were entered into Access those PCTs who did not return data were excluded. Numerator data We do not have a complete set of data due to 7 DNR PCTs. and not all PCTs had caveats 100% coverage although all that returned data had at least 95% coverage. We do not want to include an estimate for this LA. There were no LAs partially made up with PCTs who did not return data so no LAs were excluded at this stage.

First. Stat Med 1998. When there are no observed events. This means where you have LAs that are identical to PCTs.G. B = z z 2 + 4rq . Barking and Dagenham PCT have a smoking in pregnancy prevalence of 11. Reference: Newcombe.3% using the CQC definition.org. Newcombe. the interval becomes n/(n+z2) to 1. Then the confidence interval for the population proportion is given by (A-B)/C to (A+B)/C This method has the considerable advantage that it can be used for any data. Methods used to The indicator value is calculated as follows in Excel: calculate indicator Percentage of mothers who smoke in pregnancy: numerator/denominator *100 value Small Not used Populations: How Isles of Scilly and City of London populations have been dealt with Disclosure Control None Confidence The 95% and 99. where z is z1-α/2. When r = n so that p = 1. r and hence p are both zero. Where there is not 100% data coverage the health profiles percentage will be higher than the CQC percentage due to the smaller denominator in the former.4% according to the health profile definition.8% confidence intervals are calculated using Julian Flowers’ Intervals (erpho) confidence interval tool: calculation http://www. where as all maternities are used as the denominator for the prevalence of smoking in pregnancy at PCT level calculated by the CQC. . from the standard Normal distribution.17:857-72. and 11.xls This calculates confidence intervals using the following method for a confidence interval of a proportion as described by R.uk/Download/Public/15374/1/Confidence_Intervals_ method Wilson. Two-sided confidence intervals for the single proportion: comparison of seven methods. If r is the observed number of subjects with some feature in a sample of size n then the estimated proportion who have the feature is p = r/n.Health Profiles 2009  The Indicator Guide 51 Section 3: Children’s and young people’s health Denominator The denominator and numerator are based on commissioning PCT whereas the data caveats weights are based on LA/PCT of residence. and C=2(n+z2). RG. and the recommended confidence interval simplifies to 0 to z2/(n+z2). In the health profiles only maternities with smoking in pregnancy status recorded is used as the denominator. calculate the three quantities A = 2r + z2.erpho. The proportion who do not have the feature is q = 1-p. For example. the two percentages will not be identical unless there is 100% data coverage (see supporting indicator). The denominator is different from that used by the CQC.

a local authority is statistically significantly better or statistical process control to test the or worse respectively than the England average. The county. thereby masking any variation in prevalence which may exist within that PCT. Why is it being measured? Breast feeding has well known health benefits for the child and for the mother in later life. if any of its component PCTs have not returned data or have invalid data. Are there any caveats/warnings/ The indicator is based on observation and is problems? therefore susceptible to measurement bias. What is being measured? Breast Feeding Initiation 2. SHA and England prevalences were calculated from the LAs with data returned. 4. significance tests.Health Profiles 2009  The Indicator Guide 52 Section 3: Children’s and young people’s health 8. GOR. How is this indicator actually defined? The percentage of women giving birth in 2007/08 who put their baby to the breast in the first 48 hours after delivery. When does it measure it? Financial year 2007/08 6. It costs nothing to implement and should be amenable to change through public health intervention. 3. therefore if these LAs are not truly representative of the areas they are being aggregated to. Are particular tests needed such The data point is green or red when the figure in as standardisation. The data is originally recorded at PCT level which has been converted to LA level using birth weighting. 10. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. BREAST FEEDING INITIATION INDICATOR Basic Information 1. 7. A LA will not have an estimate. it would result in a biased estimate for aggregated areas. Will It measure absolute numbers or Proportions: Number of women who initiate breast proportions? feeding per 100 maternities where breast feeding initiation status is recorded. out of all maternities where breast feeding initiation status is recorded. . 9. Where does the data actually come Care Quality Commission from? 8. 5. Who does it measure? Women giving birth in 2007/08 with breast feeding initiation status recorded. If there are several LAs within one PCT they will all have the same prevalence. How accurate and complete will the 92% of LAs have less than or equal to 5% mothers data be? with unknown breast feeding initiation status and were therefore deemed as having valid prevalence estimates to be included in the Health Profiles 2009.

Health Profiles 2009  The Indicator Guide 53 Section 3: Children’s and young people’s health Table 1 – Indicator Description Information component Page 4 Spine Chart – Indicator 8 Subject category/ Children’s and young people’s health. Rationale: Purpose To encourage uptake of breast feeding. i. A target for breast feeding initiation was also included in PCT Local Delivery Plans (LDPs).e. However. This for the financial year 2007/08. Geography The data is available at the PCT level this has been converted into the appropriate areas for Health Profiles 2009. with a particular focus on women from disadvantaged groups. It costs nothing to implement and should be amenable to change through public health intervention. The NHS Priorities and Planning Framework 2003–06 has a target to deliver a two percentage point increase in breast feeding initiation rates each year. purports to measure it does not necessarily reflect the level of sustained breast feeding. initiation of breast feeding. The argument is made that mothers who haven’t initiated breast feeding within the first 48 hours rarely do so later. directly. Rationale: It measures the percentage of babies put to the breast in the first 48 What this indicator hours after delivery. With increasing quality in the future. The numerator is the number of women initiating breast feeding and the denominator the number of maternities with breast feeding initiation status recorded. The indicator measures only whether baby received breast milk at least once within the first 48 hours rather than sustained breast feeding likely to deliver benefits. this data can be included in future health profiles. Rationale: This indicator was judged to be a valid and an important measure of Policy relevance public health and was therefore included in the ‘children’s and young people’s health’ domain of the profiles. Data is now being collected at 6–8 weeks (NI 53). behind the inclusion of To highlight LAs with low breast feeding prevalence to encourage the indicator intervention. Rationale: Breast feeding has well known health benefits for the child and for the Public Health Importance mother in later life (Breastfeeding – NHS ). . From a health inequalities perspective it is reasonable to focus attention on the early period to encourage disadvantaged groups to initiate breast feeding. Timeliness The data is released on a quarterly basis. but it is unknown what proportion persist.2009 creation Indicator definition Measures the percentage of mothers who put their baby to the breast in the first 48 hours after delivery.01. domain(s) Indicator name (* Breast Feeding Initiation Indicator title in health profile) PHO with lead ERPHO responsibility Date of PHO dataset 11.

When viewing amalgamated areas it should be taken into consideration that they may be subject to non response bias.regional and England values. no value was published for the LA (this was the case for Braintree and Runnymede LAs). Interpretation: Potential It is based on observation and therefore it prone to measurement bias. The calculation of county. Where a LA consists of a PCT with complete data and a PCT with invalid data. .Health Profiles 2009  The Indicator Guide 54 Section 3: Children’s and young people’s health Interpretation: What An indicator value better than average (green circle in health summary a high/low level of chart) represents statistically significantly more women initiating breast indicator value means feeding for that local authority when compared to the national value. An indicator value worse than average (red circle in health summary chart) represents statistically significantly fewer women initiating breast feeding for that local authority when compared to the national value. region. for error due to type of measurement method Interpretation: Potential It is likely to be subject to measurement bias by the midwives/nurses for error due to bias and who record the data and their interpretation of whether breast feeding confounding has been initiated. SHA and England prevalence is based on only those LAs which returned data. High percentage of breast feeding initiation is good as it could be considered as a proxy measure for sustained breast feeding. and the overall regional and England prevalences are only estimates. We have excluded those LAs with component PCTs with >5% missing data to try to avoid non response bias within the LA. although the complete PCT data was used for the calculation of the SHA. They may therefore not be truly representative of the whole area if those LAs which returned data have different prevalences compared with those LAs which did not.

For this purpose the national value has been treated as an exact reference value rather than as an estimate and. a mortality rate. uncertainty also arises from random differences between the sample and the population itself. but chance had led to a different set of data. These occurrences result in random fluctuations in the indicator value between different areas and time periods. The confidence intervals have also been used to make comparisons against the national value. If the interval includes the national value. under these conditions. The wider the confidence interval the greater the uncertainty in the estimate. Confidence intervals quantify the uncertainty in this estimate and. The use of 95% is arbitrary but is conventional practice in medicine and public health. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. generally speaking.Health Profiles 2009  The Indicator Guide 55 Section 3: Children’s and young people’s health Confidence Intervals: A confidence interval is a range of values that is normally used to Definition and purpose describe the uncertainty around a point estimate of a quantity. for example. Confidence intervals are given with a stated probability level. In Health Profiles 2009 this is 95%. the interval can be used to test whether the value is statistically significantly different to the national. In the case of indicators based on a sample of the population. and so we say that there is a 95% probability that the interval covers the true value. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. the difference is statistically significant and the value is shown on the health summary chart with a red or green symbol depending on whether it is worse or better than the national value respectively. out of all maternities where breast feeding Variable initiation status is recorded. the difference is not statistically significant and the value is shown on the health summary chart with an amber symbol. Indicator Percentage definition: Statistic Indicator Female definition: Gender Indicator n/a definition: age group Indicator Financial year 2007–08 definition: period . describe how much different the point estimate could have been if the underlying conditions stayed the same. If the interval does not include the national value. Table 2 – Indicator Specification Indicator The percentage of women giving birth in 2007/08 who put their baby to the breast definition: in the first 48 hours after delivery.

In the health profiles only maternities with breast feeding initiation status recorded is used as the denominator. which is sent to PHOs. where as all maternities are used as the denominator for the prevalence of breast feeding initiation at PCT level calculated by the CQC. The number of births by LA-PCT was extracted from the ONS 2007 birth file.cqc. the two percentages will not be identical unless there is 100% data coverage (see supporting indicator). Where there is not 100% data coverage the health profiles percentage will be higher than the CQC percentage due to the smaller denominator in the former. This means where you have LAs that are identical to PCTs. Numerator: Care Quality Commission source Denominator: Number of maternities in 2007/08 where breast feeding initiation status is recorded.Health Profiles 2009  The Indicator Guide 56 Section 3: Children’s and young people’s health Indicator Percentage definition: scale Geography: PCT (commissioning PCT) geographies available for this indicator from other providers Dimensions n/a of inequality: subgroup analyses of this dataset available from other providers Data Care Quality Commission extraction: Source Data The data are available on the CQC website: extraction: http://www.cfm?fde_id=1255 source URL The denominator in the Health Profiles is different from that used by the CQC. Data Received the CQC spreadsheet on 16/10/2008 extraction: date Numerator: Number of women giving birth in 2007/08 who initiate breast feeding in the first 48 definition hours after delivery. definition Denominator: Care Quality Commission source .org.uk/publications.

thereby masking any variation in prevalence which may exist within that PCT. South East (South East Coast SHA and South Central SHA) and South West differ slightly from those produced from summing the CQC PCT data. This factor should not affect prevalence estimates as multiple births are generally a random event and mothers with multiple births are likely to breast feed both babies or neither one. if these LAs are not truly representative of the areas they are being aggregated to. The ONS birth file is based on number of deliveries.Health Profiles 2009  The Indicator Guide 57 Section 3: Children’s and young people’s health Data quality: The CQC data is based on commissioning PCT for the financial year 2007/08 and not Accuracy and PCT of residence. Yorkshire and Humber. due to how PCTs that straddle SHAs were dealt with. SHA and England prevalences are calculated from LAs with returned data. There are estimated prevalence data for 92% LAs. The data is originally recorded at PCT level which has been converted to LA level using birth weighting. The regional and SHA data in the health profiles have been calculated by summing the LAs. . The regional and SHA values for North West. GOR. it would result in a biased estimate for aggregated areas. If there are several LAs within one PCT they will all have the same prevalence. East Midlands. and therefore the number of maternities is slightly different from completeness the ONS number of births in 2007 based on residence and is for a slightly different time period. As the county. where as the CQC maternity data is based on mothers and does not take into account multiple births.

dbo. OSLAUA. Expressed as an equation the numerator is calculated as follows: Breast feeding MumsLA = ∑ n/N * Breast feeding MumsPCT Breast feeding MumsLA = Estimated number of mothers known to initiate breast feeding in the LA n= number of births in the LAD-PCT overlapping block N = Number of births in the PCT Breast feeding MumsPCT = number of mothers known to initiate breast feeding in the PCT.dbo. There were no PCTs with more than 5% unknowns to exclude and so therefore only those PCTs who DNRs (did not return) were excluded in Excel which was 7 PCTs in total. therefore LAs entirely made up of PCTs with not data will not have . Weights based on births were used in order to convert the PCT data into LA data.DOBchild) = 2007 and (GOR = ‘A’ or GOR = ‘B’or GOR = ‘D’or GOR = ‘E’or GOR = ‘F’or GOR = ‘G’or GOR = ‘H’or GOR = ‘J’or GOR = ‘K’) GROUP BY OSCTY.[Mat Pcode] = HES. PCT To calculate the numerator we need to know the proportion of the LA-PCT overlap of each PCT and then multiply this proportion by the “Actual number of women known to initiate breast feeding” in the PCT. This was carried out in SQL using the syntax: SELECT OSCTY. Before the data were entered into Access those PCTs which did not return data were excluded. OSLAUA. A LA may overlap several PCTs so this has to be summed at the end. PCT.A_NationalPostcodes_Feb08 ON D_births_96_07. OSLAUA.[PCD2] WHERE [SB Ind] <> ‘1’ and year(D_Births_96_07.A_NationalPostcodes_feb08. to give the number of births in every LA-PCT overlapping block in 2006 by resident LA. The file was then loaded into Access to calculate the LA numerator.Health Profiles 2009  The Indicator Guide 58 Section 3: Children’s and young people’s health Table 3 – Indicator Technical Methods Numerator and The Numerator Denominator: The numerator is converted from the PCT level numerator: “Actual number of extraction women known to initiate breastfeeding (LDPR)”. COUNT(*) FROM D_births_96_07 LEFT JOIN HES. Births by resident LA and PCT were extracted from the ONS 2007 birth file. PCT ORDER BY OSCTY.

This is expressed in the following formula: ∑LA-PCT number of births/LA total number of births. However if they are made up of several PCTs and only one of which has valid data they will have a numerator and denominator based on this one PCT. we worked out the LA-PCT birth overlap in each LA then summed this for the LA we had a prevalence estimate for.2% according to the health profile definition. This means where you have LAs that are identical to PCTs. To find out where this is the case. Numerator data We do not have a complete set of data as there was not 100% coverage from caveats PCTs that returned data (although in all these cases coverage was over 95%) and more importantly 7 PCTs did not return data. In the health profiles only maternities with breast feeding initiation status recorded is used as the denominator. so we need to select this out. Numerator: Data was aggregated up to LA level using the method described above in Access. the health profiles percentage will be higher than the CQC percentage due to the smaller denominator in the former. The denominator The denominator is calculated in the same way as the numerator. We do not want to include an estimate for this LA. Barking and Dagenham PCT have a breast feeding initiation prevalence of 72. If it did not add up to 1 a prevalence estimate was not published (this was the case for Braintree and Runnymede LAs). aggregation/ Data was aggregated to county. For example. and a slightly higher prevalence of 72. The valid data is then loaded into Access and the denominator is calculated in the same way as the numerator using the same method of weighting and the formula: MaternitiesLA = ∑ n/N * MaternitiesPCT MaternitiesLA= Estimated number of maternities of known status for breast feeding in the LA n= number of births in the LAD-PCT overlapping block N = number of births in the PCT MaternitiesPCT = number of maternities of known status for breast feeding in the PCT The denominator along with the numerator is then exported to Excel to complete the analysis. Denominator The denominator and numerator are based on commissioning PCT whereas the data caveats weights are based on LA/PCT of residence. where as all maternities are used as the denominator for the prevalence of breast feeding initiation at PCT level calculated by the CQC.Health Profiles 2009  The Indicator Guide 59 Section 3: Children’s and young people’s health an estimate.0% according the CQC definition. region. the two percentages will not be identical unless there is 100% data coverage (see supporting indicator). At PCT level the “number of maternities with breast feeding status known” is calculated in Excel (“actual number of maternities” – “number of maternities with status unknown”). Where there is not 100% data coverage. SHA and England level using a look-up allocation table and pivot table in Excel. The denominator is different from that used by the CQC. Methods used The indicator value is calculated as follows in Excel: to calculate Percentage of women giving birth in 2007/08 initiating breast feeding: numerator/ indicator value denominator *100 .

the interval becomes n/(n+z2) to 1.xls method This calculates confidence intervals using the following method for a confidence interval of a proportion as described by R. . First. r and hence p are both zero.org. Newcombe. Then the confidence interval for the population proportion is given by (A-B)/C to (A+B)/C This method has the considerable advantage that it can be used for any data. and the recommended confidence interval simplifies to 0 to z2/(n+z2). where z is z1-α/2.uk/Download/ calculation Public/15374/1/Confidence_Intervals_Wilson. When r = n so that p = 1. RG. Stat Med 1998. calculate the three quantities A = 2r + z2. The proportion who do not have the feature is q = 1-p.erpho. B = z z 2 + 4rq . and C=2(n+z2). Reference Newcombe. If r is the observed number of subjects with some feature in a sample of size n then the estimated proportion who have the feature is p = r/n. Two-sided confidence intervals for the single proportion: comparison of seven methods.17:857-72. When there are no observed events.Health Profiles 2009  The Indicator Guide 60 Section 3: Children’s and young people’s health Small Not used Populations: How Isles of Scilly and City of London populations have been dealt with Disclosure none Control Confidence The 95% and 99. from the standard Normal distribution.G.8% confidence intervals are calculated using Julian Flowers’ Intervals (erpho) confidence interval tool: http://www.

When does it measure it? 2007/08 academic year 6. Where does the data actually come TNS Social Research: Annual Survey of School from? Sport Partnerships on behalf of the Department for Children. Who does it measure? The total number of school children in state schools who responded to the 2007/08 TNS School Sport Survey who participate in at least 2 hours of high quality PE and out of hours school sport in a typical week. What is being measured? Physical Activity provision for school children 2. Will It measure absolute numbers or Percentage of all responses to the 2007/8 TNS proportions? School Sport Survey. 7. How is this indicator actually defined? The percentage of children attending state schools belonging to a School Sport Partnership who participate in at least 2 hours of high quality PE and school sport within and beyond the curriculum in a typical week of the academic year. 3. Whilst some private schools have joined a School Sport Partnership and completed the TNS survey. with response from over 99% of all such schools. .Health Profiles 2009  The Indicator Guide 61 Section 3: Children’s and young people’s health 9. Schools and Families. 5. PHYSICALLY ACTIVE CHILDREN INDICATOR Basic Information 1. How accurate and complete will the All partnership schools in the maintained sector data be? in England were included in this survey. 8. Responses to the TNS School Sport Survey were self- reported by schools given the potential for positive response bias. 4. their data is excluded from the DCSF national results dataset. Why is it being measured? To help increase childhood participation in physical activity by highlighting areas with low participation rates in order to assess need and enable targeted intervention.

the term is still open to individual interpretation and there is some potential for positive response bias as schools are self-reporting. a local authority is statistically significantly better or statistical process control to test the or worse respectively than the England average. and so cannot be used as a total measure of physical activity for children. It is important to make the distinction between physical activity and structured PE/sport. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. significance tests. Local Authority: Counties. Unitary Authorities. 9 component Subject category/ Children’s and Young People’s Health domain(s) Indicator name Physically active children (*Indicator title in health profile) PHO with lead EMPHO responsibility Date of PHO February 2009 dataset creation Indicator definition The percentage of children attending state schools belonging to a School Sport Partnership who participate in at least 2 hours of high quality PE and school sport within and beyond the curriculum in a typical week of the academic year. Are particular tests needed such The data point is green or red when the figure in as standardisation. County Districts. Metropolitan County Districts. Although efforts have been made to clearly define ‘high quality PE’. 10.Health Profiles 2009  The Indicator Guide 62 Section 3: Children’s and young people’s health 9. Results were published in October 2008. physical activity is not necessarily PE/sport. . Geography England. London Boroughs Timeliness The survey was carried out between May and July 2008. Table 1 – Indicator Description Information Page 4: Health summary – Indicator No. Are there any caveats/warnings/ The indicator is a direct measure of service provision problems? within state schools. While PE/ sport may be physical activity. and this data should only be considered as a part of this wider issue within an area. It is important to acknowledge that this indicator does not take into account physical activity provision within private schools or physical activity undertaken by children outside of school. GOR. The survey is carried out annually with the results from the 2009 survey due out in October 2009.

teachernet. some of the key risk factors for diseases such as coronary heart disease.uk/en/Publicationsandstatistics/ Publications/PublicationsPolicyAndGuidance/DH_4080994 Increasing childhood participation in physical activity is also a key message in “Choosing Activity: A Physical Activity Action Plan”. early in life.dh. In 2004. Physical activity during childhood has a range of Importance benefits including healthy growth and development. This indicator relates indirectly to indicator NI 57 in the National Indicator Set for Local Authorities and Local Authority Partnerships – “Children and young people’s participation in high-quality PE and sport”. See “Chapter 4: Health benefits of physical activity in childhood and adolescence” at http://www. The benefits continue well into adulthood by reducing. Rationale: Purpose To help increase childhood participation in physical activity by highlighting behind the areas with low participation rates in order to assess need and enable targeted inclusion of the intervention. See http://www. indicator Rationale: This indicator relates directly to Indicator 5 of PSA Target 22: Policy relevance “Increase the percentage of 5 to 16 year olds participating in at least two hours per week of high-quality PE and sport at school” to 85% by 2008.uk/ en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/ DH_083471.pdf for further information.uk/d/pbr_csr07_psa22. diabetes and osteoporosis.uk/documents/localgovernment/pdf/735125. See http://www.uk/teachingandlearning/subjects/pe/ or http:// www.communities. psychological well-being and social interaction.Health Profiles 2009  The Indicator Guide 63 Section 3: Children’s and young people’s health Rationale: The percentage of children in state maintained schools who participate in at What this indicator least 2 hours of high quality PE and school sport per week purports to measure Rationale: All children. Physical inactivity in childhood is a modifiable lifestyle risk factor. The long-term ambition is to offer all children at least 4 hours of sport every week by 2010.gov. See http://www. it can also improve school attendance.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_4105354 and http://www. Some evidence also suggests that participation in physical activity during childhood can help to establish a physically active lifestyle in later life.gov.gov. maintenance of energy balance. whatever their circumstance.gov.dh.hm-treasury. The in-school aspect of this indicator will be recorded through the School Sport Survey. .dh.pdf for further information. which summarises how the government will deliver the commitments on physical activity that are presented in the public health white paper “Choosing Health” and “Tackling Health Inequalities: 2007 Status report on the Programme for Action”. the CMO Report “At least 5 a week: Evidence on the impact of physical activity and its relationship to health” recommended that children and young people need at least 60 minutes of moderate intensity physical activity each day. behaviour and attainment. which will measure both in school provision and community (out-of-school hours) provision. should be able to participate in and Public Health enjoy PE and sport at school.gov.gov. Through improved concentration and self-esteem. and to at least 75% in each School Sport Partnership by 2008”.

Confidence intervals are given with a stated probability level. Although efforts have been made to clearly define ‘high quality PE’. It Potential for error is important to acknowledge that this indicator does not take into account due to type of physical activity provision within private schools or physical activity undertaken measurement by children outside of school. the difference is statistically significant and the value is shown on the health summary chart with a red or green symbol depending on whether it is worse or better than the national value respectively. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. and so we say that there is a 95% probability that the interval covers the true value. While PE/sport may be physical activity. under these conditions. for example. In Health Profiles this is 95%. . This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. physical activity is not necessarily PE/sport. describe how much different the point estimate could have been if the underlying conditions stayed the same. and not just compared to the England average value when value means assessing the need for public health intervention. If the interval includes the national value. If the interval does not include the national value. their data is excluded from the DCSF national results dataset due to bias and adding possible bias to the results. generally speaking. In the case of indicators based on a sample of the population. The wider the confidence interval the greater the uncertainty in the estimate. These occurrences result in random fluctuations in the indicator value between different areas and time periods. uncertainty also arises from random differences between the sample and the population itself. the difference is not statistically significant and the value is shown on the health summary chart with an amber symbol. and this data should only be considered as a part of this wider issue within an area. confounding It is important to make the distinction between physical activity and structured PE/sport. Interpretation: Whilst private schools are able to join a School Sport Partnership and complete Potential for error the TNS survey. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. Confidence intervals quantify the uncertainty in this estimate and. Interpretation: The indicator is a direct measure of service provision within state schools. the term is still open to individual interpretation and there is some potential for positive response bias as schools are self-reporting. The confidence intervals have also been used to make comparisons against the national value. a mortality and purpose rate. the interval can be used to test whether the value is statistically significantly different to the national. Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. and so cannot be used as a total measure of method physical activity for children. but chance had led to a different set of data. The use of 95% is arbitrary but is conventional practice in medicine and public health.Health Profiles 2009  The Indicator Guide 64 Section 3: Children’s and young people’s health Interpretation: Indicator values should be considered in conjunction with the national target What a high/low for 85% of school children to be participating in 2 or more hours of physical level of indicator activity per week.

https://dservuk.aspx Data is not available to download but was received directly from TNS. England are available from the National PE.com/ SchoolSports2008/Default. School Sport and Club available for this Links website at https://dservuk. including those taking place during break times within the school day.Health Profiles 2009  The Indicator Guide 65 Section 3: Children’s and young people’s health TABLE 2 – INDICATOR SPECIFICATION Indicator High quality PE and out-of-school hours sport definition: Variable Indicator Percentage definition: Statistic Indicator Persons definition: Gender Indicator 5–16 years definition: age group Indicator 2007/08 academic year definition: period Indicator Percentage of school children in Year 1 – Year 11 attending state schools definition: scale belonging to a School Sport Partnership Geography: Results summarised by School. As of the end of 2007 all state maintained schools in England are in School Sport Partnerships.com/schoolsports2007/default. arranged into 450 Partnerships Numerator: source TNS 2007/08 School Sport Survey Further information is available at https://dservuk. School Sport Partnership. school year subgroup analyses (Year 1 – Year 11). time spent participating in out of hours school led or school supervised sporting activities. Schools and Families. Local Education geographies Authority. Data extraction: Received directly source URL Data extraction: Received directly October 2008 date Numerator: The total number of school children in state schools who responded to the definition 2007/08 TNS School Sport Survey who participate in at least 2 hours of high quality PE and out of hours school sport in a typical week. Excludes travelling time.tns-global.aspx indicator from other providers Dimensions The TNS 2008 School Sport Survey National Results report provides 2007/08 of inequality: data broken down by school type (primary.tns-global.aspx other providers Data extraction: TNS Social Research: Annual Survey of School Sport Partnerships on behalf of Source the Department for Children. for GCSE PE students). . available from com/schoolsports2007/default.tns-global.g. special). optional PE curriculum time (e. and School Sport Partnership phase (ie when the school of this dataset joined the School Sport Partnership programme). secondary. (Includes compulsory PE curriculum time.

their data is excluded from the DCSF national results dataset. The validation concluded that the majority of schools kept auditable records of the information they submitted in their survey responses.com/ SchoolSports2008/Default.aspx Data is not available to download but was received directly from TNS. Data quality: Coverage: All partnership schools in the maintained sector in England were Accuracy and included in this survey. Isles of Scilly and City The Isles of Scilly are included in the Cornwall UA and South West of London populations regional and national totals and the City of London figures have been have been dealt with included in the regional London and national totals. Data Reliability: Validation of the 2007/08 TNS School Sport Survey was carried out in 10% of School Sport Partnerships selected at random. Numerator: aggregation/ Performed by TNS. Table 3 – Indicator Technical Methods Numerator: extraction Data received directly from TNS. This generated the percentage achieving the recommended levels for school sport participation. allocation Numerator data caveats Denominator data caveats Methods used to The number of children in state maintained schools who participated calculate indicator value in at least two hours of high quality PE/school sport per week for each local authority was divided by the total number of children within each surveyed school with valid responses to questions on physical activity in the TNS School Sport Survey and multiplied by 100.Health Profiles 2009  The Indicator Guide 66 Section 3: Children’s and young people’s health Denominator: The total number of school children in state schools who responded to the definition 2007/08 TNS School Sport Survey. For further information see the 2007/08 TNS School Sport Survey Results report. . Small Populations: How Data for the Isles of Scilly and City of London have not been presented. The questionnaire had a 99% response rate giving a relatively complete dataset. pdf The same questionnaire is used each year giving comparable results. section 2.uk/research/data/uploadfiles/DCSF-RW063.dcsf. arranged into 450 Partnerships Denominator: TNS 2007/08 School Sport Survey source Further information is available at https://dservuk. with response from over 99% of all such schools. Whilst completeness some private schools have joined a School Sport Partnership and completed the TNS survey. and that where auditable records were not available.4 at http://www. As of the end of 2007 all state maintained schools in England are in School Sport Partnerships. reasonably robust results should have been produced using the verbally reported approach adopted by schools. Data Quality: Responses to the TNS School Sport Survey were self-reported by schools giving the potential for positive response bias.tns-global.gov.

When r = n so that p = 1. calculate the three quantities A = 2r + z2. If r is the observed number of subjects with some feature in a sample of size n then the estimated proportion who have the feature is p = r/n. the interval becomes n/(n+z2) to 1. where z is z1-α/2. When there are no observed events. Then the confidence interval for the population proportion is given by (A-B)/C to (A+B)/C This method has the considerable advantage that it can be used for any data. Reference Newcombe. from the standard Normal distribution. r and hence p are both zero. Two-sided confidence intervals for the single proportion: comparison of seven methods. . First. The proportion who do not have the feature is q = 1-p.17:857-72.Health Profiles 2009  The Indicator Guide 67 Section 3: Children’s and young people’s health Disclosure Control None applied Confidence Intervals Confidence intervals have been calculated using the following method calculation method for a confidence interval of a proportion as described by RG Newcombe. RG.   and   C=2(n+z2).   B = z z 2 + 4rq . and the recommended confidence interval simplifies to 0 to z2/(n+z2). Stat Med 1998.

4. coverage of school children aged 4–5 is not complete. The NCMP does not include children in the Independent sector. How is this indicator actually defined? Prevalence of childhood obesity. To help reduce the prevalence of childhood obesity. ages 4–5. persons. Will It measure absolute numbers or Proportion: Percentage of school children in proportions? Reception year who are obese. The data are usually made available around February following publication of the Information Centre National Report. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. ensure the proper targeting of resources to tackle obesity. Are there any caveats/warnings/ There is the potential for error in the collection. percentage of school children in Reception year. 6. a local authority is statistically significantly better or statistical process control to test the or worse respectively than the England average. 125 PCTs exceeded 85% coverage for Reception year. Why is it being measured? To estimate and monitor prevalence of obesity in children.Health Profiles 2009  The Indicator Guide 68 Section 3: Children’s and young people’s health 10. 8. . inform planning and delivery of services for children. 10. Where does the data actually come The Information Centre for Health and Social Care from? (IC). 2007/08. 9. 3. therefore. What is being Prevalence of obesity in Reception year pupils measured? 2. significance tests. problems? collation and interpretation of the data (bias may be introduced due to poor response rates and selective opt out of larger children which it is not possible to control for). When does it measure it? The National Child Measurement Programme (NCMP) takes place every school year. 7. ages 4–5) 5. How accurate and complete will the All 152 PCTs provided data and the participation data be? rate across all PCTs was 89% for Reception year (477. Are particular tests needed such The data point is green or red when the figure in as standardisation.652 children measured). OBESE CHILDREN INDICATOR BASIC INFORMATION1. Who does it measure? Children in Reception year (Year R.

For those aged 2 to 10.nhs.ic. Rationale: Estimate of prevalence of obesity in children in Reception year (Year R.3 per cent to 16.Health Profiles 2009  The Indicator Guide 69 Section 3: Children’s and young people’s health Table 1 – Indicator Description Information Pg 4 Health Summary – Indicator No. glucose intolerance. and from 12. psychological problems – social isolation. The National Institute of Health and Clinical Excellence has produced guidelines to tackle obesity in adults in children – Obesity: the prevention. the proportion who were classified as obese increased from 10. Local Authority: Counties. exacerbation of conditions such as asthma.6 per cent for boys and 10. but more to the proportion of children ‘classified as obese’ according to these population monitoring criteria.7 per cent for girls.nice. and produces higher prevalence figures. The Health Survey for England (HSE) found that among boys and girls Importance aged 2 to 15. The health consequences of childhood obesity include: increased blood lipids. London Boroughs. persons Geography England. assessment and management of overweight and obesity in adults and children. 2007–08.0 per cent to 18. Available at http://guidance. Rationale: The UK is experiencing an epidemic of obesity affecting both adults and Public Health children.uk/statistics-and-data- collections/health-and-lifestyles/obesity/statistics-on-obesity-physical-activity- and-diet-england-2006) There is concern about the rise of childhood obesity and the implications of such obesity persisting into adulthood.1 per cent among girls.org. The 2007/08 data were made available in December 2008. GOR. purports to measure Note: the definition for childhood obesity used for population monitoring is different to that used in a clinical setting. 10 component Subject category/ Children’s and young people’s health domain(s) Indicator name (* Prevalence of obesity in Reception year pupils (*Obese children) Indicator title in health profile) PHO with lead SEPHO responsibility Date of PHO 14/01/2009 dataset creation Indicator definition Prevalence of childhood obesity.0 per cent in 2005 among boys. Metropolitan County Districts. ages 4–5.6 per cent to 16. teasing and bullying. County Districts.9 per cent in 1995 to 18. Timeliness The National Child Measurement Programme (NCMP) takes place every year. (see http://www. The prevalence figures here do not equate to the proportion of the child population that would be clinically classified as obese.uk/CG43/guidance . Unitary Authorities. hypertension. identification. type 2 diabetes. ages What this indicator 4–5). low self-esteem. percentage of school children in Reception year. the increase over the same period was from 9. increases in liver enzymes associated with fatty liver.

uk/our-services/improving- patient-care/national-child-measurement-programme. The government strategy on excess weight is set out in “Healthy Weight. Every year. ensure the proper targeting of resources to tackle obesity. value means A low indicator value (yellow circle in health summary chart) represents a statistically significant lower level of estimated child obesity prevalence when compared to the national value.uk/publications/localgovernment/nationalindicator Interpretation: A high indicator value (red circle in health summary chart) represents a What a high/low statistically significant higher level of estimated child obesity prevalence when level of indicator compared to the national value. Rationale: The National Child Measurement Programme (NCMP) was established in Policy relevance 2005 and is one element of the Government’s work programme on childhood obesity.uk/en/Publichealth/ Healthimprovement/Healthyliving/DH_073787 Childhood obesity was the subject of a Public Service Agreement (PSA) target set in July 2004 which aims to halt the year-on-year rise in obesity among children under 11 by 2010 in England. communities.ic. However obesity in children at any prevalence level greater than 0 is undesirable. Schools and Families (DCSF) and central collection and analysis of the NCMP data is coordinated by the Information Centre for health and social care (The IC) which published the final report on its website along with a web tool to view the results by area: http://www. For further details on the NCMP see: http://www. children in Reception (typically aged 4–5 years) and Year 6 (aged 10–11 years) are weighed and measured during the school year.dh. It is operated by the Department of Health and the Department for Children. In September 2007. Obesity among primary school age children in Reception Year is indicator NI 56 in the new national indicator set. . behind the inclusion of the To help reduce the prevalence of childhood obesity.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_082378 Performance Assessment Framework indicators will be abolished from April 2008 when a new performance framework for local authorities and local authority partnerships comes into place. as part of the NCMP. This framework is supported by a national indicator set. The findings are used to inform local planning and delivery of services for children and gather population-level surveillance data to allow analysis of trends in excess weight. and therefore a low indicator value should not mean that PH action is not needed.Health Profiles 2009  The Indicator Guide 70 Section 3: Children’s and young people’s health Rationale: Purpose To estimate and monitor prevalence of obesity in children.gov. and by 2020 they aim to have reduced the proportion of overweight and obese children to 2000 levels. The programme also seeks to raise awareness of the importance of healthy weight in children. See: http://www. The government’s initial focus is on children.gov. inform planning and indicator delivery of services for children.nhs.gov. the government announced a new ambition: to reverse the rising tide of obesity and overweight in the population by ensuring that all individuals are able to maintain a healthy weight. Healthy Lives: A Cross-Government Strategy for England” 2008 see: http://www.dh.

measurement bias may measurement be introduced via the weighing and measuring and recording process. Consequently. Confidence intervals are given with a stated probability level. generally speaking. indoor clothing was overseen by healthcare professionals due to type of and undertaken in schools by trained staff. The wider the confidence interval is the greater is the uncertainty in the estimate. as it is not known how suitable the British 1990 Growth Reference is for ethnic populations. The NCMP does not include pupils at independent schools and. some children were almost two years older than others in the same school year at the point of measurement. There is also evidence that a systematic ‘rounding down’ of measures has occurred in certain areas. However. Confidence intervals quantify the uncertainty in this estimate and. as these pupils may be from a more affluent background. Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity.Health Profiles 2009  The Indicator Guide 71 Section 3: Children’s and young people’s health Interpretation: Measurement of children’s heights and weights. for method example where an area did not use the recommended scales or ensure these were calibrated. and so we say that there is a 95% probability that the interval covers the true value. child measurements could be taken at any time during confounding the 2007/08 academic year. This might be classed as a confounding factor. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. Interpretation: Bias may be introduced due to poor response rates and selective opt out of Potential for error larger children which it is not possible to control for. These occurrences result in random fluctuations in the indicator value between different areas and time periods. due to bias and For the 2007/08 NCMP. for example. As obesity prevalence is known to increase with age. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. The use of 95% is arbitrary but is conventional practice in medicine and public health. describe how much different the point estimate could have been if the underlying conditions stayed the same. and that this has the effect of reducing the reported prevalence of obesity in those areas. In the case of indicators based on a sample of the population. The dataset this reference is based on consists of only White British individuals. but chance had led to a different set of data. . a mortality and purpose rate. without shoes and coats and Potential for error in normal. The reported prevalence of obesity is also closely related to the socio-economic characteristics of the children measured. uncertainty also arises from random differences between the sample and the population itself. Further analysis is currently being undertaken to help better understand the links between child obesity and ethnicity. there is potential for this to bias the results Ethnicity has been shown to be linked closely to reported prevalence of child obesity. there is a possibility that this might bias prevalence figures using the NCMP. In Health Profiles 2009 this is 95%. light.

If the interval does not include the national value. as the 98th percentile is used in clinical settings.nhs. Indicator definition: Percentage of school children in Reception year Statistic Indicator definition: Persons Gender Indicator definition: School children in Reception year (Year R). the interval can be used to test whether the value is statistically significantly different to the national.ic. urban/rural environment subgroup analyses and prevalence. There are also some significant differences in prevalence by of this dataset gender.uk/ available for this indicator from other providers Dimensions The Information Centre’s summary report (see: http://www.uk/) shows of inequality: strong links between socio-economic status.ncmp. For this purpose the national value has been treated as an exact reference value rather than as an estimate and.Health Profiles 2009  The Indicator Guide 72 Section 3: Children’s and young people’s health The confidence intervals have also been used to make comparisons against the national value. the difference is statistically significant and the value is shown on the health summary chart with a red or amber symbol depending on whether it is worse or better than the national value respectively. This does not equate to the proportion of children clinically defined as obese.nhs. under these conditions.ic. Source Data extraction: www.nhs.ic. available from other providers Data extraction: The Information Centre for Health and Social Care (IC).uk/ source URL . Table 2 – Indicator Specification Indicator definition: Prevalence of childhood obesity. If the interval includes the national value. Note: As prevalence rates have been calculated using the 95th percentile (see Methods used to calculate indicator value). ages 4–5 age group Indicator definition: School year 2007–08 period (September 2007 to September 2008) Indicator definition: scale Geography: PCT. Variable Obesity in children is commonly defined for epidemiological purposes as having a Body Mass Index (BMI) greater than the 95th percentile (using the British 1990 growth reference). This is in line with the Health Survey for England and other population studies within the UK. new SHA geographies Available from http://www. ethnicity. the difference is not statistically significant and the value is shown on the health summary chart with a white symbol.

All 152 PCTs provided data and the participation rate across all PCTs was 89% for Reception year (477.uk/ Denominator: The total number of primary school age children in Year R (Reception year. Participation rates should be treated with caution because of difficulties in calculation of eligible pupil numbers particularly in Reception when pupils may join the school throughout the year. another PCT had undertaken measurement in that school. Low participation rates may bias prevalence figures and analysis has shown that PCTs with lower participation rates tend to have lower levels of prevalence than those with high participation rates. ages definition 4–5) with valid height and weight recorded in the school year 2007–08 who are classified as obese.ncmp. Primary Care Trust (PCT) staff used specially designed Excel spreadsheets (the NCMP Data-Capture tool) to enter these data and upload them to a central database at the Information Centre for Health and Social Care. coverage of school children aged 4–5 is not complete. 125 PCTs exceeded 85% coverage for Reception year. However. Denominator: www.nhs. Participation rates were assessed by comparing numbers measured with total numbers on school lists and are published in the IC National report (see http://www. therefore. The IC conducted checks when all data was submitted to ensure schools had not been removed by one PCT but not added on by another.uk/ source Data quality: Pupils eligible for inclusion in the NCMP were all children in Reception and Accuracy and Year 6 attending non-specialist maintained state schools in England. PCTs were set a participation rate target for NCMP 2007/08 of 85% (for Reception and Year 6).ic.ic.Health Profiles 2009  The Indicator Guide 73 Section 3: Children’s and young people’s health Data extraction: December 2008 date Numerator: The number of primary school age children in Year R (Reception year. This suggests that there might be higher levels of opting out among children with higher BMIs. despite being within their PCT boundary. Numerator: source www. Primary care trusts (PCTs) coordinate the data collection exercise with the support and cooperation of schools.ic.uk/). The completeness NCMP does not include children in the Independent sector. PCTs could also add or remove schools from their geograpically assigned list if. initial analysis by the IC shows participation rate to have little of no effect on prevalence for children in Reception.nhs. . The numbers of pupils eligible for inclusion at each school were provided by the DCSF but PCTs could edit these figures if necessary to ensure pupil denominators accurately reflected the number of children attending the school on the day of measurement. definition ages 4–5) with valid height and weight recorded in the school year 2007–08.652 children measured).nhs.

sex or age.uk/ statistics-and-data-collections/supporting-information/health-and-lifestyles/ obesity/the-national-child-measurement-programme/national-child- measurement-programme-2007/08/ncmp-2007-08-report Denominator data As above. Other Independent Special School. Further information on data quality and the validation process is included in the 2007/08 report from the Information Centre: http://www. weight.600 year R records remained. SHA figures (provided for the South East Region only) have been calculated by assigning schools to SHAs according to the PCT who measured those pupils. Community Special. caveats . where these schools had been measured and entered by PCTs • Records with extreme heights. Foundation Special. The numerator was based on a pre-calculated field included within the database which categorised each child as “healthy weight”. Numerator data The total number of children measured was the total number of records caveats uploaded to the NCMP database after the following records had been removed: • Blank school Unique Reference Number. weights and BMIs where value was further than 7 standard deviations from the mean After the above data cleaning.nhs. Independent School Approved for SEN pupils. Pupil Referral Unit. Other Independent. approximately 477. Regional figures have been calculated by allocation combining the Local Authority figures. Non-maintained Special.ic.Health Profiles 2009  The Indicator Guide 74 Section 3: Children’s and young people’s health Table 3 – Indicator Technical Methods Numerator: Numerator extracted from an Access database provided by IC which included extraction all data uploaded to the central NCMP database as at December 2008. “overweight” or “obese”. Numerator: The figures have been aggregated to local authorities from school counts aggregation/ on the basis of postcode of school. • Children outside the age range (age in months between 48 and 83 inclusive) • Independent/Private/Special Educational Needs (SEN) pupils • Records from Academies. height.

P. and Preece. These were used to calculate a z-score for each child using the following formula:  y  M     Where y is the BMI score. 17. Using the data supplied by IC. M. 17-24 (1995).Health Profiles 2009  The Indicator Guide 75 Section 3: Children’s and young people’s health Methods used to The IC undertook the following steps to calculate the number of obese calculate indicator children: value Every child’s Body Mass Index (BMI) was calculated as follows: BMI = 10. T. ‘Body Mass Index reference curves for the UK. 11. Statistics in Medicine. J. body mass index and head circumference fitted by maximum penalized likelihood’. Freeman. These data were then used to model the BMI distribution using Cole’s LMS method (3) for ages 0–20 for both males and females. This figure was multiplied by 100 to give percentage prevalence. J. J. This dataset can be used to express an individual child’s BMI as a percentile on the 1990 distribution. ages 4–5) with valid height and weight measurements recorded as obese by the total number of primary school age children in Year R with valid height and weight measurements.000 x weight (kg) height2 (cm) BMI was then referenced against the British 1990 Growth Reference (1) (2). height. T. Each child’s BMI was referenced to the age (in decimal months) and sex- specific BMI growth curve in order to retrieve corresponding L. prevalence rates were calculated by dividing the number of primary school age children in Year R (Reception year. V. Note: 40 records from Reception year had not been assigned to a local authority.. On closer examination of school location.. 1305-1319 (1992). M and S values. This uses UK growth data from pre-1990 based on a large representative sample of 37. ‘Smoothing reference centile curves: The LMS method and penalized likelihood’. (2) Cole. .V. these were reassigned to Telford local authority. J. M. The z-score was converted to a p-score using the standardised normal distribution and children with a BMI p-score >=0. 73. ‘British 1990 growth reference centiles for weight. J. A.95 were flagged as obese. and Green. Archives of Disease in Childhood.J. (1) Cole. 1990’. Statistics in Medicine. 407-429 (1998). Freeman.700 children constructed by combining data from 17 separate surveys. (3) Cole. T. A. and Preece.

J Am Stat Assoc 1927. Then the confidence interval for the population proportion is given by (A-B)/C to (A+B)/C This method has the considerable advantage that it can be used for any data. 1 Wilson EB. . and City of London populations have been dealt with Disclosure Control None applied.  Stat Med 1998.  Two-sided confidence intervals for the single proportion: comparison of seven methods. How Isles of Scilly Isles of Scilly have been included in the new Cornwall Unitary Authority. z1-α/2. from the standard Normal distribution. calculation method The estimated proportions of subjects with and without the feature of interest were calculated: observed number of obese children in each area =r sample size = n proportion with feature of interest = p = r/n proportion without feature of interest = q (1 – p) Three values (A. and the recommended confidence interval simplifies to 0 to z2/(n+z2). When there are no observed events. When r = n so that p = 1. the interval becomes n/(n+z2) to 1. 209-212 2 Newcombe. Confidence The 95% confidence intervals are calculated with the method described by Intervals Wilson1 and Newcombe2 which is a good approximation of the exact method.Health Profiles 2009  The Indicator Guide 76 Section 3: Children’s and young people’s health Small Populations: City of London has been included in the Hackney. B = z z 2 + 4rq . r and hence p are both zero.B and C) were then calculated as follows: A = 2r + z2. Regional and National totals. 22. and C=2(n+z2) where z is the appropriate value. RG.17:857-72.

How accurate and complete will the Data was only available at PCT level. When does it measure it? 2005/06 6. CHILDREN’S TOOTH DECAY INDICATOR Basic Information 1. 4.org 8. problems? 10. Why is it being measured? To draw attention to areas of high tooth decay. 3. Who does it measure? Sampled number of children at 5 years old with decayed/missing/filled teeth (dmft). To improve oral health in children by reducing the prevalence of dental decay. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. significance tests.bascd. What is being measured? Children’s tooth decay (at age 5) 2. Data for 12 PCTs was only available in combination with one or more other PCTs. How is this indicator actually defined? Mean number of teeth per child sampled which were either actively decayed or had been filled or extracted. Will It measure absolute numbers or Numbers (the mean of) proportions? 7. a local authority is statistically significantly better or statistical process control to test the or worse respectively than the England average. 11 component Subject category/ Health and ill-health in our community domain(s) Indicator name Mean number of decayed/missing/filled teeth in five-year-olds (*Children’s (*Indicator title in Tooth Decay) health profile) .Health Profiles 2009  The Indicator Guide 77 Section 3: Children’s and young people’s health 11. and had to be data be? apportioned to Local Authorities. Table 1 – Indicator Description Information Pg 4 Health Summary – Indicator No. Data was missing for 22 PCTs and consequently it was not possible to present mean dmft for 26 local authorities and one county. 5. Are there any caveats/warnings/ Positive/negative consent issue may cause bias. Are particular tests needed such The data point is green or red when the figure in as standardisation. 9. Where does the data actually come BASCD (British Association for the Study of from? Community Dentistry) www. This process can only be approximate where PCTs are not completely contained within Local Authorities. Health Profiles 2009 are based on the new unitary authority boundaries and it has not been possible to present mean dmft for 3 of these new authorities.

it cannot be deduced whether the problem is evenly distributed or confined to a small pocket of children. communities. Interpretation: An indicator value worse than average (red circle in health summary chart) What a high/low represents a statistically significant worse rate of children’s tooth decay for that level of indicator local authority when compared to the national value. GOR. Timeliness BASCD (British Association for the Study of Community Dentistry) conduct a survey of five-year-olds every two years. Tooth decay has become less common Importance over the past two decades. Metropolitan County Districts. Unitary Authorities. It results in destruction of the crowns of teeth and frequently leads to pain and infection. From this statistic alone. The 2007/08 survey results are due for publication later in 2009. Children are allocated to these geographies according to the location of their school. London Boroughs. Dental disease is more common in deprived. . missing or filled teeth per child. compared with affluent. Geography England. behind the To improve oral health in children by reducing the prevalence of dental decay. The indicator is a good direct measure of dental health and an indirect. County Districts. value means An indicator value better than average (green circle in health summary chart) represents a statistically significant better rate of children’s tooth decay for that local authority when compared to the national value. Local Authority: Counties. but is still a significant health and social problem.Health Profiles 2009  The Indicator Guide 78 Section 3: Children’s and young people’s health PHO with lead Yorkshire and Humber responsibility Date of PHO March 2008 dataset creation Indicator definition Mean number of teeth per child sampled which were either actively decayed or had been filled or extracted. inclusion of the indicator Rationale: Children’s National Service Framework Policy relevance This indicator supports Choosing Health and LAAs. Rationale: Purpose To draw attention to areas of high tooth decay. What this indicator purports to measure Rationale: Dental caries (tooth decay) and periodontal (gum) disease are the most Public Health common dental pathologies in the UK. Rationale: The mean number of decayed. proxy measure of child health and diet.

East Kent Coastal PCT (5LN). Dacorum PCT (5GW) Hertsmere PCT (5CP). St Albans and Harpenden PCT (5GX) Welwyn and Hatfield (5GG) North Hertfordshire and Stevenage PCT (5GH) . Data for 12 PCTs was only available in combination with one or more other PCTs. Data missing for these PCTs PCT PCT name 5A7 Bromley PCT 5A8 Greenwich PCT 5AK Southend on Sea PCT 5CE Bournemouth Teaching PCT 5CV South Hams and West Devon PCT 5CW Torbay Care Trust 5FN South and East Dorset PCT 5FQ North Devon PCT 5FR Exeter PCT 5FT East Devon PCT 5FV Mid Devon PCT 5FY Teignbridge PCT 5GF Huntingdonshire PCT 5J8 Durham Dales PCT 5J9 Darlington PCT 5JP Castle Point and Rochford PCT 5KA Derwentside PCT 5KC Durham and Chester-le-Street PCT 5KD Easington PCT 5KE Sedgefield PCT 5KV Poole PCT TAK Bexley Care Trust Data available for these PCTs in combination only South East Hertfordshire PCT (5GJ). Shepway PCT (5LP) Watford and Three Rivers PCT (5GV). This process can only be approximate where PCTs are not due to type of completely contained within Local Authorities.Health Profiles 2009  The Indicator Guide 79 Section 3: Children’s and young people’s health Interpretation: Data was only available at PCT level. measurement method Data was missing for 22 PCTs listed below and consequently it was not possible to present mean dmft for 26 local authorities and one county. these are also listed below. and had to be apportioned to Local Potential for error Authorities. 45 PCTs where positive consent operated for all or part of the sampling period are listed below. Royston & Buntingford and Bishops Stortford PCT (5GK) Ashford PCT (5LL). Canterbury and Coastal PCT (5LM).

in state schools. Leigh & Wigan PCT Mixed 5HH Leeds West Mixed 5HJ Leeds North East Mixed 5HK East Leeds Mixed 5HL South Leeds Mixed 5HM Leeds North West Mixed 5HN High Peak and Dales Mixed 5HQ Bolton PCT Mixed 5HX Ealing Mixed 5J6 Calderdale Mixed 5J7 North Kirklees Mixed 5LJ Huddersfield Central Mixed 5LK South Huddersfield Mixed 5LV Northamptonshire Heartlands Mixed 5LW Northampton Mixed 5M5 South Sefton PCT Mixed 5M7 Sutton and Merton Mixed The data source is a series of nationally co-ordinated dental epidemiological surveys commissioned by individual PCTs to standardised national protocols and diagnostic standards and involving the dental examination of children in the specified age-group. .Health Profiles 2009  The Indicator Guide 80 Section 3: Children’s and young people’s health Positive/Mixed consent in operation during sampling period PCT PCT name Form of Consent 5DF North Hampshire Positive 5DK Newbury Positive 5E1 North Tees Positive 5G6 Blackwater Valley & Hart PCT Positive 5HF Wyre PCT Positive 5KJ Part of Craven Harrogate & Rural (Airedale) Positive 5KL Sunderland Positive 5KM Middlesborough Positive 5L5 Guildford & Waverley PCT Positive 5L7 Surrey Heath and Woking Area PCT Positive 5AC Daventry & South Northants Mixed 5AW Airedale Mixed 5CC Blackburn with Darwen PCT Mixed 5CF Bradford City Mixed 5CG South. The data source is part of a cycle of nationally co-ordinated dental epidemiological surveys as outlined in Health Service Guidelines (93)25.West Bradford Mixed 5CH North Bradford Mixed 5CK Doncaster Central Mixed 5CX Trafford South PCT Mixed 5EE North Sheffield Mixed 5EG North Eastern Derbyshire Mixed 5EN Sheffield West Mixed 5EP Sheffield South West Mixed 5EQ South East Sheffield Mixed 5F5 Salford PCT Mixed 5F6 Trafford North PCT Mixed 5G7 Hyndburn & Ribble Valley PCT Mixed 5HA Central Liverpool PCT Mixed 5HE Fylde PCT Mixed 5HG Ashton. Surveys are conducted every second year for 5 year olds and every fourth year for 12 years olds and 14 year olds.

some parents were due to bias and required to give positive consent for their children’s teeth to be inspected. Secondly. than those living in more affluent areas (where mean dmft is lower). Firstly. Bias may result for several reasons. Anecdotal evidence so far suggests that positive consent had a large effect in some areas. eligible for inclusion unless their parents submitted a form stating that they did not wish for their children’s teeth to be inspected. It will be difficult to disentangle the impact of the introduction of positive consent from genuine reductions in the prevalence of dental caries. In 10 PCTs all schools operated positive consent throughout the sampling period. and in the remaining PCTs no schools operated positive consent. in 35 PCTs some of the schools operated positive consent for some of the sampling period. These data are published in the journal of the British Association of the Study of Community Dentistry. The picture is further confused by the fact that positive consent was not universally introduced. This has led to serious concerns that the results of the 2005/06 survey may be biased and not comparable to earlier surveys. confounding In previous surveys all children in state schools were. . which produces national tables through the Dental Health Services Research Unit at the University of Dundee. Interpretation: For the first time in the history of the BASCD survey of the dental caries Potential for error experience of 5-year-old children in England and Wales. Data are collected and analysed locally. Community Dental Health. Many Health Authorities commission larger samples in order to obtain data on intra-district variations in dental caries for local planning purposes. by default. there may be variation between schools generally in how pro-active they are at encouraging parents to return consent forms. parents living in more deprived areas (where mean dmft is higher) may be less likely to return consent forms. Summary data items are reported nationally to the British Association for the Study of Community Dentistry. It cannot be assumed that all children necessarily live in the same area. National minimum standards are set for the random sampling of children to obtain a sample representative of the age-group in the area.Health Profiles 2009  The Indicator Guide 81 Section 3: Children’s and young people’s health The data relate to children attending state schools in an area.

Health Profiles 2009  The Indicator Guide 82 Section 3: Children’s and young people’s health Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. a mortality and purpose rate. for example. and so we say that there is a 95% probability that the interval covers the true value. In the case of indicators based on a sample of the population. Confidence intervals are given with a stated probability level. generally speaking. the difference is statistically significant and the value is shown on the health summary chart with a red or green symbol depending on whether it is worse or better than the national value respectively. describe how much different the point estimate could have been if the underlying conditions stayed the same. These occurrences result in random fluctuations in the indicator value between different areas and time periods. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. but chance had led to a different set of data. Variable Indicator definition: Mean number per child Statistic Indicator definition: Persons Gender Indicator definition: age Five-year-olds group Indicator definition: Sampled during winter months of 2005–06. scale Geography: geographies PCT and SHA. If the interval includes the national value. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. Available from www.bascd. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. If the interval does not include the national value. period Indicator definition: Per child. under these conditions. the difference is not statistically significant and the value is shown on the health summary chart with an amber symbol. uncertainty also arises from random differences between the sample and the population itself. the interval can be used to test whether the value is statistically significantly different to the national. In Health Profiles this is 95%.org available for this indicator from other providers . Table 2 – Indicator Specification Indicator definition: Decayed. The use of 95% is arbitrary but is conventional practice in medicine and public health. The wider is the confidence interval the greater is the uncertainty in the estimate. filled or missing teeth. Confidence intervals quantify the uncertainty in this estimate and. The confidence intervals have also been used to make comparisons against the national value.

Health Profiles 2009  The Indicator Guide 83 Section 3: Children’s and young people’s health Dimensions of None. filled or missing teeth by this number. URL Data extraction: date March 2007 Numerator: definition Number of decayed/missing/filled teeth in the survey sample of children in the respective academic year. caveats Denominator data See: Interpretation: potential for error sections and Methods used below caveats . therefore the calculation did not proceed by dividing the number of decayed. extraction Numerator: See Methods used below aggregation/ allocation Numerator data The data for 5-year-olds relate to deciduous (milk) teeth. This was not available at local authority level. Data extraction: source Supplied privately by BASCD. inequality: subgroup analyses of this dataset available from other providers Data extraction: Source 2006/06 BASCD survey of the dental caries experience of 5-year-old children in England and Wales. therefore the calculation did not proceed by dividing this number by a local authority population. This was not available at local authority level. Data quality: Accuracy See: Interpretation: Potential for error sections and Methods used in and completeness Table 3 Table 3 – Indicator Technical Methods Numerator: Provided by BASCD. Denominator: source Provided by BASCD. Denominator: definition Number of children in the survey sample. Numerator: source Dental epidemiological survey programme undertaken by Health Authorities and co-ordinated nationally for the UK Health Departments by the British Association for the Study of Community Dentistry (BASCD).

Rather than base the estimated dmft just on the ‘parent’ PCT which may include areas with different levels of deprivation to the building block belonging to the LAD. y is the mean dmft found in the ith PCT (supplied by BASCD) • i • dmfti is the expected dmft in the ith ‘building block’ (LAD by PCT intersection) • dmftPCT is the expected dmft in the ‘parent’ PCT • Ni is number of residences in the ith ‘building block’ (LAD by PCT intersection) • NLAD is the total number of residences in the LAD This was the method used for LADs and Counties. to give an expected dmft for the PCT. and dividing the total number of residencies in the LAD. Ni y GOR = ∑ ∗ yi N GOR y GOR is the estimated mean dmft in the GOR yi is the mean dmft found in the ith PCT (supplied by BASCD) Ni is the total number of 5-yr-old children in the ith PCT (supplied by BASCD) NGOR is the total number of 5-yr-old children in the GOR (supplied by BASCD) . using the total five-year-old population (supplied by (BASCD) in the PCT as weights.Health Profiles 2009  The Indicator Guide 84 Section 3: Children’s and young people’s health Methods used to dmft for 2005/06 was calculated at PCT level. adding up all the building blocks in the LAD. dmft i Ni y LAD = ∑ ∗ ∗ yi dmft PCT N LAD Where: y • LAD is the estimated mean dmft in the LAD. however this was not available for the building blocks and a proxy weight was derived from the 2005 Royal Mail Postcode Address File (PAF) which is considered a good estimate of population distribution • The final LAD estimate was obtained by multiplying each building block’s dmft estimate by the number of residences in the building block. The building block estimate is calculated as follows: [PCT dmft estimate from survey ]∗ [building block expected dmft ] PCT expected dmft • The calculation needed to reflect the different populations of five-year-olds by area. A much simpler method was used for GORs and England because they are made up of whole PCTs. the calculation was adjusted for deprivation. The following steps were taken to estimate dmft for Local value Authorities (LADs): • ‘Building blocks’ were created based on intersections between PCTs and LADs. • There is a strong relationship between deprivation and dmft. A PCT may contain or overlap calculate indicator several LADs. Secondly. a dmft estimate was arrived at for each building block which reflected the fact that the more deprived ones would carry more than their ‘fair share’ of their parent PCT’s burden of dental decay. • This adjustment was made by firstly applying the regression equation between all PCTs dmft and IMD score. Estimated mean dmft in GORs and England was a weighted average of the mean dmft in the PCTs geographically contained within the GOR or England.

How Isles of Scilly and City of London populations have been dealt with Disclosure Control Not applicable Confidence The 95% confidence intervals were calculated based on the following method: Intervals calculation method Standard error of mean dmft 2  dmft i Ni  σ i2 SE LAD = ∑  dmft ∗  N LAD  ∗ ni  PCT Where the sum is taken over all building blocks in the LAD.96* SELAD .95 ± 1. and… • SELAD is the estimated standard error of mean dmft in the LAD • σ i is the dmft variance in the ith PCT (supplied by BASCD) 2 • ni is the number of 5-yr-old children sampled (supplied by BASCD) • dmfti is the expected dmft in the ith ‘building block’ (LAD by PCT intersection) • dmftPCT is the expected dmft in the ‘parent’ PCT • Ni is number of residences in the ith ‘building block’ (LAD by PCT intersection) • NLAD is the total number of residences in the LAD The confidence interval for the estimate is: 0.Health Profiles 2009  The Indicator Guide 85 Section 3: Children’s and young people’s health Small Populations: Excluded.

000 females aged 15–17. 10. How accurate and complete will the data Data relating to legal abortions and births is collated be? through mandatory reporting processes and is of sound data quality. their babies are more likely to have lower birth weight and are more likely to die in infancy. Will It measure absolute numbers or Measures the rate per 1. What is being measured? Teenage conceptions 2. Are particular tests needed such as The data point is green or red when the figure in standardisation. less likely to find a good job. significance tests. Who does it measure? Females aged under 18 who conceive 5.Health Profiles 2009  The Indicator Guide 86 Section 3: Children’s and young people’s health 12.000 females aged 15–17 proportions? 7. 4. How is this indicator actually defined? Under-18 conception rate per 1. 9. 3. or a local authority is statistically significantly better statistical process control to test the or worse respectively than the England average. TEENAGE PREGNANCY (UNDER 18) INDICATOR Basic Information 1. 2005–2007 (provisional). Table 1 – Indicator Description Information component Pg 4 Health Summary – Indicator No 12 Subject category/ Children’s and young people’s health domain(s) Indicator name Teenage conceptions (“Teenage pregnancy [under 18]”) (*Indicator title in health profile) PHO with lead EMPHO responsibility . Children born to teenage mothers run a much greater risk of poor health and have a much higher chance of becoming teenage mothers themselves. Are there any caveats/warnings/ Miscarriages and illegal abortions are not included in problems? the conception rates. resulting in rates that may be an under estimation. When does it measure it? 2005–2007 6. Teenage mothers are less likely to finish their education. Where does the data actually come Teenage Pregnancy Unit & ONS. and more likely to end up as single parents or bringing up their children in poverty. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. Why is it being measured? Teenage parents are prone to poor antenatal health. from? 8.

healthy children. There is a Policy relevance national PSA target (PSA 14) to reduce teenage conception rates by 50% by 2010 (1998 baseline). . 33 (page 34) (http://www. Metropolitan County Districts. communities.gov.  www. lower birth weight babies and higher infant mortality rates. Geography England. It provides local areas with detailed guidance on the key ingredients that need to be in place locally to reduce under-18 conception rates.uk/downloads/theme_health/ hsq33web. Public Health Importance Teenage parents are prone to poor antenatal health.uk/d/ pbr_csr07_psa14.000 females aged 15–17 (crude rate) 2005–2007 (provisional).pdf) Rationale: Purpose The purpose of including this indicator is to highlight local authorities behind the inclusion of with high teenage pregnancy rates in order to assess need and enable the indicator targeted intervention. There is an equivalent indicator in the National Indicator Set for Local Authorities and Local Authority Partnerships (NI 112).gov.pdf) and Health Statistics Quarterly No. GOR. it is worth remembering that many young people are successful in adapting to the role of parenthood and have happy. and more likely to end up as single parents or bringing up their children in poverty.gov.uk/_files/94C1FA 2E9D4C9717E5D0AF1413A329A4. Teenage mothers are less likely to finish their education. updated annually.pdf for more information. This indicator supports Choosing Health and Programme for Action.gov.hm-treasury. County Districts.uk/documents/localgovernment/pdf/735125. Unitary Authorities.Health Profiles 2009  The Indicator Guide 87 Section 3: Children’s and young people’s health Date of PHO dataset February 2009 creation Indicator definition Under-18 conception rate per 1. London Boroughs Timeliness Data published 14 months after period end. Local Authority: Counties. For further information see “Teenage Pregnancy: Accelerating the Strategy to 2010” (http://www.everychildmatters. See http://www. See http://www.statistics.everychildmatters.pdf for more information. What this indicator purports to measure Rationale: Teenage pregnancy is a significant public health issue in England. In order to assist local areas in reducing under-18 conception rates the following toolkit was produced by DfES.gov. However. (Raw data is available up to 11 months after the event) Rationale: This indicator measures the level of teenage conceptions in the area. Children born to teenage mothers run a much greater risk of poor health and have a much higher chance of becoming teenage mothers themselves. less likely to find a good job.uk/resources-and-practice/IG00198/ Rationale: Teenage conceptions are an important public health target.

the difference is not statistically significant and the value is shown on the health summary chart with an amber symbol. generally speaking. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. A low indicator value (green circle) represents a statistically significant lower rate of teenage conceptions for that local authority when compared to the national average. describe how much different the point estimate could have been if the underlying conditions stayed the same. and early loss of pregnancy may not be recognised or require medical attention. comparable data in this area is not available. uncertainty also arises from random differences between the sample and the population itself. The omission of this data retains the quality of the indicator rather than limiting it. Confidence intervals quantify the uncertainty in this estimate and. . resulting in rates that may be an under estimation. Data relating measurement method to legal abortions and births is collated through mandatory reporting processes and is of sound data quality. The risk of teenage parenthood is greatest for young people confounding who have grown up in poverty and disadvantage or those with poor educational attainment. In Health Profiles this is 95%. If the interval includes the national value. a mortality rate. If the interval does not include the national value. These occurrences result in random fluctuations in the indicator value between different areas and time periods. and so we say that there is a 95% probability that the interval covers the true value. Whilst it is acknowledged that the non-inclusion of miscarriages reflects conceptions that are not included in these figures.Health Profiles 2009  The Indicator Guide 88 Section 3: Children’s and young people’s health Interpretation: What A high indicator value (red circle) represents a statistically significant a high/low level of higher rate of teenage conceptions for that local authority when indicator value means compared to the national average. for example. The wider is the confidence interval the greater is the uncertainty in the estimate. Confidence intervals are given with a stated probability level. the interval can be used to test whether the value is statistically significantly different to the national. the difference is statistically significant and the value is shown on the health summary chart with a red or green symbol depending on whether it is worse or better than the national value respectively. under these conditions. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. Interpretation: Potential Miscarriages and illegal abortions are not included in the conception for error due to type of rates. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. but chance had led to a different set of data. In the case of indicators based on a sample of the population. Confidence Intervals: A confidence interval is a range of values that is normally used to Definition and purpose describe the uncertainty around a point estimate of a quantity. Conception cannot be inferred from the prescription of emergency contraception. The use of 95% is arbitrary but is conventional practice in medicine and public health. Rates that are lower than the England average may still represent a large number of teenage pregnancies and therefore a low indicator value should not be interpreted as meaning that public health action is not needed. The confidence intervals have also been used to make comparisons against the national value. Interpretation: Potential Teenage pregnancy is often a cause and a consequence of social for error due to bias and exclusion.

uk/resources/ source URL IG00200/ and http://www. Indicator Crude rate definition: Statistic Indicator Females definition: Gender Indicator Under 18 definition: age group Indicator 2005–2007 (provisional) pooled data definition: period Indicator Per 1. based on pregnancies which lead to a delivery at which one or more live or still births occurs and is registered in England and Wales. Available to geographies download from http://www.gov.statistics.everychildmatters.000 female population aged 15–17 definition: scale Geography: ONS publish figures for England and Wales. Schools and Families Data extraction: Data downloaded from http://www.asp?vlnk=15055& Pos=1&ColRank=2&Rank=576) Data extraction: Data downloaded on 26th February 2009 date .uk/StatBase/Product.gov.gov. subgroup analyses of this dataset available from other providers Data extraction: Produced by the Office for National Statistics and disseminated via the Teenage Source Pregnancy Unit in the Department for Children.Health Profiles 2009  The Indicator Guide 89 Section 3: Children’s and young people’s health Table 2 – Indicator Specification Indicator Estimates of conceptions (excluding pregnancies leading to spontaneous definition: Variable abortion before 24 weeks gestation). of inequality: Indicator cannot be broken down by ethnicity or socio-economic group. England. or termination of pregnancy by abortion under the 1967 Act in England and Wales. GOR and LA.everychildmatters.uk/resources/IG00200/ available for this indicator from other providers Dimensions Data is available broken down into under 16 years and under 18 years.

The population numbers were not explicitly presented in the Teenage Pregnancy Unit data. This was with the exception of the South Central SHA and the South Coast SHA. Numerator: source Produced by the Office for National Statistics and disseminated via the Teenage Pregnancy Unit in the Department for Children. Due to the rounding of the published crude rates. b) For maternities resulting in stillbirths. Again. Actual dates of conception are not directly available but have been estimated from a dataset of birth registrations and legal terminations of pregnancy recorded in the respective calendar years plus the following year (i. Local Authorities with new boundaries had their denominators calculated from pre-2009 Local Authority data. the date of conception is assumed to be the recorded gestation minus 2 weeks prior to the date of the stillbirth (recorded gestation is time since last menstrual period. c) For abortions under the 1967 Act. completeness . migration and ageing of the population. conception is assumed to occur 2 weeks after). conception is assumed to occur 2 weeks after). but were back calculated for all areas by using the indicator value and the numerator value. Data for the Local Authorities with new (2009) boundaries were also calculated from previous (2008) Local Authority data. Schools and Families. 2005– 2008) as follows: a) For maternities resulting in one or more live births. Data for South Central SHA and South East Coast SHA were subsequently calculated from Local Authority data. The mother’s age at conception is then derived from the mother’s date of birth and the estimated date of conception. the back-calculated denominators for a geographic area may not equal the sum of the denominators of its constituent areas Data quality: Data relating to legal abortions and births is collated through mandatory Accuracy and reporting processes and is of sound data quality. whose populations were subsequently calculated from their constituent local authority populations.e. Denominator: Number of females aged 15–17.Health Profiles 2009  The Indicator Guide 90 Section 3: Children’s and young people’s health Numerator: The number of conceptions estimated to have occurred to females aged definition under-18 during 2005–2007. as derived from the 2001 census with allowance for subsequent births deaths. definition Denominator: The resident population figures used are ONS revised (that take into account source improved estimates of international migration) mid year estimates 2005–2007. the date of conception is assumed to be 38 weeks prior to the date of birth (no gestation is recorded at live birth registration). the date of conception is assumed to be the recorded gestation minus 2 weeks prior to the date of the abortion (recorded gestation is time since last menstrual period.

000 n where: O is the number of observed events (i.000. the sum of the mid-year female 15-17 years population estimate for each of the years in the period 2005-2007. which are affected. A rate. Instead conception figures are combined with those populations have of Hackney LB and Cornwall UA respectively.e. 2005-2007). been dealt with Disclosure Control Teenage conceptions data is subject to disclosure control and any LA with a conception count of fewer than five individuals needs to be suppressed. r.) Small Populations: Conception data supplied by the ONS does not include data for City of London How Isles of Scilly and Isles of Scilly Local Authorities owing to the small number of events in and City of London these small populations.000 population is given by: O r= × 1.e. Numerator data The conception figures exclude any pregnancies leading to spontaneous caveats abortion before 24 weeks gestation and illegal abortions. n is the population-years at risk (i. Denominator data In under-18s. As the age at which conception can take place varies from child to child it is impossible to correctly define the population at risk (i. . with the exception of South Central SHA and aggregation/ South East Coast SHA. Their conception figures are combined with those of Hackney LB and Cornwall UA respectively.e. the population-years at risk was estimated by back calculating using the above formula. Methods used to The teenage conceptions indicator is presented as a crude rate.Health Profiles 2009  The Indicator Guide 91 Section 3: Children’s and young people’s health TABLE 3 – INDICATOR TECHNICAL METHODS Numerator: Received directly from the Teenage Pregnancy Unit extraction Numerator: No aggregation was required. the denominator. a three year age group only (15–17) is used as the denominator. A crude rate is calculate indicator defined as the number of observed events divided by the population-years at value risk. which were calculated by aggregating from their allocation constituent Local Authorities. Data for the Local Authorities with new (2009) boundaries were also calculated from previous (2008) Local Authority data. The 15–17 group is effectively treated as the “population at risk”. Because of the size of LA populations however it is only the City of London and Isles of Scilly Local Authorities due to their small population.000 population to 1 decimal place. estimated number of under-18 conceptions. and the crude rate per 1. As ONS published only the estimated number of under-18 conceptions. data identifying the female population aged 0–17 who are fertile is not available). in this case 1. caveats because the vast majority of conceptions to under-18 year olds occur in this age group (95%). To include younger populations would produce misleading results. For presentation purposes rates are usually multiplied by a scaling factor. expressed per 1.

   B = z z + 4rq . EB. . where z is z1-α/2. When there are no observed events. and statistical inference.22:209-212 quoted in Newcombe. The proportion who do not have the feature is q = 1-p. Probable inference. calculate the three quantities 2 A = 2r + z2.   and   C=2(n+z2). the interval becomes n/(n+z2) to 1.Health Profiles 2009  The Indicator Guide 92 Section 3: Children’s and young people’s health Confidence Confidence intervals have been calculated using the Wilson ‘Score’ method for Intervals a confidence interval of a proportion as described by Newcombe RG calculation method If r is the observed number of subjects with some feature in a sample of size n then the estimated proportion who have the feature is p = r/n. Stat Med 1998. Journal of American Statistical Association 1927. from the standard Normal distribution. Reference Wilson. and the recommended confidence interval simplifies to 0 to z2/(n+z2). RG. r and hence p are both zero. Two-sided confidence intervals for the single proportion: comparison of seven methods. Then the confidence interval for the population proportion is given by (A-B)/C to (A+B)/C This method has the considerable advantage that it can be used for any data.17:857-72. the law of succession. When r = n so that p = 1. First.

Health Profiles 2009  The Indicator Guide 93 Section 4: Adult’s Health and Lifestyle .

Health Profiles 2009  The Indicator Guide 94
Section 4: adult’s health and lifestyle

13a ADULTS WHO SMOKE UPPER TIER INDICATOR
Basic Information

1. What is being measured? Prevalence of adult smoking.
2. Why is it being measured? To estimate the prevalence of adult smokers.
Smoking prevalence is a direct measure of health
care need i.e. the ability to benefit from tobacco
control interventions, including smoking cessation
services.
3. How is this indicator actually defined? Prevalence of smoking, percentage of resident
population, adults, 2003–2005, persons.
4. Who does it measure? Adults (aged 16 and over).
5. When does it measure it? The Health Survey for England (HSE) is carried out
annually.
6. Will It measure absolute numbers or Percentage of resident adult population aged 16 and
proportions? over.
7. Where does the data actually come Health Surveys for England, National Centre for
from? Social Research (NatCen).
Published by The Information Centre for Health and
Social Care (IC), 2007.
8. How accurate and complete will the The HSE was designed to be representative of
data be? the general, non-institutional population living in
England. The current “full” sample size of the HSE
comprises about 16,000 adults aged 16 and over.
9. Are there any caveats/warnings/ HSE numerator data are broadly based on observed
problems? self-reported current smoking status and as such are
subject to responder bias.

The Health Survey for England under-samples
younger people, people in employment, ethnic
minorities, women, those who are healthier but
exhibit less healthy behaviour.
10. Are particular tests needed such The data point is green or red when the figure in
as standardisation, significance tests, a local authority is statistically significantly better
or statistical process control to test the or worse respectively than the England average,
meaning of the data and the variation they based on the 95% confidence intervals of the figure
show? compared to the England value.

Table 1 – Indicator Description

Information County Health Profiles: Pg 4 Health Summary – Indicator 13
component
Subject category/ Adults health and lifestyle
domain(s)
Indicator name Prevalence of adult smoking (*Adults who smoke)
(*Indicator title in
health profile)

Health Profiles 2009  The Indicator Guide 95
Section 4: adult’s health and lifestyle

PHO with lead SEPHO
responsibility
Date of PHO 21/01/2009
dataset creation
Indicator definition Prevalence of smoking, percentage of resident population, adults, 2003–2005,
persons
Geography England, GOR, County, South East SHAs, new 2009 UAs (Bedford UA, Central
Bedfordshire UA, Cheshire East UA, Cheshire West and Chester UA, County
Durham, Northumberland UA, Shropshire UA, Wiltshire UA, Cornwall UA).
Timeliness Updated annually.
Rationale: Estimate of smoking prevalence in adults.
What this indicator
purports to
measure
Rationale: Smoking is the most important cause of preventable ill health and premature
Public Health mortality in the UK. It is linked to respiratory illness, cancer and coronary heart
Importance disease. Smoking not only affects the smoker; over 17,000 children under the
age of five are admitted to hospital every year with illnesses resulting from
passive smoking.

A list of disease specific conditions attributable to smoking is published in
The Smoking Epidemic in England, HDA, 2004 http://www.nice.org.uk/page.
aspx?o=502811

Smoking is a modifiable lifestyle risk factor; effective tobacco control measures
can reduce the prevalence of smoking in the population.
Rationale: Purpose To help reduce the prevalence of smoking.
behind the
inclusion of the Smoking prevalence is a direct measure of health care need i.e. the ability
indicator to benefit from tobacco control interventions, including smoking cessation
services.
Rationale: Choosing Health: Making healthy choices easier.
Policy relevance http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_4094550

Smoking Kills. A White Paper on Tobacco
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_4006684

Tackling Health Inequalities: A Programme for Action
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_4008268
Interpretation: A high indicator value (red circle in health summary chart) represents a
What a high/low statistically significant higher level (worse) of estimated adult smoking
level of indicator prevalence when compared to the national value.
value means
A low indicator value (green circle in health summary chart) represents
a statistically significant lower (better) level of estimated adult smoking
prevalence when compared to the national value.
However smoking at any prevalence level greater than 0 is undesirable, and
therefore a low indicator value should not mean that PH action is not needed.

Health Profiles 2009  The Indicator Guide 96
Section 4: adult’s health and lifestyle

Interpretation: Each participant in the Health Survey for England was asked if they currently
Potential for error smoked cigarettes.
due to type of
Self-reported smoking status may be prone to respondent bias.
measurement
method In order to ensure agreement between these estimates at GOR and SHA level,
the lower tier synthetic estimates (districts), which are based on modelled
data, have been calibrated. However, the synthetic estimates have not been
calibrated to ensure agreement at County level. As a result, there may be
inconsistencies between lower tier and county estimates for some areas as the
datasets are derived using different methods.
Interpretation: The Health Survey for England under-samples younger people, people in
Potential for error employment, ethnic minorities, women, those who are healthier but exhibit
due to bias and less healthy behaviour.
confounding
These data have not been age-standardised and, therefore, variation between
area values may be a result of differences in population structure.
Confidence A confidence interval is a range of values that is normally used to describe the
Intervals: Definition uncertainty around a point estimate of a quantity, for example, a mortality
and purpose rate.
This uncertainty arises as factors influencing the indicator are subject to chance
occurrences that are inherent in the world around us. These occurrences result
in random fluctuations in the indicator value between different areas and
time periods. In the case of indicators based on a sample of the population,
uncertainty also arises from random differences between the sample and the
population itself.
The stated value should therefore be considered as only an estimate of the
true or ‘underlying’ value. Confidence intervals quantify the uncertainty in
this estimate and, generally speaking, describe how much different the point
estimate could have been if the underlying conditions stayed the same, but
chance had led to a different set of data. The wider is the confidence interval
the greater is the uncertainty in the estimate.
Confidence intervals are given with a stated probability level. In Health Profiles
2009 this is 95%, and so we say that there is a 95% probability that the
interval covers the true value. The use of 95% is arbitrary but is conventional
practice in medicine and public health.
The confidence intervals have also been used to make comparisons against
the national value. For this purpose the national value has been treated as an
exact reference value rather than as an estimate and, under these conditions,
the interval can be used to test whether the value is statistically significantly
different to the national. If the interval includes the national value, the
difference is not statistically significant and the value is shown on the health
summary chart with an amber symbol. If the interval does not include the
national value, the difference is statistically significant and the value is shown
on the health summary chart with a red or green symbol depending on
whether it is worse or better than the national value respectively.

Health Profiles 2009  The Indicator Guide 97
Section 4: adult’s health and lifestyle

Table 2 – Indicator Specification

Indicator definition: Prevalence of smoking.
Variable Smoking is defined as self-reported current cigarette smoking.
Indicator definition: Percentage of resident adult population aged 16 and over
Statistic
Indicator definition: Persons
Gender
Indicator definition: Adults (aged 16 and over)
age group
Indicator definition: 2003–2005
period
Indicator definition:
scale
Geography: Strategic Health Authority.
geographies http://www.ic.nhs.uk/webfiles/Popgeog/Direct%20Estimates%20%20of%20
available for this Obesity%20(adults)%202003-2005.pdf
indicator from
other providers
Dimensions Age, gender, ethnicity, social class
of inequality: http://www.dh.gov.uk/en/Publicationsandstatistics/PublishedSurvey/
subgroup analyses HealthSurveyForEngland/index.htm
of this dataset
available from
other providers
Data extraction: Health Surveys for England, National Centre for Social Research (NatCen).
Source Published by The Information Centre for Health and Social Care (IC), 2007
Data extraction: Data received directly from NatCen.
source URL
Data extraction: 16 January 2008.
date
Data for 4 new 2009 UAs (Bedford UA, Central Bedfordshire UA, Cheshire East
UA and Cheshire West UA) were calculated by NatCen as a separate exercise
on 21/01/2009 and received on the same date.
Numerator: The number of persons aged 16+ who are self-reported smokers in a sample
definition survey of the health of the population of England 2003–05.
Numerator: source Health Survey for England (HSE), commissioned by the Department of Health
and carried out by the Joint Health Survey Unit of Social and Community
Planning Research and of the Department of Epidemiology and Public Health
at University College, London.
Denominator: Total number of respondents (with valid recorded smoking status) aged 16+ in
definition the Health Survey for England 2003–2005.
Denominator: Health Survey for England (HSE), commissioned by the Department of Health
source and carried out by the Joint Health Survey Unit of Social and Community
Planning Research and of the Department of Epidemiology and Public Health
at University College, London.

Health Profiles 2009  The Indicator Guide 98
Section 4: adult’s health and lifestyle

Data quality: The Health Survey for England is designed to provide data at both national and
Accuracy and regional level about the population living in private households in England. It
completeness uses a clustered, stratified multi-stage sample design. In the 2005 HSE, for
example, a random sample of over 7,200 addresses (around 16,000 people)
were selected from the Postcode Address File (PAF) to ensure households
were sampled proportionately across the nine Government Office Regions in
England. 720 postcode sectors were selected and 26 addresses within each
sector. Each individual within a selected household was eligible for inclusion.
One of the effects of using a complex sample design is that standard errors
for survey estimates are generally higher than would be derived from a simple
random sample of the same size.
There was a full adult sample of around 16,000 in the 2003 HSE. However, the
2004 and 2005 Health Surveys had only 8,000 adults in the normal ‘general
population’ sample as these two surveys included boost samples. The 2004
HSE included a boost sample to increase the number of participants from
minority ethnic groups and a special Chinese boost sample. The 2005 HSE
included a boost sample for older people living in private households and
for five months of the year a boost of children aged 2–15 was included. To
ensure that each year’s sample was given an approximately equal weight in
the calculation of the 3-year estimates (2003–2005) respondents in the boost
sample years were weighted up by two.
The numerator and denominator counts used to estimate prevalence are based
on a sample of the population in each area and, as such, are not true counts.
For this reason the numerator and denominator data are not shown in the
data sheet.

Table 3 – Indicator Technical Methods

Numerator: Not Applicable
extraction
Numerator: Residency by local authority of each respondent is allocated by postcode of
aggregation/ residency.
allocation
Numerator data Questions about current cigarette smoking were asked by the interviewer. For
caveats those aged 16 and 17, the questions were asked through a self-completion
questionnaire to allow for greater privacy.
These data have not been age-standardised and, therefore, variation between
area values may be a result of differences in population structure.
Denominator data The HSE is a series of annual surveys that began in 1991 with the aim of
caveats monitoring the health of the population. It was designed to be representative
of the general, non-institutional population living in England. The current
“full” sample size of the HSE comprises about 16,000 adults aged 16 and
over. For each participant, the survey included an interview and a physical
examination by a nurse, at which various physical measurements, tests, and
samples of blood and saliva were collected. These measurements provided
biomedical information about known risk factors associated with disease and
objective validation for self-reported health behaviour.

Central Bedfordshire UA.scholes@natcen. As geographical coverage for the remaining 6 new 2009 UAs (County Durham UA. Northumberland UA. Data for 4 new 2009 UAs (Bedford UA. One of the effects of using a complex design is that standard errors for survey estimates are generally higher than the standard errors that would be derived from a simple random sample of the same size. have been calculated Intervals using STATA’s survey module (the svy:mean commands). and 95% confidence intervals. To ensure that each year’s sample was given an approximately equal weight in the calculation of the 2003-2005 estimates. Cheshire East UA and Cheshire West UA) were calculated by NatCen as a separate exercise on 21/01/2009 using the same method as described above.uk). Shropshire UA. Confidence The standard errors. and City of London populations have been dealt with Disclosure Control Not applicable.ac. ethnic minority populations (2004) and older people living in private households (2005).Health Profiles 2009  The Indicator Guide 99 Section 4: adult’s health and lifestyle Methods used to Estimates are based on pooling together three consecutive years of Health calculate indicator Survey for England data (2003-2005). . The general population sample size in value 2004 and 2005 was about half the sample size in 2001 owing to the sampling of specific population groups – namely. respondents in 2004 and 2005 were weighted up by two. Wiltshire UA. Small Populations: The Health Survey for England sample does not cover the Isles of Scilly and no How Isles of Scilly HSE respondents over 2003–2005 were located in the City of London. Cornwall UA) remains the same as their old County equivalents data for these areas has not been recalculated as part of this exercise. further details can be calculation method obtained from Shaun Scholes at NatCen (s.

3. 6. age. a local authority is statistically significantly better or statistical process control to test the or worse respectively than the England average. 2003–2005. How accurate and complete will the These are modelled estimates based on national data be? survey data. 2007.Health Profiles 2009  The Indicator Guide 100 Section 4: adult’s health and lifestyle 13b ADULTS WHO SMOKE LOWER TIER INDICATOR Basic Information 1. adults. Are particular tests needed such The data point is green or red when the figure in as standardisation. Smoking prevalence is a direct measure of health care need i. percentage of resident population. Why is it being measured? To estimate the expected proportion of adult smokers in local authorities given the characteristics of local authority populations. TABLE 1 – INDICATOR DESCRIPTION Information Pg 4 Health Summary – Indicator 13 component Subject category/ Adults health and lifestyle domain(s) Indicator name (* Estimated prevalence of adult smoking (*Adults who smoke) Indicator title in health profile) . persons. significance tests. Will It measure absolute numbers or Percentage of resident adult population aged 16 and proportions? over. 5. Where does the data actually come Modelled by the National Centre for Social Research from? (NatCen). The model is non-aetiological (not based on known casual factors). gender and ethnicity. The estimates do not take into account additional local factors that may impact on the true smoking prevalence rate in an area and may not match with local lifestyle survey results or modelled estimates which use known risk factors such as socio-economic status. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. 8. 4. How is this indicator actually defined? Prevalence of smoking. Who does it measure? Adults (aged 16 and over). the ability to benefit from tobacco control interventions.e. 2. 7. 9. Are there any caveats/warnings/ As these estimates are modelled they should be used problems? and interpreted with caution (see above). When does it measure it? Updated as ad-hoc. What is being measured? Estimated prevalence of adult smoking. Published by The Information Centre for Health and Social Care (IC). 10.

Policy relevance http://www.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_4008268 . Rationale: Purpose To estimate the expected proportion of adult smokers in local authorities given behind the the characteristics of local authority populations. Cornwall UA) are not based on modelled estimates but are calculated directly using results from the Health Surveys for England 2003–05. Exceptions: Data for the 9 new 2009 UAs (Bedford UA. cancer and coronary heart Importance disease.e. Shropshire UA. London Boroughs.000 children under the age of five are admitted to hospital every year with illnesses resulting from passive smoking.org. What this indicator purports to measure Rationale: Smoking is the most important cause of preventable ill health and premature Public Health mortality in the UK. County Durham. including smoking cessation services. HDA. aspx?o=502811 Smoking is a modifiable lifestyle risk factor. Rationale: Expected prevalence of adult smoking.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_4006684 Tackling Health Inequalities: A Programme for Action http://www.gov. adults. Cheshire West and Chester UA. inclusion of the Smoking prevalence is a direct measure of health care need i. It is linked to respiratory illness. Northumberland UA. Unitary Authorities. Metropolitan County Districts. Smoking not only affects the smoker.gov. the ability indicator to benefit from tobacco control interventions. effective tobacco control measures can reduce the prevalence of smoking in the population. over 17. percentage of resident population.dh.gov. A list of disease specific conditions attributable to smoking is published in The Smoking Epidemic in England. Geography Local Authority: County Districts. A White Paper on Tobacco http://www.dh. Central Bedfordshire UA. 2003-2005. Timeliness Updated as ad-hoc.uk/page.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_4094550 Smoking Kills.dh.Health Profiles 2009  The Indicator Guide 101 Section 4: adult’s health and lifestyle PHO with lead SEPHO responsibility Date of PHO 21/01/2009 dataset creation Indicator definition Prevalence of smoking. Cheshire East UA.nice. Rationale: Choosing Health: Making healthy choices easier. persons. 2004 http://www. Wiltshire UA.

The figures. respondent bias. plus new 2009 UA areas) which are based on actual Health Survey for England data. measurement They will almost certainly not mirror precisely any available measures from local method studies or surveys (although research by NatCen and others have shown that they tend to be related). local lifestyle survey results or modelled estimates which use known co-variates (e. socio-economic status. gender and ethnicity) such as the smoking prevalence estimates modelled in the Health Poverty Index available at www. Sampling errors arise solely as a result of drawing a sample rather than confounding conducting a full survey of the population. therefore.Health Profiles 2009  The Indicator Guide 102 Section 4: adult’s health and lifestyle Interpretation: Given the characteristics of the local population.g.g. age. A key source of modelling error arises from omitting variables that would otherwise help improve the model predictions either by error or because there is no available or reliable data source for them.hpi. This may lead to inconsistencies between lower tier and county estimates for some areas as the datasets are derived using different methods. interview bias and refusal to participate. Interpretation: These model based healthy lifestyle indicators are derived using the Health Potential for error Survey for England data and are subject to both sampling and non-sampling due to bias and error.uk (see variables used in generation of model in calculation of indicator section below). Generally. Non-sampling errors arise during the course of the survey activities and there is no simple direct way of estimating the size of these errors. There may also be a discrepancy between the modelled lower tier estimates (districts) and upper tier estimates (County geographies and above.e. a high indicator value (red What a high/low circle in health summary chart) represents a statistically significant higher level of indicator (worse) level of expected estimated adult smoking prevalence when compared value means to the national value. . for example.g. However smoking at any prevalence level greater than 0 is undesirable. A low indicator value (green circle in health summary chart) represents a statistically significant lower level (better) of expected estimated adult smoking prevalence when compared to the national value. is not based on known aetiological risk factors. This may lead to estimated smoking levels which are at odds with. Interpretation: It is important that users note that these model-based estimates do not take Potential for error account of any additional local factors that may impact on the true smoking due to type of prevalence rate in an area (e. The suitability of the chosen models for the given data and the validity of the model in describing real world dynamics have a bearing on the nature and magnitude of the errors introduced. The use of statistical models for prediction involves making assumptions about relationships in the data. and therefore a low indicator value should not mean that PH action is not needed. the smaller the sample size the larger the variability in the estimates that one would expect to obtain from all the possible samples. The model used is a non-aetiological model i. local initiatives designed to reduce smoking). cannot be used to monitor performance or change over time.org. Non-sampling error may include e.

As a result of limitations in the model based estimates they are published as “experimental statistics”. NatCen recommend that users adopt statements such as “given the characteristics of the local population we would expect approximately x% of adults within LA Y to be smokers”. Confidence intervals have been calculated for the model-based estimates to capture both sampling and modelling error. In statistical terms. . Primary Care Organisations and Strategic Health Authorities. To interpret the estimates.e. The 2003–2005 model based estimates are not comparable with the preceding estimates for 2000–2002 owing to differences in geography and modelling methodology: The 2000–2002 LA estimates were calculated by aggregating the model-based estimates for the component wards. Estimates for two areas can only be described as significantly different if the confidence intervals for the estimates do not overlap. The confidence intervals provide a range within which we can be fairly sure the ‘true’ value for that area lies. Users should also note that the potential sources of bias and error also apply to any ranking or banding of the small-area estimates. This term is applied to any set of ONS statistics that do not meet the rigorous quality standards of National Statistics and/or may be subject to change due to methodological development. The 2003–05 based estimates were adjusted to be consistent with the direct survey estimates at GOR/SHA level. The choice of co-variate data was different as both the Index of Multiple deprivation 2004 and ONS area classifications were excluded in the 2003–05 estimates owing to their statistical relationship with other census-based covariates. NatCen do not encourage any ranking of small area estimates within larger areas such as Local Authorities. should be treated with caution.Health Profiles 2009  The Indicator Guide 103 Section 4: adult’s health and lifestyle The model-based estimate generated for a particular area is the expected measure for that area based on its population characteristics – and not an estimate of the actual prevalence. the model-based estimate is actually a biased estimate of the true value for the area and. the model-based estimates are unable to take account of any additional local factors that may impact on the true prevalence rate. It is recommended that users look at the confidence interval for the estimates. not just the estimate. as such. Validation exercises were used to check the appropriateness of the chosen models. aggregated or averaged over any other spatial unit). The model-based estimates have been produced solely for LAs and cannot be translated onto any other geographical boundary system (i. The 2003–05 LA estimates have been calculated by modelling directly at the LA level. As mentioned above.

uncertainty also arises from random differences between the sample and the population itself. the interval can be used to test whether the value is statistically significantly different to the national. In the case of indicators based on a sample of the population. These occurrences result in random fluctuations in the indicator value between different areas and time periods.Health Profiles 2009  The Indicator Guide 104 Section 4: adult’s health and lifestyle Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. Indicator definition: Percentage Statistic Indicator definition: Persons Gender Indicator definition: Adults (aged 16 and over) age group Indicator definition: 2003–2005 period Indicator definition: Per resident adult population aged 16 and over scale . In Health Profiles 2009 this is 95%. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. and so we say that there is a 95% probability that the interval covers the true value. The use of 95% is arbitrary but is conventional practice in medicine and public health. Variable Smoking is defined as self-reported current cigarette smoking. for example. describe how much different the point estimate could have been if the underlying conditions stayed the same. The wider is the confidence interval the greater is the uncertainty in the estimate. If the interval does not include the national value. generally speaking. Confidence intervals quantify the uncertainty in this estimate and. If the interval includes the national value. but chance had led to a different set of data. the difference is not statistically significant and the value is shown on the health summary chart with an amber symbol. a mortality and purpose rate. The confidence intervals have also been used to make comparisons against the national value. TABLE 2 – INDICATOR SPECIFICATION Indicator definition: Prevalence of smoking. Confidence intervals are given with a stated probability level. the difference is statistically significant and the value is shown on the health summary chart with a red or green symbol depending on whether it is worse or better than the national value respectively. under these conditions.

definition Denominator: Not applicable. Numerator: source NatCen. December 2007 (see link above). Table 3 – Indicator Technical Methods Numerator: Not applicable extraction Numerator: Not applicable aggregation/ allocation Numerator data See Interpretation: potential sources of error section. Source Data extraction: Data received directly from NatCen.Health Profiles 2009  The Indicator Guide 105 Section 4: adult’s health and lifestyle Geography: MSOA geographies available from http://www. source Data quality: The model-based approach generates estimates that are of a different nature Accuracy and from standard survey estimates because they are dependent upon how well completeness the relationship between healthy lifestyle behaviours for individuals and the Census/administrative information about the area in which they live are specified in the model. Denominator: Not applicable. source URL Also published by IC. caveats . Census 2001.uk/pubs/healthylifestyles05 available for this indicator from other providers Dimensions None. of inequality: subgroup analyses of this dataset available from other providers Data extraction: National Centre for Social Research (NatCen).nhs. Data extraction: 16/01/2008 date Numerator: Model estimates by NatCen using data from a number of sources including definition Health Survey for England 2003–2005.ic. caveats Denominator data Not applicable. The accuracy and completeness of the information will be subject to the same constraints surrounding the Health Survey for England and Census data sets on which they are based (see Interpretation and potential sources of error section).

ic. The model-based estimates were constrained to the direct GOR/SHA estimates taken from the Health Survey for England data. The 2001 Census provided the main source for demographic and social covariate data. job seekers allowance claimant counts and educational attainment. This was done by aggregating the model-based estimates to GOR/SHA and comparing to the direct estimates. For a fuller technical description of the methodology see the Model-Based Estimates User Guide and other reports available on the Information Centre website: www.uk/webfiles/Popgeog/Healthy%20Lifestyle%20Behaviours-%20 Model%20Based%20Estimates%20for%20Middle%20Layer%20 Super%20Output%20Areas%20and%20Local%20Authorities%20in%20- England_2003-2005__%20User%20Guide. emergency hospital admissions.nhs. . Other routine sources of data providing area-level characteristics for LAs included all age-all cause mortality. a higher proportion of household residents aged 16 or over who were living as a couple and a higher proportion of residents aged 70–74. As a result. hospital admissions attributable to alcohol. The area level characteristics associated with increased propensity for an adult to be a current smoker were: a higher proportion of residents of White ethnic origin and a higher proportion of residents aged 16–74 whose highest qualification was an NVQ Level 1 (or with no qualifications). • An adjustment factor was applied to ensure that the model-based estimates for each LA corresponded with the 2003–2005 direct estimates at GOR/SHA level taken from the Health Survey for England data. diversity index. a higher proportion of residents who were unpaid carers.Health Profiles 2009  The Indicator Guide 106 Section 4: adult’s health and lifestyle Methods used to The process of creating the model-based estimates of healthy lifestyle calculate indicator behaviours involved three main stages: value • A statistical model was used to represent the relationships between current smoking and area-level characteristics in the small areas covered by the HSfE. the model-based estimates have not been calibrated to ensure agreement at County level. The relevant ratios of the HSfE direct estimates to the aggregated model-based estimates at GOR/SHA level were then used to scale the model based LA level estimates. The area-level characteristics associated with decreased propensity for an adult to be a current smoker were: a relatively higher proportion of Income Support claimants who were classified as “carers and others”.pdf For methods used to calculate data for new 2009 UAs please see metadata for upper tier geographies. life expectancy. However. there may be inconsistencies between lower tier and county estimates for some areas as the datasets are derived using different methods. • The model outputs were applied in conjunction with covariate data (available for all LAs) to estimate the ‘expected’ prevalence given the characteristics of the area.

In statistical terms. however.Health Profiles 2009  The Indicator Guide 107 Section 4: adult’s health and lifestyle Small Populations: Model based estimates were not produced for Isles of Scilly or City of London. How Isles of Scilly and City of London populations have been dealt with Disclosure Control Not applicable. . M and i  Mi is the number of postcode sectors in LA i. as such. In order to generate the confidence interval. Obtaining the confidence interval for the LA estimates required computing two area-level variance terms: one for the Primary Sampling Units and one for the LA. Xi  β̂ is the vector of parameter estimates for the LA-level covariates. an estimate of the variance of the difference between the model-based estimate and the true LA measure is required. Confidence The model-based estimate generated for a particular LA is the expected Intervals measure for that LA based on its characteristics as measured by the covariates calculation method in the model. The first term was required to allow for the clustering in the sample and the second term to estimate the residual variance at the LA level that was not explained by the model. σ̂ u2u  σˆ 2 is the estimate of the between LA-level variance. β̂  σ̂ 2 is the estimate of the between PSU-level variance. The confidence interval for the model-based LA estimates was estimated to be: 1   βˆ T X i 2  2   e   M i  N ij  2  2  −1  log it αˆ + βˆ X i ± 1.96  ˆ T  ∑ σˆ + σˆ 2 + X T Var ( β ) X   T βˆ X i   j =1  N i   u v i i     1+ e         where: Χi is the vector of covariates values for LA i. Ni i  Nijij is N the population estimate of the number of adults in postcode sector ij. σˆ v2v  N is the population estimate of the number of adults in LA i. we can generate a range within which we can be fairly sure the ‘true’ value for that area lies. By placing confidence intervals around a model-based estimate. the model-based estimate is actually a biased estimate of the true value for an area and. should be treated with caution. The estimate of the variance has two components which correspond to the variance that is not explained by the model (and hence is not predicted by the model-based estimate) and the uncertainty of the model-based estimate itself.

those who are healthier but exhibit less healthy behaviour. 10. percentage of resident population. people in employment. Who does it measure? Adults (aged 16 and over). significance tests. 6. 2003–2005. 9. 2. ethnic minorities. 4.Health Profiles 2009  The Indicator Guide 108 Section 4: adult’s health and lifestyle 14a BINGE DRINKING ADULTS UPPER TIER INDICATOR Basic Information 1.000 adults aged 16 and over. 5. Why is it being measured? To estimate the proportion of binge drinking adults in local authorities. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. Self-reported consumption may be prone to respondent bias. The current “full” sample size of the HSE comprises about 16. How is this indicator actually defined? Prevalence of binge drinking. persons. 2007. Are particular tests needed such as The data point is green or red when the figure in standardisation. (*Indicator title in health profile) . 7. non-institutional population living in England. How accurate and complete will the data The HSE was designed to be representative of be? the general. women. When does it measure it? The Health Survey for England (HSE) is carried out annually. Are there any caveats/warnings/ HSE numerator data are based on observed problems? self-reported drinking behaviour. Published by The Information Centre for Health and Social Care (IC). Table 1 – Indicator Description Information County Health Profiles: Pg 4 Health Summary – Indicator 14 component Subject category/ Adults health and lifestyle domain(s) Indicator name Prevalence of adults who binge drink (*Binge drinking adults). What is being measured? Prevalence of adult binge drinking. National Centre for from? Social Research (NatCen). Where does the data actually come Health Surveys for England. To help reduce the prevalence of excessive alcohol consumption and the health risks associated with single episodes of intoxication. Will It measure absolute numbers or Percentage of resident adult population aged 16 and proportions? over. or a local authority is statistically significantly better statistical process control to test the or worse respectively than the England average. The Health Survey for England under-samples younger people. 3. 8. adults.

drink driving legislation and taxation. stupor. breast cancer. persons. Effective interventions to reduce alcohol consumption and alcohol related harm exist. percentage of resident population. respiratory depression. For some people. It is well known that binge drinkers are at increased risk of accidents and alcohol poisoning. both of which impact on the health service. Cheshire West and Chester UA.000 and 1. • school based alcohol education programmes. Importance alcohol poisoning. alcohol consumption in the workplace or during the working day and drinking during pregnancy. up to 70 per cent of all admissions to accident and emergency units are related to alcohol consumption. • brief interventions in a variety of settings. depressed reflexes. GOR. A growing body of research suggests that binge drinkers also have a higher all-cause mortality rate than those who have the same average alcohol consumption but drink more frequently. binge drinking is an occasional event. The Strategy Unit has estimated that. delinquency. Alcohol plays a role in many accidents. hypothermia. hypotension and coma. Nationally between 780. new 2009 UAs (Bedford UA. it is part of a chronic drinking pattern Binge drinking and severe intoxication can cause muscular in-coordination. Wiltshire UA. such as primary health care. What this indicator purports to measure Rationale: Harmful drinking is a significant public health problem in the UK and is Public Health associated with a wide range of health problems. blurred vision. Shropshire UA. chronic liver disease. multi-faceted interventions work best. The total cost of alcohol misuse to the health service is estimated to be in the region of £1. and reducing harmful drinking is one important element in the broad policy thrust to reduce health inequalities following the recommendations of the Acheson Report (1998). acts of violence and other instances of criminal behaviour. South East SHAs. Death can occur from respiratory or circulatory failure or if binge drinkers inhale their own vomit. work- based training programmes etc. . These include: • population level measures such as restricting the availability and price of alcohol. Geography England. The evidence suggests that multi-sectoral.7 billion a year. There are particular risks associated with drink-driving. Alcohol-related problems contribute to social and health inequalities. convulsions. Central Bedfordshire UA. at peak times. County Durham UA. County.3 million children are affected by their parents’ alcohol misuse. Cornwall UA). including brain damage. mental ill-health and social problems. Rationale: Prevalence of adult binge drinking. hyperactivity and other forms of conduct disorder. Timeliness Updated annually. For others. Northumberland UA. adults. Such children are four times more likely to suffer from a psychiatric disorder by the age of 15 than the national average and are at increased risk of aggressive behaviour. Binge drinking is specifically related to accidents and violence. Cheshire East UA.Health Profiles 2009  The Indicator Guide 109 Section 4: adult’s health and lifestyle PHO with lead SEPHO responsibility Date of PHO 21/01/2009 dataset creation Indicator definition Prevalence of binge drinking. skeletal muscle damage. 2003- 2005.

due to type of measurement Men were defined as having indulged in binge drinking if they had consumed method 8 or more units of alcohol on the heaviest drinking day in the previous seven days. Interpretation: HSE numerator data are broadly based on observed self-reported drinking Potential for error behaviour. those who are healthier but exhibit due to bias and less healthy behaviour. . therefore. In order to ensure agreement between these estimates at GOR and SHA level.gov. Self-reported consumption may be prone to respondent bias.uk/upload/assets/www.dh. the lower tier synthetic estimates (districts). http://www.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_4094550 Alcohol Harm Reduction Strategy for England (2004) http://www.cabinetoffice. which are based on modelled data. and therefore a low indicator value should not mean that PH action is not needed. women. Policy relevance http://www. there may be inconsistencies between lower tier and county estimates for some areas as the datasets are derived using different methods. the synthetic estimates have not been calibrated to ensure agreement at County level. for women the cut-off was 6 or more units of alcohol. people in Potential for error employment. However binge drinking at any prevalence level greater than 0 is undesirable.gov. behind the inclusion of the To help reduce the prevalence of excessive alcohol consumption and the health indicator risks associated with single episodes of intoxication.pdf Rationale: Purpose To estimate the proportion of binge drinking adults in local authorities.Health Profiles 2009  The Indicator Guide 110 Section 4: adult’s health and lifestyle For further information please see Choosing Health in the South East: Alcohol p35 for summary list of effective interventions.uk/ strategy/caboffce%20alcoholhar. Rationale: Choosing Health: Making healthy choices easier.pdf Interpretation: A high indicator value (red circle in health summary chart) represents a What a high/low statistically significant higher level (worse) of estimated adult binge drinking level of indicator prevalence when compared to the national value.cabinetoffice. ethnic minorities.uk/ Download/Public/10571/1/sepho%20alcohol%20report%20Jan%2007.gov. However. confounding These data have not been age-standardised and. As a result. variation between area values may be a result of differences in population structure. value means A low indicator value (green circle in health summary chart) represents a statistically significant lower (better) level of estimated adult binge drinking prevalence when compared to the national value. Interpretation: The Health Survey for England under-samples younger people.org. have been calibrated.sepho.

uncertainty also arises from random differences between the sample and the population itself.Health Profiles 2009  The Indicator Guide 111 Section 4: adult’s health and lifestyle Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. Men are defined as having indulged in binge drinking if they had consumed 8 or more units of alcohol on the heaviest drinking day in the previous seven days. under these conditions. but chance had led to a different set of data. the interval can be used to test whether the value is statistically significantly different to the national. In Health Profiles 2009 this is 95%. describe how much different the point estimate could have been if the underlying conditions stayed the same. the difference is not statistically significant and the value is shown on the health summary chart with an amber symbol. Table 2 – Indicator Specification Indicator definition: Prevalence of binge drinking. the difference is statistically significant and the value is shown on the health summary chart with a red or green symbol depending on whether it is worse or better than the national value respectively. In the case of indicators based on a sample of the population. for example. The confidence intervals have also been used to make comparisons against the national value. Variable Binge drinking in adults is defined separately for men and women. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. These occurrences result in random fluctuations in the indicator value between different areas and time periods. and so we say that there is a 95% probability that the interval covers the true value. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. The use of 95% is arbitrary but is conventional practice in medicine and public health. If the interval includes the national value. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. If the interval does not include the national value. a mortality and purpose rate. Confidence intervals quantify the uncertainty in this estimate and. The wider is the confidence interval the greater is the uncertainty in the estimate. for women the cut-off was 6 or more units of alcohol. generally speaking. Indicator definition: Percentage of resident adult population aged 16 and over Statistic Indicator definition: Persons Gender Indicator definition: Adults (aged 16 and over) age group Indicator definition: 2003–2005 period Indicator definition: scale . Confidence intervals are given with a stated probability level.

Numerator: source Health Survey for England (HSE). date Data for 4 new 2009 UAs (Bedford UA. source URL Data extraction: 16 January 2008. geographies http://www. 2007 Data extraction: Data received directly from NatCen. Numerator: Proportion of adult men who drank 8 or more units of alcohol on the heaviest definition drinking day in the previous seven days at time of survey and adult women who drank 6 or more units of alcohol on the heaviest drinking day in the previous seven days at time of survey. commissioned by the Department of Health/ source IC and carried out by the Joint Health Surveys Unit of the National Centre for Social Research (NatCen) and the Department of Epidemiology and Public Health at the Royal Free and University College Medical School. National Centre for Social Research (NatCen). commissioned by the Department of Health and carried out by the Joint Health Survey Unit of Social and Community Planning Research and of the Department of Epidemiology and Public Health at University College. Denominator: Health Survey for England (HSE). 2003–2005. gender. Source Published by The Information Centre for Health and Social Care (IC).ic.pdf indicator from other providers Dimensions Age. ethnicity.gov. social class of inequality: http://www. London. Denominator: Total number of respondents (with valid measurements on drinking habits in definition the last week) aged 16+ in the Health Survey for England 2003–2005.uk/webfiles/Popgeog/Direct%20Estimates%20%20of%20 available for this Obesity%20(adults)%202003-2005.dh.htm of this dataset available from other providers Data extraction: Health Surveys for England. . Central Bedfordshire UA. Cheshire East UA and Cheshire West UA) were calculated by NatCen as a separate exercise on 21/01/2009 and received on the same date.nhs.Health Profiles 2009  The Indicator Guide 112 Section 4: adult’s health and lifestyle Geography: Strategic Health Authority.uk/en/Publicationsandstatistics/PublishedSurvey/ subgroup analyses HealthSurveyForEngland/index. London.

spirits. refused or not known were excluded. The 2005 HSE included a boost sample for older people living in private households and for five months of the year a boost of children aged 2–15 was included. allocation Numerator data These data have not been age-standardised and. and how much of each type they had usually drank in one day. Each individual within a selected household was eligible for inclusion. stratified multi-stage sample design. an estimated weekly consumption expressed in terms of units of alcohol was derived.000 adults in the normal ‘general population’ sample as these two surveys included boost samples. . Adults were first asked how often they drank each of five types of alcoholic drinks (e.g. Table 3 – Indicator Technical Methods Numerator: Not applicable.Health Profiles 2009  The Indicator Guide 113 Section 4: adult’s health and lifestyle Data quality: The Health Survey for England is designed to provide data at both national and Accuracy and regional level about the population living in private households in England. variation between caveats area values may be a result of differences in population structure. One of the effects of using a complex sample design is that standard errors for survey estimates are generally higher than would be derived from a simple random sample of the same size. The HSE question module concerning “mean weekly alcohol consumption” aims to classify respondents into broad consumption bands based on “usual” behaviour.200 addresses (around 16. are not true counts. For this reason the numerator and denominator data are not shown in the data sheet. From these two sets of questions. In the 2005 HSE. for example. the 2004 and 2005 Health Surveys had only 8. The 2004 HSE included a boost sample to increase the number of participants from minority ethnic groups and a special Chinese boost sample.000 in the 2003 HSE. Respondents for whom any information on drinking was not answered.000 people) were selected from the Postcode Address File (PAF) to ensure households were sampled proportionately across the nine Government Office Regions in England. therefore. Over the years the list of drinks included in the survey has changed to reflect the emergence of new brands and types of drinks. However. The numerator and denominator counts used to estimate prevalence are based on a sample of the population in each area and. 720 postcode sectors were selected and 26 addresses within each sector. rather than offer a precise estimate of actual weekly consumption. as such. beer. To ensure that each year’s sample was given an approximately equal weight in the calculation of the 3-year estimates (2003–2005) respondents in the boost sample years were weighted up by two. extraction Numerator: Residency by local authority of each respondent is allocated by postcode of aggregation/ residency. completeness It uses a clustered. a random sample of over 7. There was a full adult sample of around 16. wine) in the last 12 months.

and 95% confidence intervals. To ensure that each year’s sample was given an approximately equal weight in the calculation of the 2003–2005 estimates. Shropshire UA.scholes@natcen. These measurements provided biomedical information about known risk factors associated with disease and objective validation for self-reported health behaviour. For each participant. tests. Data for 4 new 2009 UAs (Bedford UA. non-institutional population living in England. . Wiltshire UA.ac. the survey included an interview and a physical examination by a nurse. Northumberland UA.000 adults aged 16 and over. Small Populations: The Health Survey for England sample does not cover the Isles of Scilly and no How Isles of Scilly HSE respondents over 2003–2005 were located in the City of London. respondents in 2004 and 2005 were weighted up by two. The current “full” sample size of the HSE comprises about 16.Health Profiles 2009  The Indicator Guide 114 Section 4: adult’s health and lifestyle Denominator data The HSE is a series of annual surveys that began in 1991 with the aim of caveats monitoring the health of the population. have been calculated Intervals using STATA’s survey module (the svy:mean commands).uk). further details can be calculation method obtained from Shaun Scholes at NatCen (s. One of the effects of using a complex design is that standard errors for survey estimates are generally higher than the standard errors that would be derived from a simple random sample of the same size. Cornwall UA) remains the same as their old County equivalents. and City of London populations have been dealt with Disclosure Control Not applicable. Central Bedfordshire UA. at which various physical measurements. It was designed to be representative of the general. As geographical coverage for the remaining 6 new 2009 UAs (County Durham UA. Methods used to Estimates are based on pooling together three consecutive years of Health calculate indicator Survey for England data (2003–2005). Confidence The standard errors. data for these areas has not been recalculated as part of this exercise. Cheshire East UA and Cheshire West UA) were calculated by NatCen as a separate exercise on 21/01/2009 using the same method as described above. The general population sample size in value 2004 and 2005 was about half the sample size in 2001 owing to the sampling of specific population groups – namely. and samples of blood and saliva were collected. ethnic minority populations (2004) and older people living in private households (2005).

What is being measured? Prevalence of adult binge drinking. When does it measure it? Updated as ad-hoc. 7. Why is it being measured? To estimate the proportion of binge drinking adults in local authorities. 2007. How accurate and complete will the data These are modelled estimates based on national be? survey data. gender and ethnicity. 6. persons. Will It measure absolute numbers or Percentage of resident adult population aged 16 and proportions? over. adults. or a local authority is statistically significantly better statistical process control to test the or worse respectively than the England average. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. percentage of resident population. Are particular tests needed such as The data point is green or red when the figure in standardisation. Are there any caveats/warnings/ As these estimates are modelled they should be used problems? and interpreted with caution (see above). significance tests. age. How is this indicator actually defined? Prevalence of binge drinking.Health Profiles 2009  The Indicator Guide 115 Section 4: adult’s health and lifestyle 14b BINGE DRINKING ADULTS LOWER TIER INDICATOR Basic Information 1. Where does the data actually come Modelled by the National Centre for Social Research from? (NatCen). 9. Published by The Information Centre for Health and Social Care (IC). 8. 3. (*Indicator title in health profile) PHO with lead SEPHO responsibility . The estimates do not take into account additional local factors that may impact on the true prevalence of binge drinking in an area and may not match with local lifestyle survey results or modelled estimates which use known risk factors such as socio-economic status. The model is non-aetiological (not based on known casual factors). 4. Table 1 – Indicator Description Information Pg 4 Health Summary – Indicator No 14 component Subject category/ Adults health and lifestyle domain(s) Indicator name Estimated prevalence of adults who binge drink (*Binge drinking adults). To help reduce the prevalence of excessive alcohol consumption and the health risks associated with single episodes of intoxication. 10. 2003–2005. 5. Who does it measure? Adults (aged 16 and over). 2.

County Durham. percentage of resident population. Cheshire East UA. Wiltshire UA. Cheshire West and Chester UA. 2003- 2005. adults. Central Bedfordshire UA. Shropshire UA. Northumberland UA. Rationale: Expected prevalence of adult binge drinking.Health Profiles 2009  The Indicator Guide 116 Section 4: adult’s health and lifestyle Date of PHO 21/01/2009 dataset creation Indicator definition Prevalence of binge drinking. persons. What this indicator purports to measure . Exceptions: Data for the 9 new 2009 UAs (Bedford UA. Geography Local Authority: County Districts. Timeliness Updated as ad-hoc. London Boroughs. Metropolitan County Districts. Unitary Authorities. Cornwall UA) are not based on modelled estimates but are calculated directly using results from the Health Surveys for England 2003–05.

The evidence suggests that multi-sectoral.000 and 1.3 million children are affected by their parents’ alcohol misuse.cabinetoffice.uk/ strategy/caboffce%20alcoholhar. inclusion of the indicator To help reduce the prevalence of excessive alcohol consumption and the health risks associated with single episodes of intoxication. at peak times. hyperactivity and other forms of conduct disorder. • brief interventions in a variety of settings. skeletal muscle damage. The Strategy Unit has estimated that. it is part of a chronic drinking pattern Binge drinking and severe intoxication can cause muscular in-coordination. For further information please see Choosing Health in the South East: Alcohol p35 for summary list of effective interventions. Such children are four times more likely to suffer from a psychiatric disorder by the age of 15 than the national average and are at increased risk of aggressive behaviour. delinquency. up to 70 per cent of all admissions to accident and emergency units are related to alcohol consumption. multi-faceted interventions work best.dh. Rationale: Choosing Health: Making healthy choices easier.cabinetoffice. including brain damage. mental ill-health and social problems.sepho. A growing body of research suggests that binge drinkers also have a higher all-cause mortality rate than those who have the same average alcohol consumption but drink more frequently Binge drinking is specifically related to accidents and violence.uk/ Download/Public/10571/1/sepho%20alcohol%20report%20Jan%2007. These include: • population level measures such as restricting the availability and price of alcohol. • school based alcohol education programmes. Effective interventions to reduce alcohol consumption and alcohol related harm exist. There are particular risks associated with drink-driving. acts of violence and other instances of criminal behaviour.7 billion a year. For others.gov. Importance alcohol poisoning. Policy relevance http://www. Nationally between 780.pdf . Alcohol-related problems contribute to social and health inequalities.gov. The total cost of alcohol misuse to the health service is estimated to be in the region of £1.pdf Rationale: Purpose To estimate the expected proportion of binge drinking adults in local behind the authorities given the characteristics of local authority populations. Alcohol plays a role in many accidents. hypothermia. hypotension and coma. convulsions. and reducing harmful drinking is one important element in the broad policy thrust to reduce health inequalities following the recommendations of the Acheson Report (1998). breast cancer. It is well known that binge drinkers are at increased risk of accidents and alcohol poisoning. respiratory depression.Health Profiles 2009  The Indicator Guide 117 Section 4: adult’s health and lifestyle Rationale: Harmful drinking is a significant public health problem in the UK and is Public Health associated with a wide range of health problems.gov. work- based training programmes etc.org. stupor. such as primary health care. depressed reflexes. blurred vision.uk/upload/assets/www. binge drinking is an occasional event. drink driving legislation and taxation. http://www.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_4094550 Alcohol Harm Reduction Strategy for England (2004) http://www. alcohol consumption in the workplace or during the working day and drinking during pregnancy. both of which impact on the health service. For some people. chronic liver disease. Death can occur from respiratory or circulatory failure or if binge drinkers inhale their own vomit.

. the smaller the sample size the larger the variability in the estimates that one would expect to obtain from all the possible samples. See http://www. local initiatives designed to reduce alcohol measurement consumption). Interpretation: It is important that users note that these model-based do not take account Potential for error of any additional local factors that may impact on the true binge drinking due to type of prevalence rate in an area (e. These estimates are not comparable with the NatCen modelled estimates owing to differences in time period. The model used is a non-aetiological model i. They will almost certainly not mirror precisely any available method measures from local studies or surveys (although research by NatCen and others have shown that they tend to be related). This may lead to estimated binge drinking levels which are at odds with other risk factors estimates such as healthy eating and physical activity. plus new 2009 UA areas) which are based on actual Health Survey for England data. local lifestyle survey results and modelled estimates which use known co-variates (see variables used in generation of model in calculation of indicator section below). There may also be a discrepancy between the modelled lower tier estimates (districts) and upper tier estimates (County geographies and above. a high indicator value (red What a high/low circle in health summary chart) represents a statistically significant higher level of indicator (worse) level of expected estimated binge drinking prevalence when compared value means to the national value. Sampling errors arise solely as a result of drawing a sample rather than confounding conducting a full survey of the population. It should be noted that the North West Public Health Observatory (NWPHO) have recently generated LA estimates of hazardous and harmful drinking using Health Survey for England data. A low indicator value (green circle in health summary chart) represents a statistically significant lower level (better) of expected estimated adult binge drinking prevalence when compared to the national value.Health Profiles 2009  The Indicator Guide 118 Section 4: adult’s health and lifestyle Interpretation: Given the characteristics of the local population. is not based on risk factors such as physical activity levels and calorie intake. nwph. Interpretation: These model based healthy lifestyle indicators are derived using the Health Potential for error Survey for England data and are subject to both sampling and non-sampling due to bias and error.net/alcohol/lape/ for the NWPHO profiles and further information. modelling methodology and covariate data. choice of alcohol indicator. therefore.g. and therefore a low indicator value should not mean that PH action is not needed. Generally. However binge drinking at any prevalence level greater than 0 is undesirable. cannot be used to monitor performance or change over time.e. The figures. This has led to inconsistencies between lower tier and county estimates for some areas as the datasets are derived using different methods.

Users should also note that the potential sources of bias and error also apply to any ranking or banding of the small-area estimates. • The 2003–2005 model based estimates are not comparable with the preceding estimates for 2000–2002 owing to differences in geography and modelling methodology: • The 2000–2002 LA estimates were calculated by aggregating the model- based estimates for the component wards. The 2003–05 LA estimates have been calculated by modelling directly at the LA level. As a result of limitations in the model based estimates they are published as “experimental statistics”. aggregated or averaged over any other spatial unit). as such. . As mentioned above. Confidence intervals have been calculated for the model-based estimates to capture both sampling and modelling error.g. interview bias and refusal to participate. A key source of modelling error arises from omitting variables that would otherwise help improve the model predictions either by error or because there is no available or reliable data source for them.e. should be treated with caution. The suitability of the chosen models for the given data and the validity of the model in describing real world dynamics have a bearing on the nature and magnitude of the errors introduced. NatCen recommend that users adopt statements such as “given the characteristics of the local population we would expect approximately x% of adults within LA Y to indulge in binge drinking”. The use of statistical models for prediction involves making assumptions about relationships in the data. The model-based estimates have been produced solely for LAs and cannot be translated onto any other geographical boundary system (i. Non sampling error may include e. • The choice of co-variate data was different as both the Index of Multiple deprivation 2004 and ONS area classifications were excluded in the 2003– 05 estimates owing to their statistical relationship with other census-based covariates. In statistical terms. To interpret the estimates. Primary Care Organisations and Strategic Health Authorities. the model-based estimates are unable to take account of any additional local factors that may impact on the true prevalence rate. respondent bias. Estimates for two areas can only be described as significantly different if the confidence intervals for the estimates do not overlap. The confidence intervals provide a range within which we can be fairly sure the ‘true’ value for that area lies. NatCen do not encourage any ranking of small area estimates within larger areas such as Local Authorities. Validation exercises were used to check the appropriateness of the chosen models. It is recommended that users look at the confidence interval for the estimates.Health Profiles 2009  The Indicator Guide 119 Section 4: adult’s health and lifestyle Non-sampling errors arise during the course of the survey activities and there is no simple direct way of estimating the size of these errors. This term is applied to any set of ONS statistics that do not meet the rigorous quality standards of National Statistics and/or may be subject to change due to methodological development. not just the estimate. • The 2003–05 based estimates were adjusted to be consistent with the direct survey estimates at GOR/SHA level.and not an estimate of the actual prevalence. the model-based estimate is actually a biased estimate of the true value for the area and. The model-based estimate generated for a particular area is the expected measure for that area based on its population characteristics .

If the interval does not include the national value. for women the cut-off was 6 or more units of alcohol. the interval can be used to test whether the value is statistically significantly different to the national. Confidence intervals are given with a stated probability level. describe how much different the point estimate could have been if the underlying conditions stayed the same. The confidence intervals have also been used to make comparisons against the national value. a mortality and purpose rate. generally speaking. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. These occurrences result in random fluctuations in the indicator value between different areas and time periods. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. The wider is the confidence interval the greater is the uncertainty in the estimate. for example. Men are defined as having indulged in binge drinking if they had consumed 8 or more units of alcohol on the heaviest drinking day in the previous seven days. Confidence intervals quantify the uncertainty in this estimate and. Variable Binge drinking in adults is defined separately for men and women. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. The use of 95% is arbitrary but is conventional practice in medicine and public health. TABLE 2 – INDICATOR SPECIFICATION Indicator definition: Prevalence of binge drinking. the difference is not statistically significant and the value is shown on the health summary chart with an amber symbol. but chance had led to a different set of data. uncertainty also arises from random differences between the sample and the population itself.Health Profiles 2009  The Indicator Guide 120 Section 4: adult’s health and lifestyle Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. under these conditions. In the case of indicators based on a sample of the population. If the interval includes the national value. Indicator definition: Percentage of resident adult population aged 16 and over Statistic Indicator definition: Persons Gender Indicator definition: Adults (aged 16 and over) age group Indicator definition: 2003–2005 period Indicator definition: scale . the difference is statistically significant and the value is shown on the health summary chart with a red or green symbol depending on whether it is worse or better than the national value respectively. In Health Profiles 2009 this is 95%. and so we say that there is a 95% probability that the interval covers the true value.

uk/pubs/healthylifestyles05 available for this indicator from other providers Dimensions None. extraction Numerator: Not applicable. of inequality: subgroup analyses of this dataset available from other providers Data extraction: National Centre for Social Research (NatCen). aggregation/ allocation Numerator data See Interpretation: potential sources of error section.nhs. source URL Also published by IC. source Data quality: The model-based approach generates estimates that are of a different nature Accuracy and from standard survey estimates because they are dependent upon how well completeness the relationship between healthy lifestyle behaviours for individuals and the Census/administrative information about the area in which they live are specified in the model. Numerator: source NatCen. December 2007 (see link above). Source Data extraction: Data received directly from NatCen. Data extraction: 16/01/2008 date Numerator: Model estimates by NatCen using data from a number of sources including definition Health Survey for England 2003–2005. Denominator: Not applicable. definition Denominator: Not applicable.ic. caveats . The accuracy and completeness of the information will be subject to the same constraints surrounding the Health Survey for England and Census data sets on which they are based (see Interpretation: potential sources of error section). TABLE 3 – INDICATOR TECHNICAL METHODS Numerator: Not applicable. Census 2001. caveats Denominator data Not applicable.Health Profiles 2009  The Indicator Guide 121 Section 4: adult’s health and lifestyle Geography: MSOA geographies available from http://www.

The area level characteristics associated with increased propensity for an adult to indulge in binge drinking were: a higher proportion of residents aged 25– 29. Hamlet or Isolated Dwelling (relative to living in urban areas containing more than 10. hospital admissions attributable to alcohol. diversity index. there may be inconsistencies between lower tier and county estimates for some areas as the datasets are derived using different methods. The 2001 Census provided the main source for demographic and social covariate data.ic.000 residents). Other routine sources of data providing area-level characteristics for LAs included all age-all cause mortality.Health Profiles 2009  The Indicator Guide 122 Section 4: adult’s health and lifestyle Methods used to The process of creating the model-based estimates of healthy lifestyle calculate indicator behaviours involved three main stages: value • A statistical model was used to represent the relationships between binge drinking and area-level characteristics in the small areas covered by the HSfE. • An adjustment factor was applied to ensure that the model-based estimates for each LA corresponded with the 2003–2005 direct estimates at GOR/SHA level taken from the Health Survey for England data. This was done by aggregating the model-based estimates to GOR/SHA and comparing to the direct estimates. The area-level characteristics associated with decreased propensity for an adult to indulge in binge drinking were: a higher proportion of female residents aged 55–59. and a higher proportion of residents residing in areas classified as 1) Town and Fringe or 2) Village. . emergency hospital admissions. The relevant ratios of the HSfE direct estimates to the aggregated model-based estimates at GOR/SHA level were then used to scale the model based LA level estimates.nhs. However. • The model outputs were applied in conjunction with covariate data (available for all LAs) to estimate the ‘expected’ prevalence given the characteristics of the area. The model contained an interaction between the percentage of residents aged 20–24 and the percentage of households headed by a single-parent. The model-based estimates were constrained to the direct GOR/SHA estimates taken from the Health Survey for England data.pdf For methods used to calculate data for new 2009 UAs please see metadata for upper tier geographies. An interaction term in a statistical model arises were the effect of a covariate on a healthy lifestyle behaviour depends on the values of another covariate. life expectancy. job seekers allowance claimant counts and educational attainment. As a result. the model-based estimates have not been calibrated to ensure agreement at County level. a higher proportion of residents aged 20–24.uk/webfiles/Popgeog/Healthy%20Lifestyle%20 Behaviours-%20Model%20Based%20Estimates%20for%20Middle%20 Layer%20Super%20Output%20Areas%20and%20Local%20Authorities%20 in%20England_2003-2005__%20User%20Guide. For a fuller technical description of the methodology see the Model-Based Estimates User Guide and other reports available on the Information Centre website: http://www. a higher proportion of male residents aged 55–59 and a higher proportion of residents of White ethnic origin.

96  ˆ  ∑ σˆ + σˆ v + X i Var ( β ) X i  T  2  T βˆ X i   j =1  N i   u     1+ e         where: Χi is the vector of covariates values for LA i. Obtaining the confidence interval for the LA estimates required computing two area-level variance terms: one for the Primary Sampling Units and one for the LA. σˆ v2v  N is the population estimate of the number of adults in LA i. the model-based estimate is actually a biased estimate of the true value for an area and. β̂  σ̂2u2 is the estimate of the between PSU-level variance. . The first term was required to allow for the clustering in the sample and the second term to estimate the residual variance at the LA level that was not explained by the model. The estimate of the variance has two components which correspond to the variance that is not explained by the model (and hence is not predicted by the model-based estimate) and the uncertainty of the model-based estimate itself. In order to generate the confidence interval. as such. σ̂ u  σˆ 2 is the estimate of the between LA-level variance. Confidence The model-based estimate generated for a particular LA is the expected Intervals measure for that LA based on its characteristics as measured by the covariates calculation method in the model. Xi  β̂ is the vector of parameter estimates for the LA-level covariates. an estimate of the variance of the difference between the model-based estimate and the true LA measure is required. The confidence interval for the model-based LA estimates was estimated to be: 1   βˆ T X i 2  2   e    N ij   2 Mi 2  −1  ˆ ˆ T log it α + β X i ± 1. How Isles of Scilly and City of London populations have been dealt with Disclosure Control Not applicable. By placing confidence intervals around a model-based estimate.Health Profiles 2009  The Indicator Guide 123 Section 4: adult’s health and lifestyle Small Populations: Model based estimates were not produced for Isles of Scilly or City of London. however. Ni i  Nijij is N the population estimate of the number of adults in postcode sector ij. should be treated with caution. we can generate a range within which we can be fairly sure the ‘true’ value for that area lies. M and i  Mi is the number of postcode sectors in LA i. In statistical terms.

2. 8. and cancer by up to 20%. women. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. adults. percentage of resident population. significance tests. a local authority is statistically significantly better or statistical process control to test the or worse respectively than the England average. 6. The current “full” sample size of the HSE comprises about 16. 7. 2007. those who are healthier but exhibit less healthy behaviour. Published by The Information Centre for Health and Social Care (IC). Where does the data actually come Health Surveys for England. 5. that is adults who consume 5 or more portions of fruit and vegetables per day. What is being measured? Prevalence of adult healthy eating. Why is it being measured? To estimate the proportion of healthy eating adults. 10. persons. Will It measure absolute numbers or Percentage of resident adult population aged 16 and proportions? over. The Health Survey for England under-samples younger people. non-institutional population living in England. 3. stroke.Health Profiles 2009  The Indicator Guide 124 Section 4: adult’s health and lifestyle 15a HEALTHY EATING ADULTS UPPER TIER INDICATOR Basic Information 1. When does it measure it? The Health Survey for England (HSE) is carried out annually. 9. . There is evidence that eating at least 5 portions of a variety of fruit and vegetables a day could reduce the risk of deaths from chronic diseases such as heart disease.000 adults aged 16 and over. Self-reported consumption may be prone to respondent bias. 2003–2005. National Centre for from? Social Research (NatCen). How is this indicator actually defined? Prevalence of healthy eating. How accurate and complete will the The HSE was designed to be representative of data be? the general. people in employment. 4. Are there any caveats/warnings/ HSE numerator data are broadly based on observed problems? self-reported daily consumption of fruit and vegetables. Who does it measure? Adults (aged 16 and over). ethnic minorities. Are particular tests needed such The data point is green or red when the figure in as standardisation.

A recent study found that each increase of 1 portion of fruit and vegetables a day lowered the risk of coronary heart disease by 4% and the risk of stroke by 6%.Health Profiles 2009  The Indicator Guide 125 Section 4: adult’s health and lifestyle Table 1 – Indicator Description Information County Health Profiles: Pg 4 Health Summary – Indicator 15 component Subject category/ Adults health and lifestyle domain(s) Indicator name Prevalence of adults who eat healthily (*Healthy eating adults). reducing fat intake. Higher consumption of fruit and vegetables also reduces the risk of coronary heart disease and stroke. Rationale: Prevalence of adult healthy eating. Evidence also suggests an increase in fruit and vegetable intake can help lower blood pressure. and that increasing fruit and vegetable consumption is the second most important cancer prevention strategy. new 2009 UAs (Bedford UA. persons. eating fruit and vegetables can help to achieve other dietary goals including increasing fibre intake. (*Indicator title in health profile) PHO with lead SEPHO responsibility Date of PHO 21/01/2008 dataset creation Indicator definition Prevalence of healthy eating. purports to measure Rationale: The indicator is a measure of a protective lifestyle factor. stroke. South East SHAs. including delaying the development of cataracts. There was also weakly consistent evidence that higher fruit and vegetable consumption would reduce the risk of breast cancer. and helping to manage diabetes. that is. and cancer by up to 20%. GOR. Central Bedfordshire UA. . adults who consume 5 or more What this indicator portions of fruit and vegetables per day. percentage of resident population. Cheshire East UA. improving bowel function. 2003- 2005. and substituting for foods with added sugars (as frequent consumption of foods with added sugars can contribute to tooth decay). Cornwall UA). It has been estimated that eating at least 5 portions of a variety of fruit and vegetables a day could reduce the risk of deaths from chronic diseases such as heart disease. reducing the symptoms of asthma. the Department of Health’s Committee on Medical Aspects of Food Policy and Nutrition reviewed the evidence and concluded that higher vegetable consumption would reduce the risk of colorectal cancer and gastric cancer. adults. Geography England. It has been estimated that diet might contribute to the development of one- third of all cancers. Northumberland UA. In 1998. Shropshire UA. Research suggests that there are other health benefits. Timeliness Updated annually. These cancers combined represent about 18% of the cancer burden in men and about 30% in women. County Durham. County. help maintain a healthy weight. Wiltshire UA. A diet rich in fruit Public Health and vegetables confers protective effects against the development of heart Importance disease and certain cancers. after reducing smoking. Cheshire West and Chester UA. As well as the direct health benefits.

gov.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_4009609 National Service Framework for Coronary Heart Disease http://www.dh.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_4094275 National Service Framework for Diabetes http://www.gov. the synthetic estimates have not been calibrated to ensure agreement at County level.gov. inclusion of the To help increase the prevalence of healthy eating and the health benefits indicator associated with eating a healthy diet. which are based on modelled data.gov.dh.gov.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_4094550 Department of Health National 5 A Day programme http://www. . Rationale: Choosing Health: Making healthy choices easier.gov. Although everyday measures were used to help informants to define how much they had consumed.dh.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_4003066 Interpretation: A high indicator value (green circle in health summary chart) represents a What a high/low statistically significant higher level (better) of adults who are estimated to level of indicator consume 5 or more portions of fruit and vegetables per day when compared value means to the national value. Policy relevance http://www.dh. such as fruit in composite foods like apple pie. A low indicator value (red circle in health summary chart) represents a statistically significant lower (worse) level of adults who are estimated to consume 5 or more portions of fruit and vegetables per day when compared to the national value. have been calibrated.uk/en/Policyandguidance/Healthandsocialcaretopics/ Diabetes/DH_4015717 National Service Framework for Older People http://www.dh.uk/en/Policyandguidance/Healthandsocialcaretopics/ FiveADay/FiveADaygeneralinformation/index. the lower tier synthetic estimates (districts).htm The NHS Plan http://www.dh.Health Profiles 2009  The Indicator Guide 126 Section 4: adult’s health and lifestyle Rationale: Purpose To estimate the proportion of adults who consume 5 or more portions of fruit behind the and vegetables per day in local authorities.dh. due to type of Self-reported consumption may be prone to respondent bias. Interpretation: HSE numerator data are broadly based on observed self-reported daily Potential for error consumption of fruit and vegetables. As a result. However. In order to ensure agreement between these estimates at GOR and SHA level. there may be inconsistencies between lower tier and county estimates for some areas as the datasets are derived using different methods. this task may have been difficult for certain food items.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_4002960 The NHS Cancer Plan http://www.gov. There may measurement be variation in how informants defined and reported the amount of food method consumed.

the difference is not statistically significant and the value is shown on the health summary chart with an amber symbol. people in Potential for error employment. Confidence intervals are given with a stated probability level. The use of 95% is arbitrary but is conventional practice in medicine and public health. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. women. If the interval includes the national value. uncertainty also arises from random differences between the sample and the population itself. therefore. Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. the difference is statistically significant and the value is shown on the health summary chart with a red or green symbol depending on whether it is worse or better than the national value respectively. ethnic minorities. The wider is the confidence interval the greater is the uncertainty in the estimate. The confidence intervals have also been used to make comparisons against the national value. Variable Healthy eating is defined as those who consume 5 or more portions of fruit and vegetables per day. but chance had led to a different set of data. those who are healthier but exhibit due to bias and less healthy behaviour. a mortality and purpose rate.Health Profiles 2009  The Indicator Guide 127 Section 4: adult’s health and lifestyle Interpretation: The Health Survey for England under-samples younger people. describe how much different the point estimate could have been if the underlying conditions stayed the same. Indicator definition: Percentage of resident adult population aged 16 and over Statistic Indicator definition: Persons Gender Indicator definition: Adults (aged 16 and over) age group Indicator definition: 2003–2005 period . TABLE 2 – INDICATOR SPECIFICATION Indicator definition: Prevalence of healthy eating. the interval can be used to test whether the value is statistically significantly different to the national. generally speaking. variation between area values may be a result of differences in population structure. If the interval does not include the national value. for example. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. In the case of indicators based on a sample of the population. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. These occurrences result in random fluctuations in the indicator value between different areas and time periods. In Health Profiles 2009 this is 95%. confounding These data have not been age-standardised and. and so we say that there is a 95% probability that the interval covers the true value. Confidence intervals quantify the uncertainty in this estimate and. under these conditions.

London. Central Bedfordshire UA. commissioned by the Department of Health/ IC and carried out by the Joint Health Surveys Unit of the National Centre for Social Research (NatCen) and the Department of Epidemiology and Public Health at the Royal Free and University College Medical School. .nhs. gender. ethnicity. A portion of fruit or vegetables was defined as an 80g serving. commissioned by the Department of Health/ source IC and carried out by the Joint Health Surveys Unit of the National Centre for Social Research (NatCen) and the Department of Epidemiology and Public Health at the Royal Free and University College Medical School. Denominator: Health Survey for England (HSE). Numerator: source Health Survey for England (HSE). Source Published by The Information Centre for Health and Social Care (IC).dh. Cheshire East UA and Cheshire West UA) were calculated by NatCen as a separate exercise on 21/01/2009 and received on the same date. Numerator: Proportion of adults who reported consumption of 5 or more portions of fruit definition and vegetables per day at the time of the survey. date Data for 4 new 2009 UAs (Bedford UA.htm of this dataset available from other providers Data extraction: Health Surveys for England.pdf indicator from other providers Dimensions Age. social class of inequality: http://www.uk/webfiles/Popgeog/Direct%20Estimates%20%20of%20 available for this Obesity%20(adults)%202003-2005.ic. 2003–2005. National Centre for Social Research (NatCen). London. Denominator: Total number of respondents (with valid record of consumption of fruit and definition vegetables on the day before the interview) aged 16+ in the Health Survey for England 2003–2005. 2007 Data extraction: Data received directly from NatCen. geographies http://www.gov.Health Profiles 2009  The Indicator Guide 128 Section 4: adult’s health and lifestyle Indicator definition: scale Geography: Strategic Health Authority. source URL Data extraction: 16 January 2008.uk/en/Publicationsandstatistics/PublishedSurvey/ subgroup analyses HealthSurveyForEngland/index.

In the 2005 HSE. One of the effects of using a complex sample design is that standard errors for survey estimates are generally higher than would be derived from a simple random sample of the same size. . are not true counts. For this reason the numerator and denominator data are not shown in the data sheet. The definition of portion size for pulses and very small fruits was changed in 2002.200 addresses (around 16. There was a full adult sample of around 16. The current “full” sample size of the HSE comprises about 16. These measurements provided biomedical information about known risk factors associated with disease and objective validation for self-reported health behaviour. Denominator data The HSE is a series of annual surveys that began in 1991 with the aim of caveats monitoring the health of the population.000 in the 2003 HSE. 720 postcode sectors were selected and 26 addresses within each sector. Table 3 – Indicator Technical Methods Numerator: Not Applicable extraction Numerator: Residency by local authority of each respondent is allocated by postcode of aggregation/ residency.000 adults aged 16 and over. For each participant. However. as studies of foods in these categories indicated that an 80g portion is larger than that defined in HSE 2001. at which various physical measurements. a random sample of over 7.000 people) were selected from the Postcode Address File (PAF) to ensure households were sampled proportionately across the nine Government Office Regions in England. From 2002 onwards. tests. stratified multi-stage sample design. Each individual within a selected household was eligible for inclusion. the 2004 and 2005 Health Surveys had only 8. It is likely that HSE 2001 overestimated the consumption of pulses and very small fruits. The 2004 HSE included a boost sample to increase the number of participants from minority ethnic groups and a special Chinese boost sample. The 2005 HSE included a boost sample for older people living in private households and for five months of the year a boost of children aged 2–15 was included. allocation Numerator data These data have not been age-standardised and. non-institutional population living in England. The numerator and denominator counts used to estimate prevalence are based on a sample of the population in each area and. It was designed to be representative of the general. To ensure that each year’s sample was given an approximately equal weight in the calculation of the 3-year estimates (2003–2005) respondents in the boost sample years were weighted up by two. variation between caveats area values may be a result of differences in population structure. a portion of pulses was defined as 3 tablespoons (rather than 2) and a portion of very small fruit as 2 handfuls (rather than 1). the survey included an interview and a physical examination by a nurse. for example. therefore. as such. It completeness uses a clustered.000 adults in the normal ‘general population’ sample as these two surveys included boost samples.Health Profiles 2009  The Indicator Guide 129 Section 4: adult’s health and lifestyle Data quality: The Health Survey for England is designed to provide data at both national and Accuracy and regional level about the population living in private households in England. and samples of blood and saliva were collected.

where a portion is defined as an 80g serving. Estimates are based on pooling together three consecutive years of Health Survey for England data (2003–2005). A range of foods. respondents in 2004 and 2005 were weighted up by two. Cheshire East UA and Cheshire West UA) were calculated by NatCen as a separate exercise on 21/01/2009 using the same method as described above. data for these areas has not been recalculated as part of this exercise. The general population sample size in 2004 and 2005 was about half the sample size in 2003 owing to the sampling of specific population groups – namely. Wiltshire UA. These everyday measures were converted back to portions prior to analysis. ethnic minority populations (2004) and older people living in private households (2005). salads and fruit juice contribute to the total number of portions consumed. Fruit and vegetable consumption is measured in portions per day. The questions are interviewer value administered as part of the Computer Assisted Personal Interview (CAPI). including fruit. Portion size was translated into everyday measures to help informants to report how much they had consumed. Northumberland UA. informants were asked how many tablespoons of vegetables.Health Profiles 2009  The Indicator Guide 130 Section 4: adult’s health and lifestyle Methods used to Questions about fruit and vegetable consumption have been included in calculate indicator the Health Survey for England since 2001. Central Bedfordshire UA. cereal bowls of salad. vegetables. or pieces of medium sized fruit (such as apples) they had consumed in the previous 24 hours. The table below shows portion sizes for the different food items included in the questionnaire. pulses. Questions are designed to assess fruit and vegetable consumption and focus on consumption on the day before the interview. For example. To ensure that each year’s sample was given an approximately equal weight in the calculation of the 2003– 2005 estimates. As geographical coverage for the remaining 6 new 2009 UAs (County Durham UA. This time period was selected to ensure that variations in informant work patterns and times of meals did not affect the average measure of daily consumption. Shropshire UA. which was defined as the 24 hours from midnight to midnight. . Data for 4 new 2009 UAs (Bedford UA. Cornwall UA) remains the same as their old County equivalents.

scholes@natcen. .uk).Health Profiles 2009  The Indicator Guide 131 Section 4: adult’s health and lifestyle Small The Health Survey for England sample does not cover the Isles of Scilly and no Populations: How HSE respondents over 2003–2005 were located in the City of London. and 95% confidence intervals. method One of the effects of using a complex design is that standard errors for survey estimates are generally higher than the standard errors that would be derived from a simple random sample of the same size. further details can be calculation obtained from Shaun Scholes at NatCen (s. Confidence The standard errors. Isles of Scilly and City of London populations have been dealt with Disclosure Control Not applicable.ac. have been calculated Intervals using STATA’s survey module (the svy:mean commands).

Are there any caveats/warnings/ As these estimates are modelled they should be used problems? and interpreted with caution (see above). Will It measure absolute numbers or Percentage of resident adult population aged 16 and proportions? over 7. age. 6. Table 1 – Indicator Description Information Pg 4 Health Summary – Indicator No 15 component Subject category/ Adults health and lifestyle domain(s) Indicator name Estimated prevalence of adults who eat healthily (*Healthy eating adults) (*Indicator title in health profile) .Health Profiles 2009  The Indicator Guide 132 Section 4: adult’s health and lifestyle 15b. There is evidence that eating at least 5 portions of a variety of fruit and vegetables a day could reduce the risk of deaths from chronic diseases such as heart disease. significance tests. How is this indicator actually defined? Prevalence of healthy eating. a local authority is statistically significantly better or statistical process control to test the or worse respectively than the England average. The model is non-aetiological (not based on known casual factors). The estimates do not take into account additional local factors that may impact on the true prevalence of healthy eating in an area and may not match with local lifestyle survey results or modelled estimates which use known risk factors such as socio-economic status. Who does it measure? Adults (aged 16 and over). percentage of resident population. 4. HEALTHY EATING ADULTS LOWER TIER INDICATOR BASIC INFORMATION 1. Are particular tests needed such The data point is green or red when the figure in as standardisation. Where does the data actually come Modelled by the National Centre for Social Research from? (NatCen). How accurate and complete will the These are modelled estimates based on national data be? survey data. persons. 9. 10. 5. 8. adults. What is being measured? Estimated prevalence of adult healthy eating. 3. Published by The Information Centre for Health and Social Care (IC). that is adults who consume 5 or more portions of fruit and vegetables per day 2. 2003–2005. 2007. and cancer by up to 20%. Why is it being measured? To estimate the proportion of healthy eating adults. gender and ethnicity. When does it measure it? Updated as ad-hoc. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. stroke.

help maintain a healthy weight. There was also weakly consistent evidence that higher fruit and vegetable consumption would reduce the risk of breast cancer. after reducing smoking. Cornwall UA) are not based on modelled estimates but are calculated directly using results from the Health Surveys for England 2003–05.Health Profiles 2009  The Indicator Guide 133 Section 4: adult’s health and lifestyle PHO with lead SEPHO responsibility Date of PHO 21/01/2009 dataset creation Indicator definition Prevalence of healthy eating. and cancer by up to 20%. persons. Exceptions: Data for the 9 new 2009 UAs (Bedford UA. Wiltshire UA. including delaying the development of cataracts. Timeliness Updated as ad-hoc. Central Bedfordshire UA. Research suggests that there are other health benefits. purports to measure Rationale: The indicator is a measure of a protective lifestyle factor. reducing the symptoms of asthma. Cheshire East UA. the Department of Health’s Committee on Medical Aspects of Food Policy and Nutrition reviewed the evidence and concluded that higher vegetable consumption would reduce the risk of colorectal cancer and gastric cancer. As well as the direct health benefits. Public Health A diet rich in fruit and vegetables confers protective effects against the Importance development of heart disease and certain cancers. A recent study found that each increase of 1 portion of fruit and vegetables a day lowered the risk of coronary heart disease by 4% and the risk of stroke by 6%. County Durham. percentage of resident population. Metropolitan County Districts. eating fruit and vegetables can help to achieve other dietary goals including increasing fibre intake. adults. These cancers combined represent about 18% of the cancer burden in men and about 30% in women. In 1998. 2003- 2005. reducing fat intake. improving bowel function. It has been estimated that eating at least 5 portions of a variety of fruit and vegetables a day could reduce the risk of deaths from chronic diseases such as heart disease. Higher consumption of fruit and vegetables also reduces the risk of coronary heart disease and stroke. and substituting for foods with added sugars (as frequent consumption of foods with added sugars can contribute to tooth decay). It has been estimated that diet might contribute to the development of one- third of all cancers. Geography Local Authority: County Districts. London Boroughs. stroke. . Shropshire UA. and that increasing fruit and vegetable consumption is the second most important cancer prevention strategy. Northumberland UA. Rationale: Expected prevalence of adult healthy eating that is adults who consume 5 or What this indicator more portions of fruit and vegetables per day. Cheshire West and Chester UA. Evidence also suggests an increase in fruit and vegetable intake can help lower blood pressure. Unitary Authorities. and helping to manage diabetes.

Policy relevance http://www.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/ Diabetes/DH_4015717 National Service Framework for Older People http://www. a low indicator value (red circle in health summary chart) represents a statistically significant lower (worse) proportion of adults who are estimated to consume 5 or more portions of fruit and vegetables per day when compared to the national value. .gov.gov. Given the characteristics of the local population.htm The NHS Plan http://www.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_4094550 Department of Health National 5 A Day programme http://www.dh.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_4009609 National Service Framework for Coronary Heart Disease http://www. a high indicator value (green What a high/low circle in health summary chart) represents a statistically significant higher level of indicator (better) proportion of adults who are estimated to consume 5 or more portions value means of fruit and vegetables per day when compared to the national value.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_4002960 The NHS Cancer Plan http://www.dh.gov.dh.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_4003066 Interpretation: Given the characteristics of the local population.dh. Rationale: Choosing Health: Making healthy choices easier.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_4094275 National Service Framework for Diabetes http://www.Health Profiles 2009  The Indicator Guide 134 Section 4: adult’s health and lifestyle Rationale: Purpose To estimate the expected proportion of adults who 5 or more portions of fruit behind the and vegetables per day in local authorities given the characteristics of local inclusion of the authority populations.dh.gov.gov.dh.dh.gov. indicator To help increase the prevalence of healthy eating and the health benefits associated with eating a healthy diet.uk/en/Policyandguidance/Healthandsocialcaretopics/ FiveADay/FiveADaygeneralinformation/index.

To interpret the estimates. Non-sampling errors arise during the course of the survey activities and there is no simple direct way of estimating the size of these errors.g. as such. local initiatives designed to increase measurement fruit and vegetable consumption). is not based on known aetiological risk factors. There may also be a discrepancy between the modelled lower tier estimates (districts) and upper tier estimates (County geographies and above. The model-based estimate generated for a particular area is the expected measure for that area based on its population characteristics . The figures. Interpretation: These model based healthy lifestyle indicators are derived using the Health Potential for error Survey for England data and are subject to both sampling and non-sampling due to bias and error. A key source of modelling error arises from omitting variables that would otherwise help improve the model predictions either by error or because there is no available or reliable data source for them. The use of statistical models for prediction involves making assumptions about relationships in the data. age.uk (see variables used in generation of model in calculation of indicator section below). therefore. Generally. As mentioned above.and not an estimate of the actual prevalence.g. They will almost certainly not mirror precisely method any available measures from local studies or surveys (although research by NatCen and others have shown that they tend to be related). The suitability of the chosen models for the given data and the validity of the model in describing real world dynamics have a bearing on the nature and magnitude of the errors introduced.e. for example. interview bias and refusal to participate. the model-based estimates are unable to take account of any additional local factors that may impact on the true prevalence rate. gender and ethnicity such as the fruit and vegetable consumption estimates modelled in the Health Poverty Index available at www. NatCen recommend that users adopt statements such as “given the characteristics of the local population we would expect approximately x% of adults within LA Y to consume 5 or more portions of fruit and vegetables per day ”. respondent bias. This may lead to estimated fruit and vegetable consumption levels which are at odds with.Health Profiles 2009  The Indicator Guide 135 Section 4: adult’s health and lifestyle Interpretation: It is important that users note that these model-based do not take account of Potential for error any additional local factors that may impact on the true prevalence rate of fruit due to type of and vegetable consumption in an area (e. Sampling errors arise solely as a result of drawing a sample rather than confounding conducting a full survey of the population. hpi. local lifestyle survey results or modelled estimates which use known co-variates such as socio- economic status. This has lead to inconsistencies between lower tier and county estimates for some areas as the datasets are derived using different methods. . The model used is a non-aetiological model i. plus new 2009 UA areas) which are based on actual Health Survey for England data. the smaller the sample size the larger the variability in the estimates that one would expect to obtain from all the possible samples.org. Non sampling error may include e. should be treated with caution. cannot be used to monitor performance or change over time. In statistical terms. the model-based estimate is actually a biased estimate of the true value for the area and.

It is recommended that users look at the confidence interval for the estimates. The choice of co-variate data was different as both the Index of Multiple deprivation 2004 and ONS area classifications were excluded in the 2003–05 estimates owing to their statistical relationship with other census-based covariates. The 2003–05 LA estimates have been calculated by modelling directly at the LA level. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. The use of 95% is arbitrary but is conventional practice in medicine and public health. a mortality and purpose rate.Health Profiles 2009  The Indicator Guide 136 Section 4: adult’s health and lifestyle Validation exercises were used to check the appropriateness of the chosen models. Estimates for two areas can only be described as significantly different if the confidence intervals for the estimates do not overlap. Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. for example. In Health Profiles 2009 this is 95%. This term is applied to any set of ONS statistics that do not meet the rigorous quality standards of National Statistics and/or may be subject to change due to methodological development. Confidence intervals are given with a stated probability level. . This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. In the case of indicators based on a sample of the population. generally speaking. The 2003–2005 model based estimates are not comparable with the preceding estimates for 2000-2002 owing to differences in geography and modelling methodology: The 2000–2002 LA estimates were calculated by aggregating the model-based estimates for the component wards. aggregated or averaged over any other spatial unit). These occurrences result in random fluctuations in the indicator value between different areas and time periods. The 2003–05 based estimates were adjusted to be consistent with the direct survey estimates at GOR/SHA level. The model-based estimates have been produced solely for LAs and cannot be translated onto any other geographical boundary system (i. Confidence intervals have been calculated for the model-based estimates to capture both sampling and modelling error. As a result of limitations in the model based estimates they are published as “experimental statistics”.e. but chance had led to a different set of data. The wider is the confidence interval the greater is the uncertainty in the estimate. Users should also note that the potential sources of bias and error also apply to any ranking or banding of the small-area estimates. not just the estimate. Confidence intervals quantify the uncertainty in this estimate and. describe how much different the point estimate could have been if the underlying conditions stayed the same. The confidence intervals provide a range within which we can be fairly sure the ‘true’ value for that area lies. NatCen do not encourage any ranking of small area estimates within larger areas such as Local Authorities. and so we say that there is a 95% probability that the interval covers the true value. uncertainty also arises from random differences between the sample and the population itself. Primary Care Organisations and Strategic Health Authorities.

Variable Healthy eating is defined as those who consume 5 or more portions of fruit and vegetables per day. Source Data extraction: Data received directly from NatCen. December 2007 (see link above).Health Profiles 2009  The Indicator Guide 137 Section 4: adult’s health and lifestyle The confidence intervals have also been used to make comparisons against the national value. . source URL Also published by IC. the difference is not statistically significant and the value is shown on the health summary chart with an amber symbol. the difference is statistically significant and the value is shown on the health summary chart with a red or green symbol depending on whether it is worse or better than the national value respectively.uk/pubs/healthylifestyles05 available for this indicator from other providers Dimensions None. Census 2001. the interval can be used to test whether the value is statistically significantly different to the national. under these conditions.nhs. of inequality: subgroup analyses of this dataset available from other providers Data extraction: National Centre for Social Research (NatCen). For this purpose the national value has been treated as an exact reference value rather than as an estimate and. Data extraction: 16/01/2008 date Numerator: Model estimates by NatCen using data from a number of sources including definition Health Survey for England 2003–2005. If the interval does not include the national value. Table 2 – Indicator Specification Indicator definition: Prevalence of healthy eating.ic. If the interval includes the national value. Numerator: source NatCen. Indicator definition: Percentage of resident adult population aged 16 and over Statistic Indicator definition: Persons Gender Indicator definition: Adults (aged 16 and over) age group Indicator definition: 2003–2005 period Indicator definition: scale Geography: MSOA geographies available from http://www.

The model contained an interaction term between SHA and the percentage of residents claiming Job Seekers Allowance over 12 months. TABLE 3 – INDICATOR TECHNICAL METHODS Numerator: Not applicable. • The model outputs were applied in conjunction with covariate data (available for all LAs) to estimate the ‘expected’ prevalence given the characteristics of the area. definition Denominator: Not applicable. caveats Denominator data Not applicable. caveats Methods used to The process of creating the model-based estimates of healthy lifestyle calculate indicator behaviours involved three main stages: value • A statistical model was used to represent the relationships between healthy eating and area-level characteristics in the small areas covered by the HSfE. • An adjustment factor was applied to ensure that the model-based estimates for each LA corresponded with the 2003–2005 direct estimates at GOR/SHA level taken from the Health Survey for England data. life expectancy. hospital admissions attributable to alcohol. emergency hospital admissions. The 2001 Census provided the main source for demographic and social covariate data. The model also contained an interaction term between the percentage of residents aged 16–74 whose highest qualification attained was an NVQ Level 1 (or with no qualifications) and living in areas characterised as containing Village.Health Profiles 2009  The Indicator Guide 138 Section 4: adult’s health and lifestyle Denominator: Not applicable. Other routine sources of data providing area-level characteristics for LAs included all age-all cause mortality. diversity index. source Data quality: The model-based approach generates estimates that are of a different nature Accuracy and from standard survey estimates because they are dependent upon how well completeness the relationship between healthy lifestyle behaviours for individuals and the Census/administrative information about the area in which they live are specified in the model. extraction Numerator: Not applicable. Hamlet and Isolated dwellings. job seekers allowance claimant counts and educational attainment. . aggregation / allocation Numerator data See Interpretation: potential sources of error section. The accuracy and completeness of the information will be subject to the same constraints surrounding the Health Survey for England and Census data sets on which they are based (see Interpretation: potential sources of error section).

and a higher proportion of residents with limiting long-term illness.Health Profiles 2009  The Indicator Guide 139 Section 4: adult’s health and lifestyle The area level characteristics associated with increased propensity for an adult to consume 5 or more portions of fruit and vegetables were: a higher proportion of residents of Pakistani ethnic origin.uk/webfiles/Popgeog/Healthy%20Lifestyle%20 Behaviours-%20Model%20Based%20Estimates%20for%20Middle%20 Layer%20Super%20Output%20Areas%20and%20Local%20Authorities%20 in%20England_2003-2005__%20User%20Guide. This was done by aggregating the model-based estimates to GOR/SHA and comparing to the direct estimates.pdf For methods used to calculate data for new 2009 UAs please see metadata for upper tier geographies. As a result.ic. However. The relevant ratios of the HSfE direct estimates to the aggregated model-based estimates at GOR/SHA level were then used to scale the model based LA level estimates.nhs. The area-level characteristics associated with decreased propensity for an adult to consume 5 or more portions of fruit and vegetables were: residing in an area with a high standardised mortality ratio and areas where a relatively higher proportion of households have no regular access to a car. . How Isles of Scilly and City of London populations have been dealt with Disclosure Control Not applicable. For a fuller technical description of the methodology see the Model-Based Estimates User Guide and other reports available on the Information Centre website: http://www. The model-based estimates were constrained to the direct GOR/SHA estimates taken from the Health Survey for England data. the model-based estimates have not been calibrated to ensure agreement at County level. Small Populations: Model based estimates were not produced for Isles of Scilly or City of London. a higher hospital admission rate for acute conditions usually managed in primary care settings. there may be inconsistencies between lower tier and county estimates for some areas as the datasets are derived using different methods.

Health Profiles 2009  The Indicator Guide 140
Section 4: adult’s health and lifestyle

Confidence The model-based estimate generated for a particular LA is the expected
Intervals measure for that LA based on its characteristics as measured by the covariates
calculation method in the model. In statistical terms, the model-based estimate is actually a biased
estimate of the true value for an area and, as such, should be treated with
caution. By placing confidence intervals around a model-based estimate,
however, we can generate a range within which we can be fairly sure the
‘true’ value for that area lies.

In order to generate the confidence interval, an estimate of the variance of
the difference between the model-based estimate and the true LA measure is
required. The estimate of the variance has two components which correspond
to the variance that is not explained by the model (and hence is not predicted
by the model-based estimate) and the uncertainty of the model-based estimate
itself.

Obtaining the confidence interval for the LA estimates required computing
two area-level variance terms: one for the Primary Sampling Units and one for
the LA. The first term was required to allow for the clustering in the sample
and the second term to estimate the residual variance at the LA level that was
not explained by the model. The confidence interval for the model-based LA
estimates was estimated to be:

1
  βˆ T X i 2
 2 
 e   M i  N ij  2  2 
−1 
log it αˆ + βˆ X i ± 1.96  σˆ u + σˆ v2 + X TiVar ( βˆ ) X i 
T
 ∑
 T
βˆ X i   j =1  
Ni    
  1+ e    
   

where:

Χi is the vector of covariates values for LA i,
Xi 
β̂ is the vector of parameter estimates for the LA-level covariates,
β̂ 
σ̂ 2 is the estimate of the between PSU-level variance,
σ̂ u2u 
σˆ 2 is the estimate of the between LA-level variance.
σˆ v2v 
N is the population estimate of the number of adults in LA i,
Ni i 
Nijij is
N the population estimate of the number of adults in postcode sector ij,
M
and
i 

Mi is the number of postcode sectors in LA i.

Health Profiles 2009  The Indicator Guide 141
Section 4: adult’s health and lifestyle

16. PHYSICALLY ACTIVE ADULTS INDICATOR
Basic Information

1. What is being measured? Adults participating in recommended levels of
physical activity.
2. Why is it being measured? To estimate prevalence of physical activity beneficial
to health in the population.

To monitor the effectiveness of programmes aiming
to increase participation of adults in sport and active
recreation.
3. How is this indicator actually defined? Participation in moderate intensity sport and active
recreation on 20 or more days in the previous 4
weeks, (averaging 5 or more times per week).
4. Who does it measure? Adults (aged 16 and over).
5. When does it measure it? The survey is to be repeated in 2008/9 and 2009/10.
6. Will It measure absolute numbers or Proportions: persons, aged 16 and over, 2007/08, as
proportions? percentage respondents of the Sport England Active
People Survey 2.
7. Where does the data actually come Data received directly from Sport England.
from?
8. How accurate and complete will the data The Active People Survey is a telephone survey
be? conducted using CATI (Computer Aided Telephone
Interviewing). At least 500 interviews are undertaken
per local authority. The exceptions were Isles of
Scilly, City of London (due to small populations)
and Birmingham where 5,000 interviews were
conducted and Liverpool where 2,500 interviews
were conducted.
9. Are there any caveats/warnings/ This measure is a crude proportion and no age-
problems? standardisation has been applied to the results to
adjust for differences in age structure between
areas. It is likely that a greater proportion of younger
people undertake levels of physical activity at the
recommended levels than older people.

Sport England numerator data are based on
observed self-reported physical activity levels in the
previous 4 weeks and self-reported physical activity
levels may be prone to respondent bias. In addition,
the indicator does not include active recreation such
as housework, DIY, activity in ones job or active
transport.
10. Are particular tests needed such as The data point is green or red when the figure in
standardisation, significance tests, or a local authority is statistically significantly better
statistical process control to test the or worse respectively than the England average,
meaning of the data and the variation they based on the 95% confidence intervals of the figure
show? compared to the England value.

Health Profiles 2009  The Indicator Guide 142
Section 4: adult’s health and lifestyle

TABLE 1 – INDICATOR DESCRIPTION

Information Pg 4 Health Summary – Indicator 16
component
Subject category/ Adults health and lifestyle
domain(s)
Indicator name (* Adults participating in recommended levels of physical activity (*Physically
Indicator title in active adults)
health profile)
PHO with lead SEPHO
responsibility
Date of PHO 04/03/2009
dataset creation
Indicator definition Participation in *moderate intensity sport and active recreation on 20 or
more days in the previous 4 weeks, (averaging 5 or more times per week),
percentage, persons, aged 16 and over, 2007/08, as percentage respondents
of the Sport England Active People Survey 2
Geography England, GOR, Local Authority: Counties, County Districts, Metropolitan
County Districts, Unitary Authorities, London Boroughs, new 2009 Unitary
Authorities.
Timeliness The survey is to be repeated in 2008/9 (APS3) and 2009/10 (APS4)
Rationale: This indicator estimates the proportion of adults participating in physical
What this indicator activity beneficial to health.
purports to
measure
Rationale: People who have a physically active lifestyle are at approximately half the risk
Public Health of developing coronary heart disease compared to those who have a sedentary
Importance lifestyle. Regular physical activity is also associated with a reduced risk of
diabetes, obesity, osteoporosis and colon cancer and with improved mental
health. In older adults physical activity is associated with increased functional
capacities.

In terms of mortality, morbidity and quality of life, the Chief Medical Officer
has estimated the cost of inactivity in England to be £8.2 billion annually.

Evidence for the effectiveness of interventions to increase the population levels
of physical activity is summarised by Kahn E, Ramsey L, Brownson R, Heath
G, Howze E, Powell K, et al. ‘The Effectiveness of Interventions to Increase
Physical Activity: A Systematic Review’. Am J Prev Med 2002; 22 (4S)
Rationale: Purpose To estimate prevalence of physical activity beneficial to health in the population
behind the
inclusion of the To monitor the effectiveness of programmes aiming to increase participation of
indicator adults in sport and active recreation

The indicator is a measure of health need i.e. the ability to benefit from public
health interventions aiming to improve levels of physical activity beneficial to
health in the adult population.

Health Profiles 2009  The Indicator Guide 143
Section 4: adult’s health and lifestyle

Rationale: Choosing Health: Making Healthy Choices Easier, Department of Health, 2004
Policy relevance
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_4094550

Choosing Health: a physical activity action plan, Department of Health, 2005
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/
documents/digitalasset/dh_4105710.pdf

At Least Five a Week: Evidence on the Impact of Physical Activity and its
Relationship to Health, 2004 – report by the CMO
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/
documents/digitalasset/dh_4080981.pdf

Game Plan: A Strategy for Delivering Government’s Sport and Physical Activity
Objectives, 2002
http://www.sportdevelopment.org.uk/html/gameplan.html

The Sport England Strategy 2008–2001 was published in June 2008 and
commits Sport England to deliver on a series of demanding targets by
2012/13:
• one million people doing more sport
• a 25% reduction in the number of 16–18 year olds who drop out of five key
sports
• improved talent development systems in at least 25 sports
• a measurable increase in people’s satisfaction with their experience of sport
– the first time the organisation has set such a qualitative measure
• a major contribution to the delivery of the five hour sports offer for children
and young people.
The strategy can be found at:
http://www.sportengland.org/index/get_resources/resource_downloads/sport_
england_strategy.htm
Interpretation: A high indicator value (green circle in health summary chart) represents
What a high/low a statistically significant higher (better) estimated percentage of adults
level of indicator participating in physical activity when compared to the national value.
value means
A low indicator value (red circle in health summary chart) represents
a statistically significant lower (worse) estimated percentage of adults
participating in physical activity when compared to the national value.
Interpretation: Sport England numerator data are based on observed self-reported physical
Potential for error activity levels in the previous 4 weeks through a series of questions which
due to type of focus on walking, cycling and other types of sport and recreational physical
measurement activity. Self-reported physical activity levels may be prone to respondent bias.
method Respondents are required to remember how long each session of physical
activity lasted and describe the intensity level of the activity they undertook. As
a result, levels of physical activity are likely to be over-reported.

The Active People Survey measures sport and active recreation but excludes
other forms of physical activity such as housework, DIY, activity in ones job,
active transport etc. and this may lead to under-estimation of levels.

Health Profiles 2009  The Indicator Guide 144
Section 4: adult’s health and lifestyle

Interpretation: This measure of adults participating in recommended levels of physical activity
Potential for error is a crude proportion and no age-standardisation has been applied to the
due to bias and results to adjust for differences in age structure between areas. It is likely that
confounding a greater proportion of younger people undertake levels of physical activity at
the recommended levels than older people.

Details of the sampling frame used and which groups may have been under
sampled (e.g. ethnic minorities, those without telephone access etc) were not
available at the time of creation of this indicator. Therefore, it is not known
how representative of the general population the survey results are.
Confidence A confidence interval is a range of values that is normally used to describe the
Intervals: Definition uncertainty around a point estimate of a quantity, for example, a mortality
and purpose rate.

This uncertainty arises as factors influencing the indicator are subject to chance
occurrences that are inherent in the world around us. These occurrences result
in random fluctuations in the indicator value between different areas and
time periods. In the case of indicators based on a sample of the population,
uncertainty also arises from random differences between the sample and the
population itself.

The stated value should therefore be considered as only an estimate of the
true or ‘underlying’ value. Confidence intervals quantify the uncertainty in
this estimate and, generally speaking, describe how much different the point
estimate could have been if the underlying conditions stayed the same, but
chance had led to a different set of data. The wider is the confidence interval
the greater is the uncertainty in the estimate.

Confidence intervals are given with a stated probability level. In Health Profiles
2009 this is 95%, and so we say that there is a 95% probability that the
interval covers the true value. The use of 95% is arbitrary but is conventional
practice in medicine and public health.

The confidence intervals have also been used to make comparisons against
the national value. For this purpose the national value has been treated
as an exact reference value rather than as an estimate and, under these
conditions, the interval can be used to test whether the value is statistically
significantly different to the national. If the interval includes the national value,
the difference is not statistically significant and the value is shown on the
health summary chart with a amber symbol. If the interval does not include
the national value, the difference is statistically significant and the value is
shown on the health summary chart with a red or green symbol depending on
whether it is worse or better than the national value respectively.

with valid responses to questions on physical definition activity in the Active People Survey 2. sport and recreational physical activity.Health Profiles 2009  The Indicator Guide 145 Section 4: adult’s health and lifestyle Table 2 – Indicator Specification Indicator definition: Participation in *moderate intensity sport and active recreation on 20 or more Variable days (averaging 5 or more times per week) in the previous 4 weeks *Moderate intensity sport and active recreation is defined as a 30 minute session of activity such as cycling. moderate activity was defined as where the effort required was enough to raise the individual’s breathing rate. of inequality: household income. Cheshire East.org available for this indicator from other providers Dimensions Age. Cheshire West and Chester Numerator: Respondents aged 16 and over. Data extraction: Data received directly from Sport England. walking.sportengland. ethnicity.org/index/ get_resources/research/active_people.sportengland. National Statistics Socio-economic Classification (NS-SEC) subgroup analyses available from Sport England. For cycling and other sport and recreational activity. housing tenure. gender.htm Indicator definition: Percentage of respondents of the Sport England Active People Survey 2 (APS2) Statistic Indicator definition: Persons Gender Indicator definition: 16 and over age group Indicator definition: October 2007–October 2008 period Indicator definition: scale Geography: At time of creation of indicator: County Sport Partnerships available from Sport geographies England www. make the respondent out of breath or sweat. of this dataset available from other providers Data extraction: Sport England. For walking. For further details see http://www. Source Ipsos MORI undertook the survey on behalf of Sport England. with valid responses to questions on physical definition activity in the Active People Survey 2 .sportengland. who participated in moderate intensity sport or recreational activities for 30 minutes or more on 20 or more days in the previous four weeks. Numerator: source Sport England Active People Survey 2 www. disability.org/ Denominator: Respondents aged 16 and over. education. working status. moderate activity was defined as walking at “a fairly brisk pace” or “a fast pace”. source URL Data extraction: 21/02/2009 – Local authority district estimates date 25/02/2009 – Regional/County data 4/3/2009 – Central Bedfordshire UA.

A representative sample is then drawn by randomising the last four digits of each number.sportengland. Data within each reporting geography are weighted by the following factors: age within gender. This number of interviews will be repeated in the 2008/9 (Active People Survey 3) and 2009/10 (Active People Survey 4) surveys giving a cumulative local authority sample of 1. respondents were asked to state in which local authority they lived or dialling codes/exchange area telephone number were used to look this up.g.000 overall sample size. Further exceptions to the 500 sample target in APS2 were Isles of Scilly and City of London which have small populations and do not require such a large sample. Where postcode was not known (around 1 in 10).000 (equivalent to the first Active People Survey) every two years. The telephone survey is conducted using CATI (Computer Aided Telephone Interviewing) and in APS2 achieved 188. ethnicity (White/Non White). National Statistics socio-economic classification (NS SEC). Government Region etc).800 interviews overall with a minimum of 500 interviews per local authority. . The RDD sample is drawn by selecting numbers from a database comprising all exchange codes allocated for residential use in the UK.org/ Data quality: The Active People Survey was undertaken by Ipsos MORI and conducted across Accuracy and every local authority in England. Two LAs choose larger boosts: Liverpool boosted by 2. To ensure summer and winter responses are given equal weight within the annual data. The survey is conducted by telephone using completeness Random Digit Dialling (RDD) to generate a sample of telephone numbers. This was taken up by 14 local authorities. Respondents were matched to local authority of residence using postcode of residents.Health Profiles 2009  The Indicator Guide 146 Section 4: adult’s health and lifestyle Denominator: Sport England Active People Survey 2 source www. caveats Denominator data Denominator data are weighted totals and as such do not sum to overall caveats totals. extraction Numerator: Performed by Sport England. Further information is available on request from Sport England.000 to provide a 2.800 to provide a 5. All local authorities were offered the opportunity to boost their APS2 from 500 to 1. local authority. The Active People Survey data are weighted to be representative of the 16+ population of each reporting geography (e.000.500 overall sample size and Birmingham boosted by 3. Table 3 – Indicator Technical Methods Numerator: Extraction by Sport England. a final weight is applied to distribute half the sample size to the summer period and half the sample size to the winter period. aggregation / allocation Numerator data Numerator data are weighted totals and as such do not sum to overall totals.

Regional and County figures.96*SQRT((Share*(1- Share))/Total)) where share is the question proportion and total is the sample size. Confidence 95% confidence intervals have been calculated using a formula based on a Intervals normal approximation provided by Sport England as follows: calculation method Upper and lower 95% confidence interval = 100*(1. with valid responses to calculate indicator questions on physical activity in the Active People Survey 2006. with valid responses to questions on physical activity in the Active People Survey.Health Profiles 2009  The Indicator Guide 147 Section 4: adult’s health and lifestyle Methods used to The number of respondents aged 16 and over. Small Populations: Isles of Scilly and City of London are excluded from the lower tier datasets but How Isles of Scilly included in England. This generated the percentage participating in recommended levels of physical activity. who value participated in moderate intensity sport or recreational activities for 30 minutes or more on 20 or more days in the previous four weeks for each local authority was divided by the number of respondents aged 16 and over. 2006 and multiplied by 100. and City of London populations have been dealt with Disclosure Control None applied. .

The Health Survey for England under-samples younger people. people in employment. 2003–2005. when looking at the elderly or different ethnic groups. How is this indicator actually defined? Prevalence of obesity. When does it measure it? The Health Survey for England (HSE) is carried out annually. Published by The Information Centre for Health and Social Care (IC). Where does the data actually come Health Surveys for England. Are there any caveats/warnings/ BMI is calculated using measured height and problems? weight which may be subject to measurement bias. Will It measure absolute numbers or Percentage of resident adult population aged 16 and proportions? over. 6. 10. . OBESE ADULTS UPPER TIER INDICATOR Basic Information 1. non-institutional population living in England. Are particular tests needed such as The data point is green or red when the figure in standardisation.000 adults aged 16 and over. 8. What is being measured? Prevalence of obese adults 2. Why is it being measured? To estimates the proportion of adults who are classified as obese. women. 9. How accurate and complete will the data The HSE was designed to be representative of be? the general. In some sections of the population. 2007. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. 7. or a local authority is statistically significantly better statistical process control to test the or worse respectively than the England average. Who does it measure? Adults (aged 16 and over). those who are healthier but exhibit less healthy behaviour. 4. applying BMI classification is not always straightforward e. significance tests.Health Profiles 2009  The Indicator Guide 148 Section 4: adult’s health and lifestyle 17a. National Centre for from? Social Research (NatCen). The current “full” sample size of the HSE comprises about 16. 5. 3. percentage of resident population. persons. ethnic minorities. A definition based on waist-hip ratio is often considered a better measure of obesity. Obesity has serious health consequences and is association with all cause mortality and decreased life expectancy.g. adults.

County. Obesity decreases life expectancy by up to nine years. percentage of resident population. Rationale: Prevalence of adult obesity What this indicator purports to measure Rationale: Obesity in adults is defined for epidemiological purposes as body mass index Public Health (BMI) > 30 kg/m2. Cheshire East UA. heart disease. Shropshire UA. . South East SHAs. Northumberland UA. new 2009 UAs (Bedford UA. which is an important causal factor in diabetes. persons Geography England. Timeliness Updated annually. Obesity causes insulin insensitivity. Cheshire West and Chester UA. There is an association between all cause mortality and Importance obesity. hypertension and stroke. All these penalties as outlined in the table below (except the risk of gallstones and hip fracture) decrease with weight loss. the increased mechanical load increases liability to osteoarthritis and sleep apnoea. Central Bedfordshire UA. Thus there are many routes by which obesity is a detriment to wellbeing. GOR. Wiltshire UA. Obesity carries psychosocial penalties. Cornwall UA). County Durham. Obesity is associated with the development of hormone-sensitive cancers. 2003-2005. adults.Health Profiles 2009  The Indicator Guide 149 Section 4: adult’s health and lifestyle Table 1 – Indicator Description Information Pg 4 Health Summary – Indicator Number 17 component Subject category/ Adults health and lifestyle domain(s) Indicator name (* Prevalence of obese adults (*Obese adults) Indicator title in health profile) PHO with lead SEPHO responsibility Date of PHO 21/01/2009 dataset creation Indicator definition Prevalence of obesity.

9 Angina pectoris 2.5 20. pdf Tackling Obesity in England.8 Gall-bladder disease 2.8 11.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_4094550 Obesity: Defusing the Health Time Bomb (from the Annual Report of the Chief Medical Officer.radcliffe-oxford.nao.uk/CG43 Rationale: Purpose To estimate the proportion of obese adults in local authorities.uk/resources/AtoZ/toolkit_obesity/obesity_toolkit_intro. Policy relevance http://www.5 Stroke 3.pdf . http://guidance.dh.5 20.2 Genitourinary cancer 1. See NICE guidance – Obesity: the prevention.uk/publications/nao_reports/00-01/0001220.nice.3 4. 2001 (National Audit Office.7 NIDDM 2.org. assessment and management of overweight and obesity in adults and children.fphm.8 Venous thrombosis 1. Health. identification.dh.9 24.7 Gout 2. 2002). 2004).5 7.2 3.html It is estimated that obesity costs the NHS over £1 billion per year and society as a whole up to £3.gov.6 9. 2007) http://www.org.5 Source: http://hcna.0 Hypertension 2.Health Profiles 2009  The Indicator Guide 150 Section 4: adult’s health and lifestyle Proportion of various diseases attributable to obesity (BMI > 27 kg/m2) Disease Relative Risk Attributable proportion (%) Obesity   100. behind the inclusion of the To help reduce the prevalence of obesity. 2001) http://www. Effective interventions exist to prevent and treat obesity.0 14.org.1 Myocardial infarcation 1.gov. indicator Rationale: Choosing Health: Making healthy choices easier (Dept.1 Hip fracture 0.com/obframe.uk/en/Publicationsandstatistics/Publications/AnnualReports/ Browsable/DH_4875027 Tackling Obesity: A Toolbox for Local Partnership Action (The National Heart Forum.9 24.8 –3.5 billion per year.0 Osteoarthritis 1.9 13.5 7.3 Colorectal cancer 1. http://www.7 Breast cancer 1.1 25.1 Hyperlipidaemia 1.

For example. in certain Asian populations a given BMI equates to a higher percentage of body fat than the same BMI in a white European population. therefore. method unsteady or those who could not stand straight). These were included in the analysis. the converse is true. pregnant.g. and therefore a low indicator value should not mean that PH action is not needed.Health Profiles 2009  The Indicator Guide 151 Section 4: adult’s health and lifestyle Interpretation: A high indicator value (red circle in health summary chart) represents What a high/low a statistically significant higher level (worse) of estimated adult obesity level of indicator prevalence when compared to the national value. height and weight was Potential for error recorded by a nurse. which are based on modelled data. In order to ensure agreement between these estimates at GOR and SHA level. Interpretation: For each participant in the Health Survey for England. In some Black populations. ethnic minorities. confounding These data have not been age-standardised and. those who are healthier but exhibit due to bias and less healthy behaviour. BMI was then calculated for all informants who had due to type of valid height and weight measurements. value means A low indicator value (green circle in health summary chart) represents a statistically significant lower level (better) of estimated adult obesity prevalence when compared to the national value. However. . In some sections of the population. BMI is most commonly used and easier to measure routinely. however. have been calibrated. Interpretation: The Health Survey for England under-samples younger people. the synthetic estimates have not been calibrated to ensure agreement at County level. Those who weighed more than 130kg were asked for an “estimated weight” because the scales were unreliable above this level. variation between area values may be a result of differences in population structure. chair-bound. the lower tier synthetic estimates (districts). A definition based on waist-hip ratio is often considered a better measure of obesity. As a result. those considered to have unreliable measurement measurements were excluded from the analysis (e. applying the BMI classification described above is not always straightforward e. However obesity at any prevalence level greater than 0 is undesirable.g. women. there may be inconsistencies between lower tier and county estimates for some areas as the datasets are derived using different methods. when looking at the elderly or different ethnic groups. However. people in Potential for error employment.

These occurrences result in random fluctuations in the indicator value between different areas and time periods. In Health Profiles 2009 this is 95%. uncertainty also arises from random differences between the sample and the population itself. Confidence intervals are given with a stated probability level. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. under these conditions. a mortality and purpose rate. describe how much different the point estimate could have been if the underlying conditions stayed the same. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. The confidence intervals have also been used to make comparisons against the national value. the interval can be used to test whether the value is statistically significantly different to the national. If the interval does not include the national value. Table 2 – Indicator Specification Indicator definition: Prevalence of obesity. Variable Obesity in adults is defined for epidemiological purposes as body mass index (BMI) > 30 kg/m2. Indicator definition: Percentage of resident adult population aged 16 and over Statistic Indicator definition: Person Gender Indicator definition: Adults (aged 16 and over) age group Indicator definition: 2003–2005 period Indicator definition: scale . the difference is not statistically significant and the value is shown on the health summary chart with an amber symbol. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. for example. and so we say that there is a 95% probability that the interval covers the true value. but chance had led to a different set of data. In the case of indicators based on a sample of the population. If the interval includes the national value. The wider is the confidence interval the greater is the uncertainty in the estimate. generally speaking. Confidence intervals quantify the uncertainty in this estimate and.Health Profiles 2009  The Indicator Guide 152 Section 4: adult’s health and lifestyle Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. the difference is statistically significant and the value is shown on the health summary chart with a red or green symbol depending on whether it is worse or better than the national value respectively. The use of 95% is arbitrary but is conventional practice in medicine and public health.

Central Bedfordshire UA.000 people) were selected from the Postcode Address File (PAF) to ensure households were sampled proportionately across the nine Government Office Regions in England. 720 postcode sectors were selected and 26 addresses within each sector.uk/webfiles/Popgeog/Direct%20Estimates%20%20of%20 available for this Obesity%20(adults)%202003-2005. stratified multi-stage sample design.uk/en/Publicationsandstatistics/PublishedSurvey/ subgroup analyses HealthSurveyForEngland/index. for example. London. a random sample of over 7. .nhs. commissioned by the Department of Health/ IC and carried out by the Joint Health Surveys Unit of the National Centre for Social Research (NatCen) and the Department of Epidemiology and Public Health at the Royal Free and University College Medical School.gov. National Centre for Social Research (NatCen). social class of inequality: http://www. Source Published by The Information Centre for Health and Social Care (IC). commissioned by the Department of Health/ source IC and carried out by the Joint Health Surveys Unit of the National Centre for Social Research (NatCen) and the Department of Epidemiology and Public Health at the Royal Free and University College Medical School. Each individual within a selected household was eligible for inclusion.dh. source URL Data extraction: 16 January 2008. One of the effects of using a complex sample design is that standard errors for survey estimates are generally higher than would be derived from a simple random sample of the same size.pdf indicator from other providers Dimensions Age. date Data for 4 new 2009 UAs (Bedford UA. It completeness uses a clustered. Numerator: The number of persons aged 16+ who are obese in a sample survey of the definition health of the population of England. Denominator: Total number of respondents (with valid measurements for height and weight) definition aged 16+ in the Health Survey for England 2003_2005. Data quality: The Health Survey for England is designed to provide data at both national and Accuracy and regional level about the population living in private households in England. ethnicity. geographies http://www. Cheshire East UA and Cheshire West UA) were calculated by NatCen as a separate exercise on 21/01/2009 and received on the same date. Denominator: Health Survey for England (HSE).Health Profiles 2009  The Indicator Guide 153 Section 4: adult’s health and lifestyle Geography: Strategic Health Authority. In the 2005 HSE. Numerator: source Health Survey for England (HSE). 2007 Data extraction: Data received directly from NatCen. gender.ic.200 addresses (around 16. London.htm of this dataset available from other providers Data extraction: Health Surveys for England.

are not true counts. the survey included an interview and a physical examination by a nurse. unsteady. unsteady.5kg/m2. These have been included in the analysis. Denominator data The HSE is a series of annual surveys that began in 1991 with the aim of caveats monitoring the health of the population. turban) were excluded from the analysis. non-institutional population living in England. at which various physical measurements. The 2005 HSE included a boost sample for older people living in private households and for five months of the year a boost of children aged 2–15 was included. • Obese . It was designed to be representative of the general.000 adults aged 16 and over. or could not stand straight was not measured. The 2004 HSE included a boost sample to increase the number of participants from minority ethnic groups and a special Chinese boost sample. For this reason the numerator and denominator data are not shown in the data sheet. The current “full” sample size of the HSE comprises about 16. tests. The numerator and denominator counts used to estimate prevalence are based on a sample of the population in each area and. For caveats adults. four groups are defined according to their BMI: • Underweight . .over 30kg/m2 BMI was calculated for all informants who had valid height and weight measurements. extraction Numerator: Residency by local authority of each respondent is allocated by postcode of aggregation/ residency. These measurements provided biomedical information about known risk factors associated with disease and objective validation for self-reported health behaviour.000 in the 2003 HSE. These data have not been age-standardised and. However. The height of informants who were chair-bound. • Overweight . and samples of blood and saliva were collected. The weight of informants who were pregnant. variation between area values may be a result of differences in population structure.25 to 30kg/m2. • Desirable weight – 18. allocation Numerator data Body mass index is defined as weight (kg) divided by height squared (m2). wearing a wig. Those who weighed more than 130 kg were asked for an “estimated weight” because the scales were unreliable above this level. For each participant. therefore.Health Profiles 2009  The Indicator Guide 154 Section 4: adult’s health and lifestyle There was a full adult sample of around 16. the 2004 and 2005 Health Surveys had only 8. chair bound.g.000 adults in the normal ‘general population’ sample as these two surveys included boost samples.5 to 25kg/m2. or could not stand was not measured. Table 3 – Indicator Technical Methods Numerator: Not applicable.under 18. as such. To ensure that each year’s sample was given an approximately equal weight in the calculation of the 3-year estimates (2003–2005) respondents in the boost sample years were weighted up by two. Data for those who were considered by the interviewer to have unreliable measurements (e.

and City of London populations have been dealt with Disclosure Control Not applicable.ac. Cheshire East UA and Cheshire West UA) were calculated by NatCen as a separate exercise on 21/01/2009 using the same method as described above. Wiltshire UA. Shropshire UA.scholes@natcen. have been calculated Intervals using STATA’s survey module (the svy:mean commands). To ensure that each year’s sample was given an approximately equal weight in the calculation of the 2003-2005 estimates. Confidence The standard errors. respondents in 2004 and 2005 were weighted up by two. Northumberland UA. ethnic minority populations (2004) and older people living in private households (2005). and 95% confidence intervals. Data for 4 new 2009 UAs (Bedford UA. One of the effects of using a complex design is that standard errors for survey estimates are generally higher than the standard errors that would be derived from a simple random sample of the same size. Cornwall UA) remains the same as their old County equivalents. further details can be calculation method obtained from Shaun Scholes at NatCen (s.Health Profiles 2009  The Indicator Guide 155 Section 4: adult’s health and lifestyle Methods used to Estimates are based on pooling together three consecutive years of Health calculate indicator Survey for England data (2003–2005). Central Bedfordshire UA. The general population sample size in value 2004 and 2005 was about half the sample size in 2003 owing to the sampling of specific population groups – namely. As geographical coverage for the remaining 6 new 2009 UAs (County Durham UA. Small Populations: The Health Survey for England sample does not cover the Isles of Scilly and no How Isles of Scilly HSE respondents over 2003–2005 were located in the City of London. data for these areas has not been recalculated as part of this exercise. .uk).

6. OBESE ADULTS LOWER TIER INDICATOR Basic Information 1. Published by The Information Centre for Health and Social Care (IC). Will It measure absolute numbers or Percentage of resident adult population aged 16 and proportions? over. The estimates do not take into account additional local factors that may impact on the true prevalence of obesity in an area and may not match with local lifestyle survey results or modelled estimates which use known risk factors. 2003–2005. 9. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. 5. How accurate and complete will the data These are modelled estimates based on national be? survey data. Are particular tests needed such as The data point is green or red when the figure in standardisation. How is this indicator actually defined? Prevalence of obesity. persons. 2007. 8. percentage of resident population. The model is non-aetiological (not based on known casual factors). To help reduce the prevalence of obesity.Health Profiles 2009  The Indicator Guide 156 Section 4: adult’s health and lifestyle 17b. Are there any caveats/warnings/ As these estimates are modelled they should be used problems? and interpreted with caution (see above). significance tests. Where does the data actually come Modelled by the National Centre for Social Research from? (NatCen). 10. TABLE 1 – INDICATOR DESCRIPTION Information Pg 4 Health Summary – Indicator 17 component Subject category/ Adults health and lifestyle domain(s) Indicator name (* Estimated prevalence of obese adults (*Obese adults) Indicator title in health profile) PHO with lead SEPHO responsibility . When does it measure it? Updated as ad-hoc. 3. 7. Why is it being measured? To estimate the expected proportion of obese adults in local authorities given the characteristics of local authority populations. What is being measured? Estimated prevalence of obese adults. or a local authority is statistically significantly better statistical process control to test the or worse respectively than the England average. Who does it measure? Adults (aged 16 and over). 2. 4. adults.

County Durham. Metropolitan County Districts. All these penalties as outlined in the table below (except the risk of gallstones and hip fracture) decrease with weight loss. the increased mechanical load increases liability to osteoarthritis and sleep apnoea.radcliffe-oxford.1 Hyperlipidaemia 1.5 20. Obesity is associated with the development of hormone-sensitive cancers.3 4. Wiltshire UA. Cornwall UA) are not based on modelled estimates but are calculated directly using results from the Health Surveys for England 2003-05. Proportion of various diseases attributable to obesity (BMI > 27 kg/m2) Disease Relative Risk Attributable proportion (%) Obesity   100.5 20. Thus there are many routes by which obesity is a detriment to wellbeing.9 13.6 9. Central Bedfordshire UA. Rationale: Expected prevalence of adult obesity. Obesity causes insulin insensitivity. Timeliness Updated as ad-hoc.5 Stroke 3.0 Osteoarthritis 1.0 14.9 24. percentage of resident population.2 3. Exceptions: Data for the 9 new 2009 UAs (Bedford UA.Health Profiles 2009  The Indicator Guide 157 Section 4: adult’s health and lifestyle Date of PHO 21/01/2009 dataset creation Indicator definition Prevalence of obesity. Cheshire West and Chester UA. Obesity decreases life expectancy by up to nine years.7 Gout 2. persons.2 Genitourinary cancer 1.9 Angina pectoris 2.7 NIDDM 2. Unitary Authorities.1 Hip fracture 0. London Boroughs. Obesity carries psychosocial penalties. heart disease.com/obframe.8 11.8 -3. Geography Local Authority: County Districts.7 Breast cancer 1. Cheshire East UA. 2003–2005.3 Colorectal cancer 1. Shropshire UA.5 7. which is an important causal factor in diabetes.0 Hypertension 2. hypertension and stroke.1 Myocardial infarcation 1.html . adults. Northumberland UA.9 24.1 25.8 Venous thrombosis 1. What this indicator purports to measure Rationale: Obesity in adults is defined for epidemiological purposes as body mass index Public Health (BMI) > 30 kg/m2. There is an association between all cause mortality and Importance obesity.5 7.8 Gall-bladder disease 2.5 Source: http://hcna.

Health.5 billion per year. cannot be used to monitor performance or change over time. This has led to inconsistencies between lower tier and county estimates for some areas as the datasets are derived using different methods. However obesity at any prevalence level greater than 0 is undesirable. They will almost measurement certainly not mirror precisely any available measures from local studies or method surveys (although research by NatCen and others have shown that they tend to be related). is not based on risk factors such as physical activity levels and calorie intake. and therefore a low indicator value should not mean that PH action is not needed.uk/resources/AtoZ/toolkit_obesity/obesity_toolkit_intro.e. pdf Tackling Obesity in England. http://guidance.org.uk/publications/nao_reports/00-01/0001220. http://www. Policy relevance http://www.gov. This may lead to estimated obesity levels which are at odds with other risk factors estimates such as healthy eating and physical activity.uk/CG43 Rationale: Purpose To estimate the expected proportion of obese adults in local authorities given behind the the characteristics of local authority populations.fphm.uk/en/Publicationsandstatistics/Publications/AnnualReports/ Browsable/DH_4875027 Tackling Obesity: A Toolbox for Local Partnership Action (The National Heart Forum. The model used is a non-aetiological model i.Health Profiles 2009  The Indicator Guide 158 Section 4: adult’s health and lifestyle It is estimated that obesity costs the NHS over £1 billion per year and society as a whole up to £3. local lifestyle survey results and modelled estimates which use known co-variates (see variables used in generation of model in calculation of indicator section below). 2001) http://www. indicator Rationale: Choosing Health: Making healthy choices easier (Dept.nice.dh.nao. A low indicator value (green circle in health summary chart) represents a statistically significant lower level (better) of expected estimated adult obesity prevalence given the characteristics of the population for that local authority when compared to the national value. . therefore.dh. local initiatives designed to reduce obesity). plus new 2009 UA areas) which are based on actual Health Survey for England data. Effective interventions exist to prevent and treat obesity. Interpretation: It is important that users note that these model based do not take account of Potential for error any additional local factors that may impact on the true obesity prevalence rate due to type of in an area (e. inclusion of the To help reduce the prevalence of obesity. The figures. There may also be a discrepancy between the modelled lower tier estimates (districts) and upper tier estimates (County geographies and above. 2002). assessment and management of overweight and obesity in adults and children.g. See NICE guidance – Obesity: the prevention. 2007) http://www.org.gov.pdf Interpretation: A high indicator value (red circle in health summary chart) represents a What a high/low statistically significant higher level (worse) of expected estimated adult obesity level of indicator prevalence given the characteristics of the population for that local authority value means when compared to the national value. 2004). 2001 (National Audit Office.org. identification.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_4094550 Obesity: Defusing the Health Time Bomb (from the Annual Report of the Chief Medical Officer.

g. Sampling errors arise solely as a result of drawing a sample rather than confounding conducting a full survey of the population. • The 2003–05 based estimates were adjusted to be consistent with the direct survey estimates at GOR/SHA level. should be treated with caution. In statistical terms. the model-based estimates are unable to take account of any additional local factors that may impact on the true prevalence rate (e. Non sampling error may include e.g. Users should also note that the potential sources of bias and error also apply to any ranking or banding of the small-area estimates.and not an estimate of the actual prevalence. To interpret the estimates. The confidence intervals provide a range within which we can be fairly sure the ‘true’ value for that area lies. The suitability of the chosen models for the given data and the validity of the model in describing real world dynamics have a bearing on the nature and magnitude of the errors introduced. • The 2003–2005 model based estimates are not comparable with the preceding estimates for 2000–2002 owing to differences in geography and modelling methodology: • The 2000–2002 LA estimates were calculated by aggregating the model- based estimates for the component wards. the model-based estimate is actually a biased estimate of the true value for the area and. local initiatives designed to reduce obesity). interview bias and refusal to participate. not just the estimate. NatCen recommend that users adopt statements such as “given the characteristics of the local population we would expect approximately x% of adults within LA Y to be obese”. the smaller the sample size the larger the variability in the estimates that one would expect to obtain from all the possible samples. respondent bias. A key source of modelling error arises from omitting variables that would otherwise help improve the model predictions either by error or because there is no available or reliable data source for them. Validation exercises were used to check the appropriateness of the chosen models. The 2003–05 LA estimates have been calculated by modelling directly at the LA level. The model-based estimate generated for a particular area is the expected measure for that area based on its population characteristics . Estimates for two areas can only be described as significantly different if the confidence intervals for the estimates do not overlap. The use of statistical models for prediction involves making assumptions about relationships in the data. Generally. It is recommended that users look at the confidence interval for the estimates. . NatCen do not encourage any ranking of small area estimates within larger areas such as Local Authorities. As mentioned above. Primary Care Organisations and Strategic Health Authorities. Confidence intervals have been calculated for the model-based estimates to capture both sampling and modelling error. as such. Non-sampling errors arise during the course of the survey activities and there is no simple direct way of estimating the size of these errors. • The choice of co-variate data was different as both the Index of Multiple deprivation 2004 and ONS area classifications were excluded in the 2003– 05 estimates owing to their statistical relationship with other census-based covariates.Health Profiles 2009  The Indicator Guide 159 Section 4: adult’s health and lifestyle Interpretation: These model based healthy lifestyle indicators are derived using the Health Potential for error Survey for England data and are subject to both sampling and non-sampling due to bias and error.

The wider is the confidence interval the greater is the uncertainty in the estimate. but chance had led to a different set of data. the interval can be used to test whether the value is statistically significantly different to the national. The use of 95% is arbitrary but is conventional practice in medicine and public health. aggregated or averaged over any other spatial unit). uncertainty also arises from random differences between the sample and the population itself. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. for example. the difference is statistically significant and the value is shown on the health summary chart with a red or green symbol depending on whether it is worse or better than the national value respectively. generally speaking. The confidence intervals have also been used to make comparisons against the national value. Confidence intervals quantify the uncertainty in this estimate and. These occurrences result in random fluctuations in the indicator value between different areas and time periods. under these conditions. the difference is not statistically significant and the value is shown on the health summary chart with an amber symbol. Confidence intervals are given with a stated probability level. Variable Obesity in adults is defined for epidemiological purposes as body mass index (BMI) > 30 kg/m2. a mortality and purpose rate. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us.e. Indicator definition: Percentage of resident adult population aged 16 and over Statistic Indicator definition: Persons Gender Indicator definition: Adults (aged 16 and over) age group . This term is applied to any set of ONS statistics that do not meet the rigorous quality standards of National Statistics and/or may be subject to change due to methodological development. TABLE 2 – INDICATOR SPECIFICATION Indicator definition: Prevalence of obesity. As a result of limitations in the model based estimates they are published as “experimental statistics”. If the interval includes the national value. describe how much different the point estimate could have been if the underlying conditions stayed the same. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. In the case of indicators based on a sample of the population. and so we say that there is a 95% probability that the interval covers the true value. If the interval does not include the national value. In Health Profiles 2009 this is 95%.Health Profiles 2009  The Indicator Guide 160 Section 4: adult’s health and lifestyle The model-based estimates have been produced solely for LAs and cannot be translated onto any other geographical boundary system (i.

December 2007 (see link above). Data extraction: 16/01/2008 date Numerator: Model estimates by NatCen using data from a number of sources including definition Health Survey for England 2003–2005. Table 3 – Indicator Technical Methods Numerator: Not applicable. definition Denominator: Not applicable. source Data quality: The model-based approach generates estimates that are of a different nature Accuracy and from standard survey estimates because they are dependent upon how well completeness the relationship between healthy lifestyle behaviours for individuals and the Census/administrative information about the area in which they live are specified in the model. Source Data extraction: Data received directly from NatCen. source URL Also published by IC.nhs. Denominator: Not applicable.Health Profiles 2009  The Indicator Guide 161 Section 4: adult’s health and lifestyle Indicator definition: 2003–2005 period Indicator definition: scale Geography: MSOA geographies available from http://www. of inequality: subgroup analyses of this dataset available from other providers Data extraction: National Centre for Social Research (NatCen). caveats .uk/pubs/healthylifestyles05 available for this indicator from other providers Dimensions None. aggregation / allocation Numerator data See Interpretation: potential sources of error section. Numerator: source NatCen.ic. The accuracy and completeness of the information will be subject to the same constraints surrounding the Health Survey for England and Census data sets on which they are based (see Interpretation: potential sources of error section). extraction Numerator: Not applicable. Census 2001.

Health Profiles 2009  The Indicator Guide 162 Section 4: adult’s health and lifestyle Denominator data Not applicable.pdf For methods used to calculate data for new 2009 UAs please see metadata for upper tier geographies. emergency hospital admissions. As a result. Other routine sources of data providing area-level characteristics for LAs included all age-all cause mortality. For a fuller technical description of the methodology see the Model-Based Estimates User Guide and other reports available on the Information Centre website: http://www. 4 or 5. there may be inconsistencies between lower tier and county estimates for some areas as the datasets are derived using different methods. However. diversity index. and a higher proportion of households without basic amenties (central heating and/or sole use of a bath). The area-level characteristics associated with decreased propensity for an adult to be classed as obese were: a higher proportion of residents aged 16–74 whose highest qualification attained was Level 2. . • The model outputs were applied in conjunction with covariate data (available for all LAs) to estimate the ‘expected’ prevalence given the characteristics of the area. The 2001 Census provided the main source for demographic and social covariate data. The relevant ratios of the HSfE direct estimates to the aggregated model-based estimates at GOR/SHA level were then used to scale the model based LA level estimates. life expectancy. job seekers allowance claimant counts and educational attainment. • An adjustment factor was applied to ensure that the model-based estimates for each LA corresponded with the 2003–2005 direct estimates at GOR/SHA level taken from the Health Survey for England data. the model-based estimates have not been calibrated to ensure agreement at County level. and a higher proportion of male residents. a relatively higher proportion of residents aged 20–24. hospital admissions attributable to alcohol. This was done by aggregating the model-based estimates to GOR/SHA and comparing to the direct estimates. caveats Methods used to The process of creating the model-based estimates of healthy lifestyle calculate indicator behaviours involved three main stages: value • A statistical model was used to represent the relationships between obesity and area-level characteristics in the small areas covered by the HSfE. a relatively higher proportion of Income Support claimants who were classifed as ‘carers and others’. The model-based estimates were constrained to the direct GOR/SHA estimates taken from the Health Survey for England data. The area level characteristics associated with increased propensity for a person to be classed as obese were: a higher proportion of residents of Black or ethnic origin.nhs.uk/webfiles/Popgeog/Healthy%20Lifestyle%20 Behaviours-%20Model%20Based%20Estimates%20for%20Middle%20 Layer%20Super%20Output%20Areas%20and%20Local%20Authorities%20 in%20England_2003-2005__%20User%20Guide.ic. a higher proportion of residents aged 16–74 who had never worked or were long-term unemployed.

an estimate of the variance of the difference between the model-based estimate and the true LA measure is required. How Isles of Scilly and City of London populations have been dealt with Disclosure Control Not applicable. Confidence The model based estimate generated for a particular LA is the expected Intervals measure for that LA based on its characteristics as measured by the covariates calculation method in the model. σˆ v2v  N is the population estimate of the number of adults in LA i. By placing confidence intervals around a model-based estimate. we can generate a range within which we can be fairly sure the ‘true’ value for that area lies.96  ˆ  ∑ σˆ + σˆ v + X i Var ( β ) X i  T  2  T βˆ X i   j =1  N i   u     1+ e         where: Χi is the vector of covariates values for LA i. The estimate of the variance has two components which correspond to the variance that is not explained by the model (and hence is not predicted by the model-based estimate) and the uncertainty of the model-based estimate itself. M and i  Mi is the number of postcode sectors in LA i. the model-based estimate is actually a biased estimate of the true value for an area and. Obtaining the confidence interval for the LA estimates required computing two area-level variance terms: one for the Primary Sampling Units and one for the LA. however. . Xi  β̂ is the vector of parameter estimates for the LA-level covariates. Ni i  Nijij is N the population estimate of the number of adults in postcode sector ij. σ̂ u  σˆ 2 is the estimate of the between LA-level variance. In statistical terms. β̂  σ̂2u2 is the estimate of the between PSU-level variance. as such. The first term was required to allow for the clustering in the sample and the second term to estimate the residual variance at the LA level that was not explained by the model. should be treated with caution.Health Profiles 2009  The Indicator Guide 163 Section 4: adult’s health and lifestyle Small Populations: Model based estimates were not produced for Isles of Scilly or City of London. The confidence interval for the model-based LA estimates was estimated to be: 1   βˆ T X i 2  2   e    N ij   2 Mi 2  −1  ˆ ˆ T log it α + β X i ± 1. In order to generate the confidence interval.

Health Profiles 2009  The Indicator Guide 164 Section 5: Disease and poor health .

significance tests. 3.Health Profiles 2009  The Indicator Guide 165 Section 5: disease and poor health 18. Where does the data actually come 2001 Census. or a local authority is statistically significantly better statistical process control to test the or worse respectively than the England average. Who does it measure? All persons. What is being measured? Over 65s Self-Assessed General Health: ‘Not Good’. from? 8. meaning of the data and the variation based on the 95% confidence intervals of the figure they show? compared to the England value. Why is it being measured? As a perception of general health. 10. proportions? 7. 6. This indicator may help monitor likely health care burden. Are there any caveats/ warnings/ ‘Not in good health’ is the self-assessed perception problems? of health and therefore subject to differing thresholds applied by individuals. 2. 5. When does it measure it? 2001. Will it measure absolute numbers or Age and sex standardised percentage. Are particular tests needed such as The data point is green or red when the figure in standardisation. ONS. 2001. 9. 65 years and over. over 65s. directly age and sex standardised percentage. . How is this indicator actually defined? Self assessed general health: ‘Not Good’. OVER 65s ‘NOT IN GOOD HEALTH’ INDICATOR Basic Information 1. 4. persons. How accurate and complete will the This census data has been subject to edit and data be? imputation procedures to correct for incorrect or missing data. next Census will be in 2011.

org. Policy relevance Interpretation: A high indicator value (red blob in spine chart) represents a statistically What a high/low significant higher level of estimated self assessed “not good” health for that level of indicator local authority when compared to the national value. Time trend analysis is appropriate. next update available in 2012. Metropolitan County Districts. GOR.nwpho. behind the inclusion of the indicator Rationale: No direct policy driver. Rationale: Perception of General Health. London Boroughs Timeliness Every 10 years. uk/inequalities) Rationale: Purpose To help monitor likely health care burden. persons Geography England. For further information see: Where Wealth means Health (www. over 65s. Self reported single item of health has a good correlation Importance with mortality and health care utilisation. 2001. What this indicator purports to measure Rationale: The indicator was chosen as the best available measure of self assessed Public Health population health. Unitary Authorities. Local Authority: Counties. County Districts. . directly age and sex standardised percentage.Health Profiles 2009  The Indicator Guide 166 Section 5: disease and poor health Table 1 – Indicator Description Information Pg 4 Health Summary – Indicator No 18 component Subject category/ Disease and poor health. value means A low indicator value (green blob) represents a statistically significant lower level of estimated self assessed “not good” health for that local authority when compared to the national value. domain(s) Indicator name (* Over-65s ‘not in good health’ Indicator title in health profile) PHO with lead WMPHO responsibility Date of PHO 12/02/2009 dataset creation Indicator definition Self Assessed General Health: ‘Not Good’.

Age standardisation does assume that minor differences in age structure within age bands are unimportant and in general this is true for younger age groups. due to type of Age standardisation does assume that minor differences in age structure within measurement age bands are unimportant and in general this is true for younger age groups. Although age standardisation will reduce the effect of age differences in the population it cannot be assumed to eliminate them. . especially as all over 85s are grouped together.Health Profiles 2009  The Indicator Guide 167 Section 5: disease and poor health Interpretation: Self reported health status can be subject to variation according to non Potential for error causative effects (e. Although age standardisation will reduce the effect of age differences in the population it cannot be assumed to eliminate them. especially as all over 85’s are grouped together. However with older groups minor differences in average age within age band may become important. good weather). hospitals • Rough sleepers • Areas with high population density • Areas with high numbers of multi-occupancy households • Migrants: someone who spends 3 to 12 months in the country for certain purposes (excluding tourism). The European Standard Population is younger than the UK population and therefore biases comparisons towards younger age groups. asylum seekers. The European Standard Population is younger than the UK population and therefore biases comparisons towards younger age groups. nursing homes. Interpretation: The following groups may be under-sampled within the census: Potential for error • Areas with high non-white population due to bias and • Full-time students aged 18–74 (out of term time residents) confounding • Prisoners • Men aged 20–39 • Residential homes.g. This can result in an underestimate or overestimate of self assessed ill-health in some areas. migrant/seasonal workers. method However with older groups minor differences in average age within age band may become important.

under these conditions. but chance had led to a different set of data. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value.Health Profiles 2009  The Indicator Guide 168 Section 5: disease and poor health Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. . and so we say that there is a 95% probability that the interval covers the true value. the interval can be used to test whether the value is statistically significantly different to the national. the difference is statistically significant and the value is shown on the health summary chart with a red or green symbol depending on whether it is worse or better than the national value respectively. The use of 95% is arbitrary but is conventional practice in medicine and public health. These occurrences result in random fluctuations in the indicator value between different areas and time periods. generally speaking. Confidence intervals are given with a stated probability level. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. uncertainty also arises from random differences between the sample and the population itself. The wider the confidence interval. In the case of indicators based on a sample of the population. for example. a mortality and purpose rate. the difference is not statistically significant and the value is shown on the health summary chart with an amber symbol. If the interval includes the national value. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. Confidence intervals quantify the uncertainty in this estimate and. the greater the uncertainty in the estimate. describe how much different the point estimate could have been if the underlying conditions stayed the same. In Health Profiles 2009 this is 95%. The confidence intervals have also been used to make comparisons against the national value. If the interval does not include the national value.

it did not include anyone present on Census Day who had another usual address or anyone who had been living or intended to live in a special establishment.nomisweb.asp source URL Data extraction: Data extracted from source as at: 12/02/2009 date Numerator: All people aged over 65 usually resident in the area at the time of the 2001 definition Census.uk/Default.Health Profiles 2009  The Indicator Guide 169 Section 5: disease and poor health Table 2 – Indicator Specification Indicator definition: Self Assessed General Health: ‘Not Good’ (over 65s) Variable Indicator definition: Directly age & sex standardised percentage Statistic Indicator definition: Persons Gender Indicator definition: Over 65s age group Indicator definition: 2001 period Indicator definition: Age & sex standardised percentage scale Geography: Unique dataset not available elsewhere. if it was their term-time address. . However. people who worked away from home for part of the time. a baby born before 30 April 2001 even if it was still in hospital. nursing home or hospital. visiting friends or relatives. such as a residential home. and people present on Census Day.co. of inequality: subgroup analyses of this dataset available from other providers Data extraction: Nomis Official Labour Market Statistics (a service provided by the Office for Source National Statistics) Data extraction: https://www. even if temporarily. or temporarily in a hospital or similar establishment). Numerator: source Office for National Statistics (ONS). students. for six months or more. Denominator: All people aged over 65 counted as usually resident in the area at the time of definition the 2001 Census by 5 year age band. A usual resident was generally defined as someone who spent most of their time at a specific address. who had no other usual address. who described their general health in the 12 months before Census day as ‘Not good’. It included: people who usually lived at that address but were temporarily away (on holiday. geographies available for this indicator from other providers Dimensions None.

completeness covering every local authority. Response rates were lowest for inner city areas where characteristics known to be related to non-response such as multi-occupancy and higher proportions of non-English speaking population. an Accuracy and independent doorstep survey of a sample of a third of a million households. Numerator: Where available data published for higher geographies has been used and aggregation/ not aggregated from lower geographies. since the 2001 census new Unitary Authorities have been created. This census data has been subject to edit and imputation procedures to correct for incorrect or missing data. Table 3 – Indicator Technical Methods Numerator: extraction Downloaded from Nomis website. Shropshire. . which was used to adjust the Census counts for under-enumeration. New UA name Old LA name Bedford Bedford Central Bedfordshire Mid Bedfordshire South Bedfordshire Cheshire East Congleton Crewe and Nantwich Macclesfield Cheshire West and Chester Chester Ellesmere Port & Neston Vale Royal Cornwall* Caradon Carrick Kerrier North Cornwall Penwith Restormel *=Cornwall Unitary Authority is the same as the previous Cornwall County however the data for this county in the data source was aggregated with Isles of Scilly and so has instead been aggregated from its local authorities. including checks against administrative records and sources of information on particular groups such as students and the armed forces. The new Unitary Authorities of Northumberland. are most prevalent. Wiltshire and Durham have the same boundaries as the counties of the same name so have been allocated these data. There has been an extensive quality assurance process. However. source Data quality: The Census was followed by the Census Coverage Survey (CCS). Data for five other new unitary Authorities have been calculated from the aggregation of previous Local Authorities.Health Profiles 2009  The Indicator Guide 170 Section 5: disease and poor health Denominator: Office for National Statistics (ONS). Under-enumeration in the 2001 Census did not occur uniformly across all areas. This census data has been subject allocation to edit and imputation procedures to correct for incorrect or missing data as a result summation of areas to higher geographies may not result in the total stated in the published census data.

The methodology is explained in detail in the APHO Technical Briefing on Commonly Used Public Health Statistics and their Confidence Intervals http://www.org. Breslow NE. This is less accurate for small numerators so for numerators less than 389 an exact method based on the Poisson distribution2 has been used.apho.org. Day NE. Small Populations: Isles of Scilly and City of London are excluded from local authority level but How Isles of Scilly are included for higher level geographies.uk/resource/view. 1. 1994.aspx?RID=48617. Sex standardisation has been used. a percentage.aspx?RID=48457 and the associated Excel tool http://www. Oxford: Blackwell. The standard population used is the European Standard Population for age standardisation. 3. World Health Organisation. Armitage P. The European Standard Population is younger than the UK population and therefore biases comparisons towards younger age groups. However with older groups minor differences in average age within age band may become important. 1987. Confidence intervals for weighted sums of Poisson parameters. based on a 1:1 ratio of males and females. Statistical methods in cancer research. . 2.Health Profiles 2009  The Indicator Guide 171 Section 5: disease and poor health Numerator data See earlier comments on Data quality: Accuracy and completeness caveats Denominator data See earlier comments on Data quality: Accuracy and completeness caveats Methods used to The directly age & sex standardised rate is the rate of events that would calculate indicator occur in a population with a standard age and sex structure if that value population were to experience the age & sex specific rates of the subject population.uk/resource/item. volume II: The design and analysis of cohort studies. especially as all over 85’s are grouped together. Stat Med 1991.org. Lyon: International Agency for Research on Cancer.apho. Age standardisation does assume that minor differences in age structure within age bands are unimportant and in general this is true for younger age groups.8% confidence intervals were calculated using a method calculation method described by Dobson1.e. Statistical methods in medical research (3rd edn).apho.aspx?RID=48617. Although age standardisation will reduce the effect of age differences in the population it cannot be assumed to eliminate them. The methodology is explained in detail in the APHO Technical Briefing on Commonly Used Public Health Statistics and their Confidence Intervals http://www.10:457-62.org.uk/resource/view. Dobson A et al. This has been expressed as a rate per 100 i. The Byar’s1 method has been used when the numerator is greater than 388. Berry G.apho. because females have a longer life expectancy and therefore make up a larger proportion of responses in older age groups.uk/resource/item.aspx?RID=48457 and the associated Excel tool http://www. and City of London populations have been dealt with Disclosure Control Not applicable Confidence Intervals 95% and 99.

Table 1 – Indicator Description Information Pg 4 Health Summary: Indicator No 19. component Subject category/ Disease and poor health. MENTAL HEALTH INDICATOR Basic Information 1. 5. per thousand working age population. August and November 2008. significance tests.Health Profiles 2009  The Indicator Guide 172 Section 5: disease and poor health 19. Are there any caveats/warnings/ Benefit counts are rounded quarterly point estimates problems? from the end of February. 2007. 6. with mental or behavioural disorders. meaning of the data and the variation based on the 95% confidence intervals of the figure they show? compared to the England value. Crude rate. 8. What is being measured? Working age people who are in receipt of benefits for mental health conditions. domain(s) Indicator name Claimants/beneficiaries of incapacity benefit/severe disablement allowance (*Indicator title in with mental or behavioural disorders (*Incapacity benefits for mental illness). Where does the data actually come Collection and collation from incapacity benefits data from? via the Department for Work and Pensions. 7. Why is it being measured? People with long term psychiatric disabilities are less likely to be in employment than those with long- term physical disabilities. Who does it measure? Working age adults: 16–64 males and 16–59 females. May. all persons of working age. To help improve the provision of services to help mentally ill people find work and reduce social exclusion. 9. How is this indicator actually defined? Claimants/beneficiaries of incapacity benefit/severe disablement allowance. 10. despite indications that most people with severe mental illness would like to work. Are particular tests needed such as The data point is green or red when the figure in standardisation. 2. Population data are mid-2007 and rounded to the nearest 100. Will It measure absolute numbers or Proportions: number of working age claimants per proportions? thousand working age population. or a local authority is statistically significantly better statistical process control to test the or worse respectively than the England average. How accurate and complete will the The data is based on all claims for benefit (100% data be? sample) and double counts are removed. When does it measure it? Reported quarterly and updated every year. 4. health profile) . 3.

Severe mental illness severely restricts the capacity to fully participate in society and in particular the employment market. These high rates reflect the disability caused by severe mental illness. Geography England. crude rate. More than 900. Art.uk/pa/cm200506/cmselect/ cmworpen/616/6022719.parliament.1002/14651858. Bond G.htm Rationale: Purpose To estimate the prevalence of those with severe mental illness who are not behind the in work because of their mental ill health. These low rates of employment should be considered against the facts that at least 30-40% of people who are significantly disabled by enduring mental illness are capable of holding down a job.000 adults in England claim sickness and disability benefits for mental health conditions. No.: CD003080. Public Health and a direct measure of socio-economic disadvantage in those ‘not in work’ Importance because of mental illness. but they also reflect discrimination (unemployment rates are higher than in other disabled group) and the low priority given to employment by psychiatric services. Timeliness This indicator is potentially suitable for time-series analysis. People with long-term psychiatric disabilities are even less likely to be in employment than those with long-term physical disabilities. London Boroughs. working age.publications. Marshall M.CD003080 See Royal College of Psychiatrists Memorandum to Select Committee on Work and Pensions available at: http://www. Huxley P. Cochrane Database of Systematic Reviews 2001. Vocational rehabilitation services can help mentally ill people find work. This group is now larger than the total number of unemployed people claiming Jobseeker’s Allowance in England. surveys have consistently shown that most want to work. Metropolitan County Districts. 2007. Despite high unemployment rates amongst the severely mentally ill. purports to measure Rationale: This is a proxy measure of levels of severe mental illness in the community. Vocational rehabilitation for people with severe mental illness. males and females. County Districts. Unemployment rates are high amongst people with severe mental illness. DOI: 10. Unitary Authorities. Per 1000 working age population. In the UK unemployment rates of 60–100% have been reported. See: Crowther R. Rationale: Prevalence of working age people with severe mental illness who are in receipt What this indicator of benefits for mental health conditions. Issue 2. To help improve the provision of inclusion of the services for helping mentally ill people find work indicator .Health Profiles 2009  The Indicator Guide 173 Section 5: disease and poor health PHO with lead NEPHO responsibility Date of PHO February 2009 dataset creation Indicator definition Claimants/beneficiaries of incapacity benefit/severe disablement allowance with mental or behavioural disorders. Local Authority: Counties. GOR.

After this time. The report draws attention to the fact that adults with long- term mental health problems are one of the most excluded groups in society facing numerous barriers that only serve to stop them from achieving their full potential as individuals and members of the community as a whole. Interpretation: The first 28 weeks of incapacity are assessed under the “own occupation test” Potential for error which looks at a person’s ability to do their usual job and is based on medical due to type of certificates from a GP. and • difficulties in arranging home visits for some clients. The DWP uses a system that allocates points to certain activities and tasks. with 10 points needed to determine a person’s eligibility on grounds of mental incapacity. Forms are difficult to understand and complete. Mental Health National Service Framework Interpretation: An indicator value worse than average (red circle in health summary chart) What a high/low represents a statistically significant worse rate of benefit claimants for mental level of indicator and behavioural disorders for that local authority when compared to the value means national value.uk/pa/cm200506/cmselect/ cmworpen/616/6022719.htm . The assessment process may lead to underestimation of unemployment due to severe mental illness. There may be an “institutional bias” against people with mental health problems in the incapacity benefit questionnaire which does not establish information about fluctuating conditions. • poor recording of clinical findings. • incorrect assumptions based on information from the client and from the medical examination. and Disability Employment Brokers. • effects of mental illness not appropriately taken into account by the scoring system employed. the personal capability assessment (PCA) measurement applies which involves completing an incapacity questionnaire (IB50) that method assesses ability to do any work. Problems those with severe mental illness face with personal capability assessments conducted by Medical Services include: • doctors not listening to clients.parliament. New Deal for Disabled People. Mental health descriptors are not itemised in the same detail as physical descriptors and a client is therefore less likely to answer in the way most helpful to a successful outcome in their case. An indicator value better than average (green circle in health summary chart) represents a statistically significant better rate of benefit claimants for mental and behavioural disorders for that local authority when compared to the national value. Current government policy is focusing on finding ways of returning people to work via initiatives such as Pathways to Work.Health Profiles 2009  The Indicator Guide 174 Section 5: disease and poor health Rationale: In June 2004 the Social Exclusion Unit of the Office of the Deputy Prime Policy relevance Minister (ODPM) published the ‘Mental Health and Social Exclusion’ report.publications. See Royal College of Psychiatrists Memorandum to Select Committee on Work and Pensions available at: http://www. This report highlights the large number of adults in England claiming sickness and disability benefits for mental health conditions (approximately 40% of all claims) with the statistics showing that more adults now fall into this group than the total number of unemployed people claiming Jobseeker’s Allowance.

See Royal College of Psychiatrists Memorandum to Select Committee on Work and Pensions available at: http://www. • Permitted work rules: These may deter people who will be at risk of losing incapacity benefit and associated benefits. (For example. Therefore severe mental illness as a cause of inability to participate in the labour market may be overestimated due to these disincentives to return to work. education and training – which can help get back to work . • Fear of drop in income.parliament. • Transition to work may disrupt income: People returning to work will lose housing benefit. • 52-week linking rule: The time period may not be long enough for people whose illness has a relapsing and remitting course. the average time to clinical relapse for people being treated for schizophrenia is approximately two years.Health Profiles 2009  The Indicator Guide 175 Section 5: disease and poor health Interpretation: There may be disincentives to return to work: These include: Potential for error • Medical review process: There are concerns that engagement in voluntary due to bias and work.uk/pa/cm200506/cmselect/ cmworpen/616/6022719. .may confounding trigger the medical review process. independent benefits advice on return to work. those with functional illiteracy.) • Difficulties in getting financial support for practical needs at work.htm There are groups of people who may be less likely to engage with. This may underestimate the problem. married women. or be able to benefit from. rough sleepers. Should the return to work fail. • Lack of expert. the benefit system eg certain ethnic minorities. they will be at risk of losing their home.publications.

The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. uncertainty also arises from random differences between the sample and the population itself. a mortality and purpose rate. the difference is not statistically significant and the value is shown on the health summary chart with an amber symbol. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. These occurrences result in random fluctuations in the indicator value between different areas and time periods. scale . under these conditions. If the interval does not include the national value. Indicator definition: Crude rate. Confidence intervals are given with a stated probability level. Statistic Indicator definition: Males and Females. In the case of indicators based on a sample of the population. Confidence intervals quantify the uncertainty in this estimate and. Table 2 – Indicator Specification Indicator definition: Claimants/beneficiaries of incapacity benefit/severe disablement allowance Variable with mental or behavioural disorders. the difference is statistically significant and the value is shown on the health summary chart with a red or green symbol depending on whether it is worse or better than the national value respectively. The confidence intervals have also been used to make comparisons against the national value. If the interval includes the national value. describe how much different the point estimate could have been if the underlying conditions stayed the same. for example. generally speaking. the interval can be used to test whether the value is statistically significantly different to the national. The wider is the confidence interval the greater is the uncertainty in the estimate. Gender Indicator definition: 16–64 yrs (males working age) age group 16– 59 yrs (females working age) Indicator definition: 2007 period Indicator definition: Per 1000 working age population. For this purpose the national value has been treated as an exact reference value rather than as an estimate and.Health Profiles 2009  The Indicator Guide 176 Section 5: disease and poor health Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. In Health Profiles 2009 this is 95%. and so we say that there is a 95% probability that the interval covers the true value. but chance had led to a different set of data. The use of 95% is arbitrary but is conventional practice in medicine and public health.

. The advanced query tool provided on this website was used to extract relevant data at local authority district level. of inequality: subgroup analyses Data relating to the age and gender of benefit claimants is collected by the of this dataset DWP and may be available upon request. Accuracy and completeness Table 3 – Indicator Technical Methods Numerator: Quarterly benefit claimant statistics are published routinely on the NOMIS extraction website (http://www.co. For the definition purposes of calculating this indicator working age has been defined as 16 to 64 years for males and 16 to 59 years for females.co. Wards.Health Profiles 2009  The Indicator Guide 177 Section 5: disease and poor health Geography: Super Output Area. date Numerator: Count of working age claimants/beneficiaries of incapacity benefit/severe definition disablement allowance with mental or behavioural problems. This can result in a margin of error. Metropolitan County Districts. available from other providers Data extraction: Numerator: NOMIS Source Denominator: Office for National Statistics (ONS) Data extraction: Numerator: source URL http://www. England. Denominator data Local authority level working-age mid-2007 population estimates. May. allocation August and November 2007. source Data quality: This is a 100% data source with double-counts removed. Aggregated numerator data is based upon rounded data. Numerator: Average annual benefit count figures at local authority district level were aggregation/ derived from quarterly benefit count figures taken at the end of February. 2007.uk/statbase/Product. Numerator data The numerator counts are derived from quarterly figures recorded as point caveats estimates taken at the end of February. Denominator: Estimated count of working age people (rounded to nearest 100).statistics. available for this indicator from Available from Department of Work & Pensions. Unitary Authorities. August and November 2007.uk Denominator: http://www.gov. GOR. other providers Dimensions None. Local Authority: Counties. London Boroughs. Numerator: source NOMIS/Department for Work and Pensions. Data are caveats rounded to nearest 100 to comply with ONS publication policy. May.nomisweb. Denominator: Office for National Statistics (ONS). County geographies Districts.nomisweb.uk).asp?vlnk=15106 Data extraction: 4 February 2009. 2007.

. For new the unitary authorities where totals of old local authority district level populations did not total up to ONS county council population. This value was then rounded to the nearest value of ten. r and hence p are both zero. The numerator was then divided by the denominator. and the recommended confidence interval simplifies to 0 to z2/(n+z2). J Am Stat Assoc 1927. the ONS total for the counties was used. calculate the three quantities A = 2r + z2.000 working age population. the interval becomes n/(n+z2) to 1. The local authority values were extracted from this table and these values were then multiplied by 1000 to give unit level figures rounded to the nearest number of 100. where z is the appropriate value. RG. from the standard Normal distribution. Numerator values have been rounded to the nearest value of ten as a means of disclosure control. z1-α/2. the resulting value was then multiplied by 1000 to give a crude rate per 1. 209-212 Newcombe.Health Profiles 2009  The Indicator Guide 178 Section 5: disease and poor health Methods used to Mental Health Indicator: calculate indicator Calculation of the numerator: average annual count of claimants/beneficiaries value of incapacity benefit/severe disablement allowance February to November 2007 was calculated by adding four quarterly counts together and dividing the result by four. 22. Second. proportion with feature of interest = p = r/n proportion without feature of interest = q = 1 . Calculation of the denominator: Persons level working age population data was downloaded from the ONS website. First calculate the estimated proportions of subjects with (p) and without (q) some feature of interest from a sample of size n. Totals for counties and regions were calculated by aggregating up the local authority district level data to the appropriate geography. populations have been dealt with Disclosure Control To preserve claimant confidentiality this data is rounded by the DWP prior to publication. Small Populations: Isles of Scilly and City of London have been included in regional and England How Isles of Scilly numerators and denominators. Then the confidence interval for the population proportion is given by (A-B)/C to (A+B)/C This method has the considerable advantage that it can be used for any data. When there are no observed events.17:857-72. Isles of Scilly has been included in the and City of London numerator and denominator for the County of Cornwall. Stat Med 1998. Wilson EB. Confidence The 95% confidence intervals are calculated with the method described Intervals by Wilson and by Newcombe which is a good approximation of the exact calculation method method. When r = n so that p = 1. Two-sided confidence intervals for the single proportion: comparison of seven methods. Denominator values are rounded to the nearest value of 100 as a means of disclosure control.p where r is the observed number of subjects with the feature of interest. B = z z 2 + 4rq . and C=2(n+z2).

000 European Standard population. HOSPITAL STAYS FOR ALCOHOL RELATED HARM INDICATOR Basic Information 1. This indicator may help to monitor likely health care burden. admissions per 100. all ages. How is this indicator Hospital Admissions for Alcohol Related Harm (2007/08). Are particular The data point is green or red when the figure in a local authority is tests needed such statistically significantly better or worse respectively than the England as standardisation. What is being Hospital stays for Alcohol Related Harm: NI39. measure? 5. component Subject category/ Disease and poor health. How accurate and HES Data and ONS population statistics are considered to be complete and complete will the data robust. Where does the data Collection and collation from Hospital Episode Statistics via the DH. proportions? 7. 3. 20. (*Indicator title in health profile) . all ages. When does it Continually reported and updated every year. Are there any Hospital admission data can be coded differently in different parts of the caveats/ warnings/ country. actually come from? 8.Health Profiles 2009  The Indicator Guide 179 Section 5: disease and poor health 20. or statistical process control to test the meaning of the data and the variation they show? Table 1 – Indicator Description Information Pg 4 Health Summary – Indicator No. measured? 2. measure it? 6. domain(s) Indicator name Hospital stays for alcohol-related harm. Will it measure Proportions: numbers of admissions per hundred thousand European absolute numbers or standard population. problems? 10. Who does it All admissions. directly age and actually defined? sex standardised rate. 4. average. the England value. be? 9. based on the 95% confidence intervals of the figure compared to significance tests. Why is it being The acute or long term effects of excessive alcohol consumption are a measured? major cause of avoidable hospital admissions.

pdf Geography The following geographies: England. Local Authority: County Districts.nwph. Health Profiles 2007 and Health Profiles 2008 because the indicator calculation changed from multiple years to a single year.dh. based on residence in the area. London Boroughs.net/alcohol/lape Timeliness Updated every year. these are: Vital Signs Indicator VSC26. age and sex specific attributable indicator fractions can be found at: http://www. GOR. Interpretation: A high indicator value (red circle in health summary chart) represents a What a high/low statistically significant higher level of hospital admissions for alcohol-related harm level of indicator for that local authority when compared to the national value.2. A comprehensive list of ICD10 codes.uk/en/Publichealth/Healthimprovement/Alcoholmisuse/ DH_085387 This indicator is included in three key indicator sets and performance management frameworks. per 100.pdf measure Rationale: The acute or long term effects of excessive alcohol consumption are a major Public Health cause of avoidable hospital admissions. next update available in 2010. Full indicator definition can be found at: http://www.uk/media/cabinetoffice/strategy/assets/caboffce%20alcoholhar. Metropolitan County Districts. www. responsibility Date of PHO March 2009.Health Profiles 2009  The Indicator Guide 180 Section 5: disease and poor health PHO with lead NWPHO. National Indicator NI39 and Public Service Agreement Indicator 25.gov.000 European Standard population. Time trend analysis is appropriate from data available from the NWPHO. Potential for error due to type of measurement method . relevance gov. Rationale: This indicator measures the number of admissions to hospital for alcohol-related What this harm. value means A low indicator value (green circle in health summary chart) represents a statistically significant lower level of hospital admissions for alcohol-related harm for that local authority when compared to the national value. for this and other alcohol related indicators are available from the NWPHO web site.cabinetoffice. Interpretation: Hospital admission data can be coded differently in different parts of the country. Unitary Authorities. directly age and sex definition standardised hospital admissions for all ages. Reducing Alcohol Harm (2008) http://www. Purpose behind the inclusion of the indicator Rationale: Policy Alcohol Harm Reduction Strategy for England (2004): http://www. dataset creation Indicator Hospital admissions for alcohol-related harm 2007/08.net/alcohol/lape/NI39Technical_ purports to Dec2008. Time trend analysis should not be done between Health Profiles 2006. Importance Rationale: To help monitor likely health care burden.net/alcohol/lape/NI39Technical_Dec2008.nwph.pdf.nwph.

uncertainty also arises from random differences between the sample and the population itself. the interval can be used to test whether the value is statistically significantly different to the national.000 European Standard population. The confidence intervals have also been used to make comparisons against the national value. Gender Indicator definition: All Ages. Confidence intervals quantify the uncertainty in this estimate and. If the interval does not include the national value. describe how much different the point estimate could have been if the underlying conditions stayed the same. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. In Health Profiles this is 95%. age group Indicator definition: 2007/08. but chance had led to a different set of data.Health Profiles 2009  The Indicator Guide 181 Section 5: disease and poor health Interpretation: Potential for error due to bias and confounding Confidence A confidence interval is a range of values that is normally used to describe the Intervals: uncertainty around a point estimate of a quantity. The use of 95% is arbitrary but is conventional practice in medicine and public health. Variable Indicator definition: Directly age and sex standardised rate. If the interval includes the national value. Statistic Indicator definition: Persons. This uncertainty arises as factors influencing the indicator are subject to purpose chance occurrences that are inherent in the world around us. Table 2 – Indicator Specification Indicator definition: Hospital Admissions for Alcohol-Related Harm. a mortality Definition and rate. generally speaking. period Indicator definition: Per 100. for example. the difference is statistically significant and the value is shown on the health summary chart with a red or amber symbol depending on whether it is worse or better than the national value respectively. The wider is the confidence interval the greater is the uncertainty in the estimate. In the case of indicators based on a sample of the population. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. and so we say that there is a 95% probability that the interval covers the true value. These occurrences result in random fluctuations in the indicator value between different areas and time periods. scale . under these conditions. Confidence intervals are given with a stated significance level. the difference is not statistically significant and the value is shown on the health summary chart with a white symbol.

Health Profiles 2009  The Indicator Guide 182
Section 5: disease and poor health

Geography: The following geographies: England, GOR, Local Authority: County Districts,
geographies Metropolitan County Districts, Unitary Authorities, London Boroughs, for this
available for this and other alcohol related indicators are available from the NWPHO web site.
indicator from www.nwph.net/alcohol/lape
other providers
Dimensions HES data is available by LSOA, therefore analysis by deprivation and
of inequality: geodemographics is possible.
subgroup analyses
of this dataset
available from
other providers
Data extraction: The Department of Health (from HES).
Source
Data extraction: Hospital Episodes Statistics (HES). Record level access is restricted to authorised
source URL users, for example PHOs. Further information regarding HES can be found at:
www.hesonline.org.uk
Data extraction: February 2009
date
Numerator: A detailed definition of the numerator data used for this indicator can be
definition found at: http://www.nwph.net/alcohol/lape/NI39Technical_Dec2008.pdf
Numerator: source Produced by the Department of Health.
Denominator: Mid-year population estimates (2007) by 5-year age band.
definition
Denominator: Office for National Statistics (ONS).
source
Data quality: HES Data and ONS population statistics are considered to be complete and
Accuracy and robust.
completeness

TABLE 3 – INDICATOR TECHNICAL METHODS

Numerator: A detailed definition of the extraction method and application of attributable
extraction fractions to produce the numerator data used for this indicator can be found at:
http://www.nwph.net/alcohol/lape/NI39Technical_Dec2008.pdf
Numerator: Data extracted using area of residence (GOR, County and LA) of patient.
aggregation /
allocation
Numerator Hospital admission data can be coded differently in different parts of the country.
data caveats Identification of persons in any one year can also affect the analysis if people are
prone to moving within a local authority on a regular basis
In some cases the PCT of residence is recorded in HES but not the LA. To ensure
that the figures for coterminous PCTs and LAs were the same, details of LA were
added where this information could be ascertained from PCT of residency.
Denominator
data caveats

Health Profiles 2009  The Indicator Guide 183
Section 5: disease and poor health

Methods used The directly age-standardised rate is the rate of events that would occur in a
to calculate standard population if that population were to experience the age/sex-specific rates
indicator value of the subject population. Explicitly:

∑w r i
i i
DSR = × 100,000
∑w i
i

(expressed per 100,000 population)

where:
wi is the number, or proportion, of individuals in the standard population in age/sex
group i.
ri is the crude age/sex-specific rate in the subject population in age/sex group i,
given by:

Oi
ri =
ni

where:
Oi is the observed number of events in the subject population in age/sex group i.
ni is the number of individuals in the subject population in age/sex group i.
The standard population generally used for the direct method is the European
Standard Population.
Small Isles of Scilly and City of London were excluded. Though these are available from
Populations: www.nwph.net/alcohol/lape .
How Isles of
Scilly and City
of London
populations
have been
dealt with
Disclosure Not applicable
Control

Health Profiles 2009  The Indicator Guide 184
Section 5: disease and poor health

Confidence Confidence intervals for the rates were calculated using the method described in
Intervals the NCHOD Compendium for directly standardised rates. www.nchod.nhs.uk
calculation
95% confidence intervals for the age-standardised rates were calculated using a
method
normal approximation. Standard errors are obtained using the method described
by Breslow and Day but modified to use the binomial variance for a proportion to
estimate the variances of the crude age/sex-specific rates. This method is likely to
be unreliable when there are fewer than 50 cases in an area, hence confidence
intervals for rates based on less than 50 cases should be viewed with caution. The
lower and upper limits for the rates are denoted by DSRLL and DSRUL respectively.

1 wi2 ⋅ rij (1 − rij )
DSRLL / UL = DSR ± 1.96 × 100,000 × ×∑
 
2
ij nij
 ∑ wi 
 
 ij 

(expressed per 100,000 population)
where:
wi is the number, or proportion, of individuals in the standard population in age/sex
group i.
rij is the crude age/sex-specific rate in the subject population in age/sex group i, in
year j.
nij is the number of individuals in the subject population in age/sex group i, in year
j.
Ref:
Breslow NE and Day NE. Statistical Methods in Cancer Research, Volume II: The
Design and Analysis of Cohort Studies. Lyon: International Agency for Research on
Cancer, World Health Organization, 1987: 59
Keyfitz N. Sampling variance of age-standardised mortality rates. Human Biology.
1966; 38: 309-317.

Health Profiles 2009  The Indicator Guide 185
Section 5: disease and poor health

21. DRUG MISUSE
Basic Information

1. What is being measured? Estimated Problem Drug Users (Crack &/or Opiates)
2. Why is it being measured? To help monitor likely health care burden from drug
misuse.
3. How is this indicator actually defined? Estimated problem drug users (Crack &/or Opiates),
crude rate, 15–64 Ages, 2006/07, persons.
4. Who does it measure? All persons, 15–64 Ages.
5. When does it measure it? Continually reported and updated every year
6. Will it measure absolute numbers or Proportions: number of cases Per 1,000 residents
proportions? aged 15–64 years
7. Where does the data actually come Collection and collation from The National Treatment
from? Agency.
8. How accurate and complete will the County district estimates are based on a model
data be? applied to top tier local authorities. This model
relied on a probabilistic allocation of cases to Local
Authorities based on postal sector of residence. A
regression model uses number of users in treatment
(2006/07) to disaggregate the County level estimates
to County Districts.
9. Are there any caveats/ warnings/ The number of users in treatment will have impacted
problems? on the prevalence estimates published by the
Home Office and the regression model which may
introduce bias to the estimates.
10. Are particular tests needed such as The data point is green or red when the figure in
standardisation, significance tests, or a local authority is statistically significantly better
statistical process control to test the or worse respectively than the England average,
meaning of the data and the variation based on the 95% confidence intervals of the figure
they show? compared to the England value.

Table 1 – Indicator Description

Information Pg 4 Health Summary – Indicator No. 21
component
Subject category/ Disease and poor health
domain(s)
Indicator name Drug misuse
(*Indicator title in
health profile)
PHO with lead NWPHO
responsibility
Date of PHO Revised January 09
dataset creation

Health Profiles 2009  The Indicator Guide 186
Section 5: disease and poor health

Indicator definition Estimated Problem Drug Users (Crack and/or Opiates), Crude Rate, 15–64
Ages, 2006/07, persons
Geography England, GOR, Local Authority: Counties, County Districts, Metropolitan
County Districts, Unitary Authorities, London Boroughs
Timeliness Every year. Time trend analysis is not appropriate.
Rationale: This indicator estimates the number of problem drug users (Crack and/or
What this indicator Opiates) in an area.
purports to
measure
Rationale: The indicator was chosen as the best available estimate of drug use prevalence
Public Health in an area.
Importance
Rationale: Purpose To help monitor likely health care burden from drug misuse.
behind the
inclusion of the
indicator
Rationale: The Department of Health has introduced a ten year drug strategy (2008-
Policy relevance 2018) which is aimed at restricting the supply of illegal drugs and reducing the
demand for them. http://www.dh.gov.uk/en/Publichealth/Healthimprovement/
Drugmisuse/DH_085886

Interpretation: A high indicator value (red circle in health summary chart) represents a
What a high/low statistically significant higher estimate of problem (crack and/or opiates) drug
level of indicator users for that local authority when compared to the national value.
value means A low indicator value (amber circle in health summary chart) represents a
statistically significant lower estimate of problem (crack and/or opiates) drug
users for that local authority when compared to the national value.
Confidence Intervals for Top Tier Local authorities (Counties, MCDs, UAs, LBs)
were taken from the HO published prevalence data but cannot currently be
calculated for County Districts. Therefore interpretation of significance for
County Districts cannot be made.
Interpretation: The base estimates of the number of problem drug users were published by
Potential for error the Home Office (2004/05) and issues with the methods are outlined in the
due to type of report (www.homeoffice.gov.uk/rds/pdfs06/rdsolr1606.pdf). A regression
measurement model uses number of users in treatment (2006/07) to disaggregate the
method County level estimates to County Districts. Treatment data is only available
with postcode sector of residence which is not available for a large proportion
of cases reported by DAATs, consequently the allocation of cases to LAs is likely
to be less accurate for some areas than for others.
Interpretation: The number of users in treatment will have impacted on the prevalence
Potential for error estimates published by the Home Office and the regression model which may
due to bias and introduce bias to the estimates.
confounding

The wider is the confidence interval the greater is the uncertainty in the estimate. the interval can be used to test whether the value is statistically significantly different to the national. For this purpose the national value has been treated as an exact reference value rather than as an estimate and.Health Profiles 2009  The Indicator Guide 187 Section 5: disease and poor health Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. generally speaking. If the interval does not include the national value. but chance had led to a different set of data. In the case of indicators based on a sample of the population. These occurrences result in random fluctuations in the indicator value between different areas and time periods. under these conditions. Confidence intervals quantify the uncertainty in this estimate and. The confidence intervals have also been used to make comparisons against the national value. If the interval includes the national value. Table 2 – Indicator Specification Indicator definition: Problem Drug Users (Crack and/or Opiates) Variable Indicator definition: Crude Rate Statistic Indicator definition: Persons Gender Indicator definition: 15–64 age group Indicator definition: 2006/07 period Indicator definition: Per 1. In Health Profiles 2009 this is 95%. the difference is not statistically significant and the value is shown on the health summary chart with a white symbol. The use of 95% is arbitrary but is conventional practice in medicine and public health.000 residents aged 15–64 years scale Geography: The data is available by DAAT from the Home Office and NTA. describe how much different the point estimate could have been if the underlying conditions stayed the same. for example. uncertainty also arises from random differences between the sample and the population itself. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. a mortality and purpose rate. the difference is statistically significant and the value is shown on the health summary chart with a red or amber symbol depending on whether it is worse or better than the national value respectively. geographies available for this indicator from other providers . Confidence intervals are given with a stated probability level. and so we say that there is a 95% probability that the interval covers the true value. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value.

There were 451 cases in which there were no DAT and PCT of residence. of inequality: 2007) is available in the APHO publication ‘Indications of Public Health in subgroup analyses English Regions 10: Drug Use which will be published in April 2009. of this dataset available from other providers Data extraction: Source of data: The National Treatment Agency Source Data extraction: The data extraction source URL is not available to the public domain source URL Data extraction: Data extracted from source July.Health Profiles 2009  The Indicator Guide 188 Section 5: disease and poor health Dimensions Analysis of the 2006/07 PDU estimates by Index of Multiple Deprivation (IMD. Region and England. Each case was allocated into LA and GOR of residence using a schema provided by NWPHO. County. Numerator: aggregation/ See Methods used to calculate indicator value allocation Numerator data caveats The number of users in treatment will have impacted on the prevalence estimates published by the Home Office and the regression model which may introduce bias to the numerator (also see above). Table 3 – Indicator Technical Methods Numerator: extraction Downloaded from NTA website. 2007 date Numerator: Estimate of resident persons aged 15–64 believed to be problem drug users in definition 2006/07. Denominator: Office for National Statistics (ONS). Coverage includes all DAAT areas. The National Treatment Agency provided data on individuals in contact with structured treatment with their DAT of residence and PCT of residence. . The number of users in treatment is based on probabilistic completeness allocation of cases to Local Authorities from postal sector of residence. these were not used in the regression model. Numerator: source The National Treatment Agency Denominator: 2006 Mid-year population estimates (persons aged 15–64) by Local Authority definition District. source Data quality: This is a modelled estimate of the number of problem drug users in a local Accuracy and authority district.

Health Profiles 2009  The Indicator Guide 189 Section 5: disease and poor health Denominator data caveats The Mid 2006 Resident Population Estimates for All persons15 to 64 year age group has been used. UAs. These current estimates (for HP3) are an interim measure until the new HO data are available. of Scilly and City of London populations have been dealt with Disclosure Control Not applicable Confidence Intervals The Confidence Intervals were calculated for the estimated calculation method prevalence of drug users (opiate and/or crack users) with the Exact method. . The results of this model were then used to estimate the likely prevalence of problem drug users for the given number of opiate and crack users in treatment for County Districts. These totals for County Districts were then reconciled to ensure consistency with the County Prevalence Total. In future the Home Office will calculate direct Multiple Indicator Methods (MIM) and Capture Recapture (CR) estimates of drug users for all LADs. This method takes no account of uncertainty in the model used to estimate numbers of drug users at the County Districts. Small Populations: How Isles Isles of Scilly and City of London were excluded. a model was created based on the number of opiate and/or crack users in treatment and the prevalence for Unitary Authorities and Metropolitan County Districts. LBs) and the number of opiate and/or crack users in treatment data by Local Authority District provided by the NTA (2006/07). To allow for disaggregating of the County level prevalence data to County Districts. Census data and mid-year estimates are known to be deficient in their estimates of: • Non-white populations • Full-time students • Men aged 20–39 • People living in nursing homes etc • Rough sleepers • Inner-city populations • Households of multiple occupation • Migrants Methods used to calculate The analysis uses the problem drug user prevalence data (2006/07) indicator value provided by the HO & NTA for Top Tier Local Authorities (Counties. MCDs.

Health Profiles 2009  The Indicator Guide 190 Section 5: disease and poor health 22. and is published online by the Information Centre. a national system developed by NHS Connecting for Health. The NSTS practice file does not completely match the QOF practices and therefore the apportioning may not mirror exactly where the patients come from. 8. Record level data is not available therefore we have to apportion practices to LAs based on a look up file created from NSTS data. 4. 3. aged 17 and over at midnight on the 31st March 2008. 7. It is the 5th leading cause of death globally and accounts for about 10% of NHS costs. The diabetes prevalence will not match up with the QOF published prevalence where the areas are identical due to a different denominator being used (QOF uses the practice list size whereas the Health Profiles use the resident population). When does it measure it? Patients registered with GP practices. all ages 5. . Where does the data actually come The published QOF information is derived from the from? Quality Management Analysis System (QMAS). but it is the best approximation with the data provided. 9. based on the meaning of the data and the variation 95% confidence intervals of the figure compared to the they show? England value. 10. collation and interpretation. such as ethnic populations. homeless people. significance tests. with a coded diagnosis of diabetes on the 1st April 2007. (QOF DM1). problems? It is a measure of recorded diabetes prevalence and not actual prevalence and therefore under-reports groups who are less likely to be registered with a GP. Are particular tests needed such as The data point is green or red when the figure in a local standardisation. Are there any caveats/warnings/ Potential errors in collection. What is being measured? Prevalence of recorded diabetes 2. young people. How is this indicator actually The prevalence of QOF-recorded diabetes (in adults aged defined? 17+) in the population. PEOPLE DIAGNOSED WITH DIABETES INDICATOR Basic Information 1. Will It measure absolute numbers or Proportion (displayed as a percentage): Number of proportions? recorded cases of diabetes in adults aged 17+ per 100 resident population. Who does it measure? All persons. Why is it being measured? Diabetes is a common disease with serious consequences. or authority is statistically significantly better or worse statistical process control to test the respectively than the England average. 6. How accurate and complete will the The data covers more than 99% of GP-registered patients data be? in England. although not everyone is registered with a GP (especially some groups with particular needs). migrants and travellers.

Geography England.htm . Important modifiable risk factors are obesity. and together with the Delivery Strategy.gov. http://www. Rationale: Purpose To encourage better collection of the primary care data to give more accurate behind the estimates of disease prevalence. Local Authority: Counties. It is treatable and in most cases preventable. renal disease. diet and lack of physical activity. Unitary Authorities. GOR. London Boroughs Timeliness Data is extracted from the QMAS system annually in June and published in QPID (quality and prevalence indicators database) in September-October each year. inclusion of the To monitor diabetes prevalence indicator To emphasise the burden of disease To encourage preventative action Rationale: The twelve standards of the Diabetes National Service Framework cover Policy relevance all aspects of diabetes care and prevention. heart disease and other complications. neuropathy. amputation.dh.Health Profiles 2009  The Indicator Guide 191 Section 5: disease and poor health TABLE 1 – INDICATOR DESCRIPTION Information P4 Health Summary – Indicator No 22 component Subject category/ Disease and poor health domain(s) Indicator name Prevalence of recorded diabetes (“People diagnosed with diabetes”) (*Indicator title in health profile) PHO with lead ERPHO responsibility Date of PHO 18th February 2009 dataset creation Indicator definition The prevalence of QOF-recorded diabetes (in adults aged 17+) in the population. What this indicator purports to measure Rationale: Diabetes is a common disease with serious consequences.uk/en/Healthcare/NationalServiceFrameworks/Diabetes/ index. We use the indicator in this context as a proxy for healthcare need and demand (a high prevalence of diabetes can indicate a less healthy population with higher service utilisation). County Districts. It is the 5th leading Public Health cause of death globally and accounts for about 10% of NHS costs. Metropolitan County Districts. set out a ten-year programme of change and improvement which will raise the quality of services and reduce unacceptable variations. Rationale: Prevalence of recorded diabetes. The burden Importance falls disproportionately on elderly and ethnic populations. The sequelae of diabetes include blindness.

for example. ethnic populations and Potential for error other vulnerable groups e. the confidence interval can be used to test whether the value is statistically significantly different to the national value. These occurrences result in random fluctuations in the indicator value between different areas and time periods. generally speaking. The use of 95% is arbitrary but is conventional practice in medicine and public health. but chance had led to a different set of data. . In Health Profiles 2009 this is 95%. confounding Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. There may also be potential biases in the attribution of practice populations to local authority areas but these are probably small. under these conditions. a mortality and purpose rate. The wider the confidence interval the greater the uncertainty in the estimate. the difference is statistically significant and the value is shown on the health summary chart with a red or green symbol depending on whether it is worse or better than the national value respectively. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. In the case of indicators based on a sample of the population.g. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. value means An indicator value worse than average (red circle in health summary chart) represents a statistically significant higher number of people diagnosed with diabetes compared with the national average.Health Profiles 2009  The Indicator Guide 192 Section 5: disease and poor health Interpretation: An indicator value better than average (green circle in health summary chart) What a high/low represents a statistically significant lower number of people diagnosed with level of indicator diabetes compared with the national average. homeless. Conversely a low value may indicate genuinely low prevalence and/or poor detection and recording. Confidence intervals quantify the uncertainty in this estimate and. This uncertainty arises because factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. If the confidence interval does not include the national value. The confidence intervals have also been used to make comparisons against the national value. Interpretation: There may be under-representation of young people. Confidence intervals are given with a stated probability level. and so we say that there is a 95% probability that the interval covers the true value. the difference is not statistically significant and the value is shown on the health summary chart with an amber symbol. A high value can indicate a genuinely high prevalence and/or better detection and recording. If the confidence interval includes the national value. Interpretation: See above. travellers in the numerator as they are due to bias and less likely to be registered with the GP. describe how much different the point estimate could have been if the underlying conditions stayed the same. uncertainty also arises from random differences between the sample and the population itself. There are a large number of codes used to record measurement diabetes on GP systems which may lead to counting errors depending on method how the data is extracted (see the QOF definitions for the codes used). Potential for error Due to the fact that recording is rewarded through QOF points there may be due to type of potential for “gaming”.

(The NSTS is part of NHS Connecting for Health and is an amalgamation of the Exeter System and the NHS central register. geographies available for this indicator from other providers Dimensions No (but could be grouped by deprivation score at practice level using derived IMD of inequality: scores) subgroup analyses of this dataset available from other providers Data extraction: Numerator: The Information Centre for health and social care.statistics.uk/statbase/Product. SHA.uk/statistics-and-data-collections/supporting-information/ source URL audits-and-performance/the-quality-and-outcomes-framework/qof-2007/08/data- tables http://www.uk/nsts Data extraction: Numerator: QOF data downloaded in October 2008 date Denominator: August 2008 Attribution table supplied: February 2009 .asp?vlnk=15106 http://www.ic.gov. Source Denominator: ONS 2007 population estimates Weight: A special extract (mapping general practice populations to local authorities for February 2007) of the NHS Strategic Tracing Service (NSTS) database commissioned from ATOS Origin (available on request).) Data extraction: http://www. general practice. PCT. definition: Variable Indicator Proportion (displayed as a percentage): Number of recorded cases of diabetes in definition: adults aged 17+ per 100 resident population Statistic Indicator Persons definition: Gender Indicator Numerator 17+ definition: age Denominator all ages group Indicator Financial year 2007/08 definition: period Indicator Per 100 resident population definition: scale Geography: National.Health Profiles 2009  The Indicator Guide 193 Section 5: disease and poor health Table 2 – Indicator Specification Indicator The prevalence of QOF-recorded diabetes (in adults aged 17+) in the population.nhs.connectingforhealth.nhs.

January to March 2008). aged 17 and over at midnight on the 31st definition March 2008. Northumberland.uk/uploads/QOF/qof_bus_rules_v9/diabetes_ruleset_ r4_v9.statistics. denominator data has been aggregated from the relevant published figures for the constituent districts. Cheshire East. source http://www.nhs.zip Data quality: QOF represents 99. Users of data derived from QMAS should recognise that QMAS was established as a mechanism to support the calculation of practice QOF payments and not as a person-based epidemiological tool.uk/webfiles/QOF/2007-08/Data%20tables/Practice/ Domain%20level%20Spreadsheets/LR/QOF0708_Pracs_Prevalence.8 per cent of registered patients in England (based on Accuracy and registration data from the ePACT system of the Prescription Pricing Division of completeness the NHS Business Services Authority. (QOF DM1). providing that the limitations of the data are acknowledged. Where the new Unitary Authorities represent only a part of the existing counties (Cornwall. We assumed the problems of list counting and inflation did not apply to the numerator (it is very unlikely that diabetics will be counted twice and there are QA checks in QOF to avoid this).Health Profiles 2009  The Indicator Guide 194 Section 5: disease and poor health Numerator: Patients registered with GP practices. There were 8294 practices in the QOFR 200708 dataset.ic.xls Denominator: Mid-year 2007 LA estimates (latest year available). The case definition of diabetes (with Read codes) can be found at: http://www. the denominator data has been drawn from the relevant county figures.pdf Numerator: Quality and Outcomes Framework (QOF). but it is potentially a rich and valuable source of such information.0.gov. It is not a comprehensive source of data on quality of care in general practice. Denominator: Office for National Statistics (ONS).9% of these could be matched to a LA(s) using the NSTS attribution lookup. Cheshire West & Chester. Shropshire and Wiltshire). Bedford and Central Bedfordshire). Denominator data has been used exactly as published in the Home Office supplied data.nhs. primarycarecontracting.nhs.uk/delivery/programmes/qof/ . connectingforhealth. See also QOF assessor validation reports available at: http://www. We used a resident population definition as a denominator rather than an apportioned registered population to avoid the list inflation in registered populations. http://www. with a coded diagnosis of diabetes on the 1st April 2007. Where new Unitary Authorities that have been created as part of the April 2009 boundary changes are exactly co-terminous with pre-existing counties (Durham. and 99.uk/downloads/ source theme_population/Mid_2007_UK_England_&_Wales_Scotland_and_Northern_ Ireland%20_21_08_08.

 We summed  the  LA estimated counts to whole LAs to give an overall figure for the LA. In addition. and  excluded  populations where the number of patients in a practice from a particular  LA was ≤50. as the practice    population  is always greater than the actual population of the country. assuming a uniform spatial distribution of diabetes patients practice  to each  within each practice.     This can be expressed in a formula as:   Ʃ          KEY   P-LApop: population of a practice from a particular LA in the cases where this  population is >50 The look up table is derived from a Practice–LA look-up table provided by the NSTS Ppop: Total practice population excluding P-LA populations which are ≤50 Pnum: Practice number of patients registered with disease (QOF) . This made the weighting simpler.   We used these proportions to distribute the counts of diabetic patients in each   LA. Ʃ    We calculated the proportion of  each  GP-registered  population in each LA. this   exclusion brings the total practice population  closer to the ONS estimate.Health Profiles 2009  The Indicator Guide 195 Section 5: disease and poor health Table 3 – Indicator Technical Methods Numerator: Numerators extracted from downloaded QOF prevalence by general practice extraction spreadsheets available on the IC website. then for each practice we calculated the number of persons resident in relevant LAs using the following SQL:                                     We discounted  any null returns or practices that didn’t match on to QOF. Numerator: We assigned counts of patients with recorded diabetes to give an estimated aggregation/ resident number of diabetics as follows: allocation The weights We obtained a cross boundary flow table from NSTS (February 2007) enabling us to assign GP-registered populations to LA of residence.

and the differing look-ups used by the QOF team compared to our generated look-up. How Isles of Scilly and City of London populations have been dealt with Disclosure Not relevant Control . and the NSTS file does not quite include all practices in QOF and vice versa. We have not found a satisfactory way of assessing this. therefore to keep our data consistent with the published data. the values we generated for the LA were slightly different from those published for the PCT by QOF because the practice–PCT look-up used by QOF is different from the one we derived from NSTS. There to calculate is no age adjustment. The denominator data caveats does not quite correspond with ageband of the numerator. the overall figure for registered diabetes patients derived from calculations was less than the overall QOF published figure.Health Profiles 2009  The Indicator Guide 196 Section 5: disease and poor health Where the PCT has an identical boundary to the LA.003. To keep it consistent with previous Health Profiles all ages were used as the denominator but diabetes was only recorded in patients aged 17+. The LA level data was then aggregated to higher levels using look-ups. The calculation was performed as LA count of diabetes/total indicator value LA resident population Small City of London and the Isles of Scilly data were included in the calculation of the Populations: regional and national prevalences but they do not contribute to the LA prevalences. Numerator data The allocation method may have incorrectly apportioned patients to LAs particularly caveats for practices straddling LA boundaries. which meant that the non-PCT-identical LA figures were being scaled up by 0. as there is no definitive list of practices in England.3%. be helpful to correlate the crude prevalence presented here with the proportion of the population over 65) Denominator Subject to limitations of ONS population estimation methods. There is no age adjustment so variations in prevalence need to be interpreted in the light of variations in age structures. Due to the fact that a few practices were not included in the apportioning. and so the remaining LAs that were not identical to PCTs were scaled up slightly using a weight calculated by:    This scaling weight was 1. we replaced our calculated figures with the published ones for these 91 PCTs. (It may for example. Methods used The indicator value is presented as a percentage although strictly is a ratio.

Newcombe. calculate the three quantities A = 2r + z2. r and hence p are both zero.uk/Download/ calculation Public/15374/1/Confidence_Intervals_Wilson. When r = n so that p = 1. Stat Med 1998. the interval becomes n/(n+z2) to 1. Then the confidence interval for the population proportion is given by (A-B)/C to (A+B)/C This method has the considerable advantage that it can be used for any data. B = z z 2 + 4rq . Two-sided confidence intervals for the single proportion: comparison of seven methods. and the recommended confidence interval simplifies to 0 to z2/(n+z2). The proportion who do not have the feature is q = 1-p. If r is the observed number of subjects with some feature in a sample of size n then the estimated proportion who have the feature is p = r/n.8% confidence intervals are calculated using Julian Flowers’ Intervals (erpho) confidence interval tool: http://www.erpho. First.G. from the standard Normal distribution. where z is z1-α/2.org. R.Health Profiles 2009  The Indicator Guide 197 Section 5: disease and poor health Confidence The 95% and 99. and C=2(n+z2). When there are no observed events.G.xls method This calculates confidence intervals using the following method for a confidence interval of a proportion as described by R. . Reference Newcombe.17:857-72.

Health Profiles 2009  The Indicator Guide 198 Section 5: disease and poor health 23. When does it measure it? Continuous monitoring locally. Are particular tests needed such as The data point is green or red when the figure in standardisation. all ages. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. 6. 5. proportions? 7. NEW CASES OF TUBERCULOSIS INDICATOR Basic Information 1. all ages. prisoners. recalculated for new April 2009 boundaries by the Health dataset creation Protection Agency and SWPHO in February 2009. How is this indicator actually defined? 3-year average of TB incidence per 100. validated periodically at regional level. 10. How accurate and complete will the The national surveillance system has a high level of data be? completeness and accuracy. from? 8.000 population.000 population. Why is it being measured? To reduce the spread of TB by identifying areas where rates of TB are high. 3. Are there any caveats/warnings/ A small number of cases may be assigned to the problems? wrong local authority due to missing/incorrect postcodes. Where does the data actually come Health Protection Agency. 4. TB incidence is highest in inner-cities and concentrated in certain population groups such as the homeless. Will It measure absolute numbers or Proportion: Crude rate per 100. The most recent year for which data are available is 2006. Table 1 – Indicator Description Information Pg 4 Health Summary – Indicator No 24 component Subject category/ Disease and poor health domain(s) Indicator name New cases of tuberculosis (*Indicator title in health profile) PHO with lead South West Public Health Observatory responsibility Date of PHO February 2008. Who does it measure? All persons. significance tests. . Indicator definition 3-year average of TB incidence per 100.000 population. substance mis-users and communities linked to high-TB incidence countries. 2004–06. 2004–06. or a local authority is statistically significantly better statistical process control to test the or worse respectively than the England average. 9. persons. What is being measured? New cases of tuberculosis (TB) 2.

However a low indicator value should not mean that public health action is not needed as TB is preventable and any cases of tuberculosis need to be treated. Local Authority: Counties. . Most recent complete data available is 2006. Rationale: The incidence (number of new cases per 100. Incidence is high amongst [first and subsequent generation] migrant inclusion of the populations so this indicator could identify where resources should be targeted indicator to support TB control including the prompt identification of cases and measures to ensure treatment completion. Interpretation: A high indicator value (red circle in health summary chart) represents a What a high/low statistically significant worse rate of TB incidence when compared to the level of indicator England average value. County Districts. The prompt diagnosis and treatment of infectious cases is key to halting the health burden which TB causes in the UK. Over 8. In addition. In England cases fell Importance progressively until 1987 but started to rise again in the late 1980s.Health Profiles 2009  The Indicator Guide 199 Section 5: disease and poor health Geography England. validated periodically at regional level. Timeliness Continuous monitoring locally. Other high risk groups include the homeless. provides a marker to monitor progress towards the achievement of the objectives of the CMO’s Action Plan and supports the implementation of the TB toolkit. It is very important that there are Health Protection indicators incorporated in to the wider health profiles and although many Health Protection data are not yet available at LA. value means A low indicator value (green circle in health summary chart) represents a statistically significant better rate of TB incidence when compared to the England value. London Boroughs. The Department of Health recently published “Tuberculosis prevention and treatment: a toolkit for planning. Unitary Authorities. Metropolitan County Districts. TB therefore offers a good opportunity to provide information on a re-emerging PH issue and support the Chief Medical Officer’s (CMO) Action Plan. problem drug users and prisoners. work is being undertaken to ensure that this happens.000 population) of TB notified What this indicator during the year. Rationale: Purpose To reduce the spread of TB by identifying areas where rates of TB are behind the high. in June 2007. In response to this. TB remains a disease associated with socio-economic deprivation and largely affects migrants from high incidence countries and deprived sub-groups of the population. therefore.000 new cases are now being reported each year in the UK. commissioning and delivering high-quality services in England”. GOR. Rationale: The CMO has identified TB as a re-emerging threat which needs concerted Policy relevance action to address. the National Institute for Health and Clinical Excellence (NICE) published guidelines which describe recommended measures for the control of TB. the European Centre for Disease Control has also published an action plan which outlines the disease prevention and control measures expected of European Union member states. This indicator. This indicator will help in supporting the implementation of the plan. purports to measure Rationale: TB has re-emerged as a major public health problem and is the leading cause Public Health of death worldwide among curable infectious diseases. outlining the standards for the delivery of tuberculosis services.

but chance had led to a different set of data. the interval can be used to test whether the value is statistically significantly different to the national. Confidence intervals are given with a stated probability level. The quality of national TB surveillance improved measurement significantly since the introduction of this system in 1999. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. uncertainty also arises from random differences between the sample and the population itself. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. generally speaking. Interpretation: The rates are not age-standardised or adjusted to take into account variation Potential for error between areas in risk factors associated with TB.Health Profiles 2009  The Indicator Guide 200 Section 5: disease and poor health Interpretation: New cases of TB are reported through a voluntary enhanced surveillance Potential for error system to collect detailed data on each case. TB is highest due to bias and in inner cities and concentrated in certain population groups such as the confounding homeless. the difference is not statistically significant and the value is shown on the health summary chart with an amber symbol. and so we say that there is a 95% probability that the interval covers the true value. the difference is statistically significant and the value is shown on the health summary chart with a red or green symbol depending on whether it is worse or better than the national value respectively. describe how much different the point estimate could have been if the underlying conditions stayed the same. In the case of indicators based on a sample of the population. It provides the most accurate due to type of measurement of TB incidence. If the interval does not include the national value. A national study. under these conditions. These occurrences result in random fluctuations in the indicator value between different areas and time periods. In Health Profiles this is 95%. a mortality and purpose rate. Confidence intervals quantify the uncertainty in this estimate and. Table 2 – Indicator Specification Indicator definition: New cases of tuberculosis Variable Indicator definition: 3-year average (mean) of TB incidence per 100.000 population Statistic Indicator definition: All persons Gender . on the completeness of national surveillance suggests that there may be undernotification of as much as 15% of cases. The wider is the confidence interval the greater is the uncertainty in the estimate. If the interval includes the national value. The use of 95% is arbitrary but is conventional practice in medicine and public health. In the UK. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. prisoners. substance mis-users and communities linked to high-TB incidence countries Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. The confidence intervals have also been used to make comparisons against the national value. for example. method undertaken in 2003.

mostly at national level. denominator mid-year population estimates period Indicator definition: Per 100. allocation Numerator data The TB incidence was obtained by deriving the local authority of residence for caveats each TB case. Wales and Northern Ireland. Accuracy and which commenced in January 1999.Health Profiles 2009  The Indicator Guide 201 Section 5: disease and poor health Indicator definition: All ages age group Indicator definition: Numerator 2004–2006. It is therefore robust. available on Health Protection Agency geographies website available for this www. source URL Data extraction: Data extracted from source (Enhanced Tuberculosis Surveillance system ) as at: date 27/11/2007 Numerator: Average number of TB cases reported between 2004–2006 in accordance with definition the agreed case definition Numerator: source Health Protection Agency Denominator: ONS mid-year population estimates definition Denominator: Office for National Statistics (ONS). source Data quality: Data are provided through the Enhanced Tuberculosis Surveillance system. Incorrectly entered postcode of residence or local authority may have resulted in assigning some cases to the incorrect local authority or county. . TABLE 3 – INDICATOR TECHNICAL METHODS Numerator: Health Protection Agency extraction Numerator: Cases were allocated to Local Authority based on their postcode of residence aggregation/ and summarised as a 3-year (mean) average 2004–06.org.000 resident population scale Geography: Additional data.uk indicator from other providers Dimensions Not available of inequality: subgroup analyses of this dataset available from other providers Data extraction: Health Protection Agency Source Data extraction: Data at Local Authority level not published elsewhere. A small number of cases for whom the local authority was not known were included only in the England total. standardised and completeness comprehensive throughout England.hpa.

the resulting value was then multiplied by 100. serious injuries. Eberle E. (100*α)offences. The confidence limits for the rates were then obtained by dividing the upper and lower limits for the counts by the person time exposed. The resulting rate was rounded down to an integer value. χ² a/2.2d 2 2 LL = 2 χ 1. The numerator was then divided by the denominator. The rates for all areas were rounded down to an integer value. Small Populations: These are included in the totals for their regions (respectively. Denominator count: value Mid-year 2005 population estimates (all ages).2d is the (100*a/2)th   percentage point for a chi-squared distribution with 2d degrees of freedom and χ²(1-α/2). Statistics in Medicine 1991. Confidence The confidence intervals for these crude rates were constructed using the Intervals following formula that relates the chi-square and Poisson distributions: calculation method χ α . Scherer J.2(d+1) 2 2 UL = 2 where LL and UL are the lower and upper 100*(1-a) per cent confidence limits and d denotes the number of observed events (e.g. Confidence intervals for weighted sums of Poisson parameters.000 population. South West and How Isles of Scilly London). the mid-year caveats population estimate for the middle year (2005) was used. Methods used to Calculation of the numerator: Calculated a 3-year average (mean) for 2004– calculate indicator 2006 by summing the individual years and dividing by 3. violent  deaths) per unit of time exposed. . This middle year may not always be representative of the three year period.10:457-462.Health Profiles 2009  The Indicator Guide 202 Section 5: disease and poor health Denominator data As the data were for a period of three years (2004-2006).000 to give a crude rate per 100. Kuulasmaa K. and City of London populations have been dealt with Disclosure Control Indicator values for areas where there were <5 cases over the 3-year period (giving an average of 1 or 2 per year) are suppressed and these areas are given a value and rate of zero. Reference: Dobson AJ.2(d+1) is the (100*(1-a/2))th percentage point for a chi-squared distribution on 2(d+1) degrees of freedom.α .

Who does it measure? All persons. Why is it being measured? Hip fracture is the most common injury related to falls in older people. Population estimates of higher geographies such as County. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. Will It measure absolute numbers or Proportions: numbers of cases per hundred proportions? thousand European standard population. 8. 9. HP3 2008 data have been updated to accommodate the newly created Unitary Authorities in England. this may be done through local audit. When does it measure it? Created specifically for HP3 2008. 2. 65 years and over. More than 95% of hip fractures in adults ages 65 and older are caused by a fall. significance tests. Are particular tests needed such as The data point is green or red when the figure in standardisation. and to lead to improvement in data quality and quality of care. Hip fractures in the elderly and frail can lead to loss of mobility and loss of independence. Regularly updated. SHA. directly age-standardised rate. Where does the data actually come Collection and collation from Hospital Episodes from? Statistics (HES) via the NHS Information Centre. How is this indicator actually defined? Emergency Hospital Admission for fractured neck of femur. or a local authority is statistically significantly better statistical process control to test the or worse respectively than the England average. 10. 2006–07. How accurate and complete will the data HES data and ONS population statistics are be? considered to be complete and robust. Are there any caveats/warnings/ There may be variation between Trusts in the way problems? hospital admissions are coded. 4. HIP FRACUTRE IN OVER-65s INDICATOR Basic Information 1. However. 3. Routine data do not allow for all of these aspects to be identified and removed from the indicator. What is being measured? Hip fractures in over 65 year olds. Population estimates used are Persons rounded and therefore may produce slight differences in rate calculation from those done locally. 7. 65 year and over. . Mortality after hip fracture is high: around 30% for one year. GOR and England are aggregated of the LA populations. 6. To stimulate discussion and encourage local investigation. however. 5. persons.Health Profiles 2009  The Indicator Guide 203 Section 5: disease and poor health 24. For many older people it is the event that forces them to leave their homes and move into residential care. HES data for 2007/2008 was not available for inclusion in HP4 2009.

Hip fracture is the most common injury related to falls in older people. Unitary Authorities. London Boroughs Timeliness Created specifically for HP3 2008. For many older people it is the event that forces them to leave their homes and move into residential care. indicator To stimulate discussion and encourage local investigation. GOR. directly age- standardised rate. 2006-07. What this indicator purports to measure Rationale: Hip fracture is a major cause of disability and the leading cause of mortality Public Health due to injury in older people aged over 75. Persons Geography England. . Rationale: Purpose To monitor the incidence of fracture neck of femur. County Districts. Hospital admission for fractured Importance neck of femur is a good proxy measure of the incidence of hip fracture in older people. Rationale: It is an estimate of serious falls in older people. Local Authority: Counties. Hip fractures in the elderly and frail can lead to loss of mobility and loss of independence. Mortality after hip fracture is high: around 30% for one year. behind the To monitor public health programmes aiming to reduce the risk of older people inclusion of the falling. and to lead to improvement in data quality and quality of care. Metropolitan County Districts. Falls prevention programmes aim to reduce the incidence of fractured neck of femur in the community. More than 95% of hip fractures in adults ages 65 and older are caused by a fall. Not regularly updated.Health Profiles 2009  The Indicator Guide 204 Section 5: disease and poor health Table 1 – Indicator Description Information Pg 4 Health Summary Indicator No 25 component Subject category/ Diseases and poor health domain(s) Indicator name Hip fracture in over-65s (*Indicator title in health profile) PHO with lead WMPHO responsibility Date of PHO 11/02/08 dataset creation Indicator definition Emergency Hospital Admission for fracture neck of femur. 65 year and over.

and outlines the components of integrated falls services. Studies have indicated that falls prevention services can reduce falls (Interventions to prevent falls in elderly people can be effective. However with older groups minor differences in average within age band may become important and some authorities argue that for older age bands one year groups should be used. Further the European Standard population is much younger than the UK population and therefore biases comparisons towards younger age groups. This means that an age band of 85 years and over also has to be used for age specific rates and this is clearly unsatisfactory. Interpretation: There may be variation between Trusts in the way hospital admissions are Potential for error coded. These are calculated by due to bias and summing the product of age specific rates for each age band in the group confounding by the number in that age band in the standard population.html) Interpretation: A high indicator value (red blob in spine chart) represents a statistically What a high/low significant higher level of estimated incidence of fractured neck of femur for level of indicator that local authority when compared to the national value. The method does however assume that minor differences in age structure within age bands are unimportant and in general this is true for younger age groups. which outlines the next steps in implementing the NSF. 2003. value means A low indicator value (green blob) represents a statistically significant lower level of estimated incidence of fractured neck of femur for that local authority when compared to the national value. The sum is then divided by the total number in all age bands in the standard population to obtain the age standardised rate.Health Profiles 2009  The Indicator Guide 205 Section 5: disease and poor health Rationale: Standard 6 of the National Service Framework for Older People aims to Policy relevance “reduce the number of falls which result in serious injury and ensure effective treatment and rehabilitation for those who have fallen”. however. this may be done through local audit. The rank order of age standardised rates may be appreciably changed by use of different standard populations. Routine data do not allow for all of these aspects to be identified and due to type of removed from the indicator.cochrane. Any difference between groups in age standardised rate is then not due to difference in age structure since the same standard population was used to calculate all age standardised rates.org/reviews/en/ab000340. A New ambition for old age (DH. 2004). http://www. Therefore for groups above 65 and particularly for groups including those over age of 85 the use of age standardised rates will reduce the effect of age differences in the populations but cannot be assumed to have eliminated it. The problem is further compounded by the use of the European Standardised Population which has a top age band of 85 years and over. There is NICE Guidance on the assessment and prevention of falls in older people (NICE. measurement method Interpretation: In order to allow comparison of groups with different age structures it Potential for error is common to present “age standardised” rates. 2006). . lists ‘falls and bone health’ as one of its 10 programmes. Cochrane Collaboration. For the age standardised rates given in this report five year age bands have generally been used.

describe how different the point estimate could have been if the underlying conditions stayed the same. In the case of indicators based on a sample of the population. and so we say that there is a 95% probability that the interval covers the true value. under these conditions. but chance had led to a different set of data. the difference is statistically significant and the value is shown on the health summary chart with a red or green symbol depending on whether it is worse or better than the national value respectively. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. The wider the confidence interval. These occurrences result in random fluctuations in the indicator value between different areas and time periods. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. the difference is not statistically significant and the value is shown on the health summary chart with an amber symbol. If the interval includes the national value. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. for example. uncertainty also arises from random differences between the sample and the population itself. Table 2 – Indicator Specification Indicator definition: Emergency Hospital Admission for fractured neck of femur Variable Indicator definition: Directly age-standardised rate Statistic Indicator definition: Persons Gender Indicator definition: 65 years and over age group Indicator definition: 2006–07 Financial year period Indicator definition: Per 100. The use of 95% is arbitrary but is conventional practice in medicine and public health. Confidence intervals quantify the uncertainty in this estimate and. The confidence intervals have also been used to make comparisons against the national value.000 European Standard population scale Geography: None. geographies available for this indicator from other providers . generally speaking. In Health Profiles 2009 this is 95%. Dataset unique to WMPHO. a mortality and purpose rate. the greater the uncertainty in the estimate. the interval can be used to test whether the value is statistically significantly different to the national. Confidence intervals are given with a stated probability level. If the interval does not include the national value.Health Profiles 2009  The Indicator Guide 206 Section 5: disease and poor health Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity.

HP2007 data for this indicator was extracted for all admissions.0. These were examined locally and admission to patient ratios calculated.6% in South West Region. Data are based on the latest revisions of ONS mid-year population estimates for the respective years. NHS Source Health and Social Care Information Centre. NHS Health and Social Care Information Centre. England.1.2). ICD10 codes for fractured proximal femur refer to the following diagnoses: • S72. admitted in the respective financial year.2 Subtrochanteric fracture Numerator: source Hospital Episode Statistics (HES) for the respective financial year. last updated 21/08/07. © Crown Copyright 2004 Data extraction: Extracted through direct link from HES. Denominator: Office for National Statistics (ONS).6% in North East Region to 21. HES Universe 2006/2007 (universe ID HIP0606) This material is Crown Copyright but may be reproduced without formal permission or charge for personal or in-house use. Whilst this brings about improvement over time. some shortcomings remain. There was considerable variation in patterns of admission for fractured neck of femur across the country with the numbers of transfer admissions between hospitals varying from 2. WMPHO then investigated using emergency admissions only and produced almost identical results in these two LAs. England. © Crown Copyright 2004 Denominator: Denominator data – Mid year population estimates 2006 for persons aged 65+ definition rounded.0 Fracture of neck of femur. Data extraction: Data extracted from source as at: 28th January 2008 date Numerator: Emergency Hospital Admissions for primary diagnosis of fractured neck of definition femur in 65+ age group. HES Universe 2006/2007 (universe ID HIP0606) This material is Crown Copyright but may be reproduced without formal permission or charge for personal or in-house use. Specific problems with over counting due to incorrect coding of internal transfers giving new admissions were identified in Ashfield and Nottingham City. • S72. • S72. The decision to extract emergency admissions only should reduce erroneous geographical variations. Diagnosis of fractured neck of femur classified by primary diagnosis (ICD10 S72. NHS Health and Social Care source URL Information Centre. source Data quality: Hospital Episode Statistics (HES) are compiled from data sent by over 300 Accuracy and NHS Trusts and Primary Care Trusts (PCTs) in England.Health Profiles 2009  The Indicator Guide 207 Section 5: disease and poor health Dimensions None available of inequality: subgroup analyses of this dataset available from other providers Data extraction: Hospital Episode Statistics (HES) for the respective financial year. S72. S72.1 Pertrochanteric fracture. . The Health and Social completeness Care Information Centre liaises closely with these organisations to encourage submission of complete and valid data and seeks to minimise inaccuracies and the effect of missing and invalid data via HES processes.

Shropshire. Numerator: Residency (by Local Authority) of each Finished Admission Episodes is allocated by HES. • S72. 75–79. • S72. sex is 1. for 65+ ages with any emergency method of admission and with any of the following primary diagnoses (DIAG_01.2 Subtrochanteric fracture Data were extracted as Finished Admission Consultant Episodes The data was ungrossed Counts are by: age/sex/organisation of residence in Finished Admission Episode (values for England are aggregates of these) where: age bands 65–69.Health Profiles 2009  The Indicator Guide 208 Section 5: disease and poor health Table 3 – Indicator Technical Methods Numerator: HES extraction - extraction The number of finished admission episodes including transfers. 2 (male and female) Method of admission = Emergency. 80-84. ICD 10 codes) in the respective financial year:Fractured proximal femur • S72.1 Pertrochanteric fracture. 70–74. Wiltshire and Durham have the same boundaries as the counties of the same name so have been allocated these data. New UA name Old LA name Bedford Bedford Central Bedfordshire Mid Bedfordshire South Bedfordshire Cheshire East Congleton Crewe and Nantwich Macclesfield Cheshire West and Chester Chester Ellesmere Port & Neston Vale Royal Cornwall* Caradon Carrick Kerrier North Cornwall Penwith Restormel . /allocation The new Unitary Authorities of Northumberland.0 Fracture of neck of femur. aggregation Since the 2001 census new Unitary Authorities have been created. Data for five other new unitary Authorities have been calculated from the aggregation of previous Local Authorities. 85+.

0 only. The standard population generally used for the direct method is the European Standard Population.0-S72. The age groups used are: 65–69. These were examined locally and admission to patient ratios calculated.2.9 range.Health Profiles 2009  The Indicator Guide 209 Section 5: disease and poor health Numerator The value shown in the health profiles is for emergency admissions with a primary data caveats diagnosis of fractured neck of femur as defined by ICD10 codes S72.6% in South West Region. or as various other combinations within the S72.6% in North East Region to 21. GOR and England are aggregates of the LA populations. If local values have used all diagnosis of fractured neck of femur they will have higher values. Specific problems with over counting due to incorrect coding of internal transfers giving new admissions were identified in Ashfield and Nottingham City. Fractured neck of femur is sometimes defined as S72. The decision to extract emergency admissions only should reduce erroneous geographical variations. of individuals in the standard population in age group i. Population estimates of higher geographies such as County. 70–74. HP2007 data for this indicator was extracted for all admissions. Denominator Population estimates used are Persons rounded and therefore may produce slight data caveats differences in rate calculation from those done locally. 80–84.0–S72.000 population) where: wi is the number.9 grouping.0 to S72. Methods The directly age-standardised rate is the rate of events that would occur in a standard used to population if that population were to experience the age-specific rates of the subject calculate population. ri is the crude age-specific rate in the subject population in age group i. or as the whole S72. . given by: Oi ri = ni where: Oi is the observed number of events in the subject population in age group i. WMPHO then investigated using emergency admissions only and produced almost identical results in these two LAs. or proportion. There was considerable variation in patterns of admission for fractured neck of femur across the country with the numbers of transfer admissions between hospitals varying from 2.000 ∑w i i (expressed per 100. The value shown in the health profiles is for primary diagnosis of fractured neck of femur only. 75–79. ni is the number of individuals in the subject population in age group i. 85+. Explicitly: indicator value ∑w r i i i DSR = × 100. SHA.

000 × ×∑   2 ij nij  ∑ wi     ij  (expressed per 100. 1966. hence confidence intervals for rates based on less than 50 cases should be viewed with caution. in year j. Statistical Methods in Cancer Research. Lyon: International Agency for Research on Cancer. nij is the number of individuals in the subject population in age group i.96 × 100. Ref: Breslow NE and Day NE. of individuals in the standard population in age group i. How Isles of Scilly and City of London populations have been dealt with Disclosure Not applicable Control Confidence Confidence intervals for the rates were calculated using the method described in the Intervals NCHOD Compendium for directly standardised rates. Sampling variance of age-standardised mortality rates. www. The lower and upper limits for the rates are denoted by DSRLL and DSRUL respectively. Standard errors are obtained using the method described by Breslow and Day but modified to use the binomial variance for a proportion to estimate the variances of the crude age-specific rates.nhs. or proportion. 1 wi2 ⋅ rij (1 − rij ) DSRLL / UL = DSR ± 1. .000 population) where: wi is the number. This method is likely to be unreliable when there are fewer than 50 cases in an area. Human Biology. Volume II: The Design and Analysis of Cohort Studies. World Health Organization.Health Profiles 2009  The Indicator Guide 210 Section 5: disease and poor health Small Scilly Isles and City of London has been excluded at LA level and included at Region Populations: and National levels.uk calculation method 95% confidence intervals for the age-standardised rates were calculated using a normal approximation. rij is the crude age-specific rate in the subject population in age group i. in year j.nchod. 38: 309-317. 1987: 59 Keyfitz N.

Health Profiles 2009  The Indicator Guide 211 Section 6: Life expectancy and cause of death .

2. How accurate and complete will the data It is the most reliable mortality data source available. the number of deaths in the non-winter period will increase.7. from? 8. Are there any caveats/warnings/ EWM Index was calculated based on the “ONS problems? Method” which defines the winter period as December to March. 9. if mortality starts to increase prior to this.04 to 31. Who does it measure? The ratio of extra deaths from all causes that occur in the winter months compared to the average of the number of non-winter deaths of the same period. What is being measured? Excess winter deaths 2. This winter period was selected as they are the months which over the last 50 years have displayed above average monthly mortality.8. . When does it measure it? All those that died between 1.07.Health Profiles 2009  The Indicator Guide 212 Section 6: life expectancy and cause of death 25. in common with other European countries. 3. There is some evidence to suggest that excess winter mortality (EWM) is preventable. How is this indicator actually defined? The Excess Winter Mortality Index (EWM Index) is the excess winter deaths expressed as a ratio of the expected deaths based on the non-winter death rate for the period 1. suggesting that it is more than just lower temperatures responsible for the excess mortality in winter1. which in turn will decrease the estimate of excess winter mortality. be? and apart from the small number of deaths registered with a long delay due to the coroner’s investigation.7. Where does the data actually come The Annual Mortality File provided by ONS for PHOs.04 to 31. The EWM Index will be partly dependent on the proportion of older people in the population as most excess winter deaths effect older people (there is no standardisation in this calculation by age or any other factor). Will It measure absolute numbers or Ratio proportions? 7. 4.8. for example in November. However. experiences higher levels of mortality in the winter than in the summer. 5. Mortality in winter increases more in England compared to other European countries with colder climates.07 6. Why is it being measured? England. it is supposed to be complete. EXCESS WINTER DEATHS INDICATOR Basic Information 1. and the non-winter period as August to November of that same year and April to July of the following year.

Health Profiles 2009  The Indicator Guide 213
Section 6: life expectancy and cause of death

10. Are particular tests needed such as The data point is green or red when the figure in
standardisation, significance tests, or a local authority is statistically significantly better
statistical process control to test the or worse respectively than the England average,
meaning of the data and the variation they based on the 95% confidence intervals of the figure
show? compared to the England value.

Table 1 – Indicator Description

Information 25
component
Subject category/ Life expectancy and causes of death
domain(s)
Indicator name (* Excess winter deaths
Indicator title in
health profile)
PHO with lead ERPHO
responsibility
Date of PHO 19.2.08
dataset creation
Indicator definition Excess Winter Mortality Index (EWM Index) is the excess winter deaths as a
ratio of the expected deaths based on the non-winter death rate for the period
1.8.04 to 31.7.07.
Geography LA/UA
Timeliness The most recent year of data available is 2007
Rationale: This indicator measures excess winter deaths expressed as the EWM Index, in
What this indicator order that comparisons can be made easily between different geographies.
purports to It indicates whether there are higher than expected deaths in the winter
measure compared to the rest of the year.
Rationale: The number of excess winter deaths depends on the temperature and the
Public Health level of disease in the population as well as other factors, such as how well
Importance equipped people are to cope with the drop in temperature. Most excess winter
deaths are due to circulatory and respiratory diseases, and the majority occur
amongst the elderly population. Research carried out by the Eurowinter Group1
and Curwen2 found that mortality during winter increases more in England
and Wales compared to other European countries with colder climates,
suggesting that many more deaths could be preventable in England and Wales.
Rationale: Purpose To highlight areas with higher than expected levels of excess winter deaths, to
behind the give an idea where interventions need to be improved or instigated to cope
inclusion of the with the change of seasonal temperature.
indicator
Rationale: The Department of Health’s annual Keep Warm Keep Well campaign is aimed
Policy relevance at financially disadvantaged older or disabled people and their carers, and
families with young children on low incomes. It gives information on the
health benefits of keeping warm in winter, providing advice on healthy eating
and exercise, home heating and energy efficiency, and details of the grants
and benefits available.

Health Profiles 2009  The Indicator Guide 214
Section 6: life expectancy and cause of death

Interpretation: An indicator value better than average (green circle in health summary chart)
What a high/low indicates that excess winter deaths are statistically significantly lower for that
level of indicator local authority compared to the national average.
value means
An indicator value worse than average (red circle in health summary chart)
indicates that excess winter deaths are statistically significantly higher for this
area compared to the national average.
Interpretation: EWM Index was calculated based on the “ONS Method” which defines the
Potential for error winter period as December to March, and the non-winter period as August
due to type of to November of that same year and April to July of the following year. This
measurement winter period was selected as they are the months which over the last 50 years
method have displayed above average monthly mortality. However, if mortality starts
to increase prior to this, for example in November, the number of deaths in
the non-winter period will increase, which in turn will decrease the estimate of
excess winter mortality.
Interpretation:
Potential for error
due to bias and
confounding
Confidence A confidence interval is a range of values that is normally used to describe the
Intervals: Definition uncertainty around a point estimate of a quantity, for example, a mortality
and purpose rate.
This uncertainty arises as factors influencing the indicator are subject to chance
occurrences that are inherent in the world around us. These occurrences result
in random fluctuations in the indicator value between different areas and
time periods. In the case of indicators based on a sample of the population,
uncertainty also arises from random differences between the sample and the
population itself.
The stated value should therefore be considered as only an estimate of the
true or ‘underlying’ value. Confidence intervals quantify the uncertainty in
this estimate and, generally speaking, describe how much different the point
estimate could have been if the underlying conditions stayed the same, but
chance had led to a different set of data. The wider the confidence interval the
greater the uncertainty in the estimate.
Confidence intervals are given with a stated probability level. In Health Profiles
this is 95%, and so we say that there is a 95% probability that the interval
covers the true value. The use of 95% is arbitrary but is conventional practice
in medicine and public health.
The confidence intervals have also been used to make comparisons against
the national value. For this purpose the national value has been treated as an
exact reference value rather than as an estimate and, under these conditions,
the interval can be used to test whether the value is statistically significantly
different to the national. If the interval includes the national value, the
difference is not statistically significant and the value is shown on the health
summary chart with an amber symbol. If the interval does not include the
national value, the difference is statistically significant and the value is shown
on the health summary chart with a red or green symbol depending on
whether it is worse or better than the national value respectively.

Health Profiles 2009  The Indicator Guide 215
Section 6: life expectancy and cause of death

Table 2 – Indicator Specification

Indicator The Excess Winter Mortality Index (EWM Index) is the excess winter deaths
definition: Variable expressed as a ratio of the expected deaths based on the non-winter deaths for
the period 1.8.04 to 31.7.07.
Indicator Ratio expressed as a percentage
definition: Statistic
Indicator Person
definition: Gender
Indicator All ages
definition: age
group
Indicator Deaths occurring in the period: 1.8.04 to 31.7.07
definition: period
Indicator In per cent
definition: scale
Geography:
geographies
available for this
indicator from
other providers
Dimensions
of inequality:
subgroup analyses
of this dataset
available from
other providers
Data extraction: Annual Mortality File provided by ONS for PHOs (2001-2007)
Source
Data extraction: This is not publically available
source URL
Data extraction:
date
Numerator: The numerator, excess winter deaths, calculated as:
definition Total number of winter deaths i.e. deaths occurring in the months December to
March for the period 1.08.04 to 31.07.07 minus half number of deaths in the
non-winter months (August to November, April to July).
Numerator: source Annual Mortality File (ONS)
Denominator: The average number of deaths occurring in the equivalent non-winter period
definition i.e. the deaths occurring in August to November, April to July divided by 2)
Denominator: Annual Mortality File (ONS)
source

Data quality: It is the most reliable mortality data source available, and apart from the
Accuracy and small number of deaths registered with a long delay due to the coroner’s
completeness investigation, it is supposed to be complete.

Health Profiles 2009  The Indicator Guide 216
Section 6: life expectancy and cause of death

Table 3 – Indicator Technical Methods

Numerator: The number of winter deaths and non-winter deaths was extracted from the
extraction Annual Mortality File using the following SQL:

CREATE TABLE P25xx_Winterdeaths_LA
(Y_MOD varchar(10),
LACode varchar(4),
LAName varchar(50),
Deaths int)

INSERT INTO P25xx_Winterdeaths_LA
(Y_MOD,
LACode,
LAName,
Deaths)
SELECT
Left([DOD],6),
[LA Code now],
[LA name],
COUNT(*)
FROM M_DEATHS2001to2007
LEFT JOIN HES.dbo.A_LACounty ON M_DEATHS2001to2007.ResCty + M_
DEATHS2001to2007.ResLAUA = HES.dbo.A_LACounty.[LA Code]
LEFT JOIN HES.dbo.A_NationalPostcodes_Feb08 ON M_DEATHS2001to2007.
Pcode_8dig = HES.dbo.A_NationalPostcodes_Feb08.[PCD2]
where [DOD]>=20040801 and [DOD]<=20070731
Group by
[LA Code now],
[LA name],
Left([DOD],6)

-----------------------------------------------------------------------

UPDATE P25xx_Winterdeaths_LA
SET Y_MOD = ‘S’
WHERE
Y_MOD = ‘200408’
or Y_MOD = ‘200409’
or Y_MOD = ‘200410’
or Y_MOD = ‘200411’
or Y_MOD = ‘200504’
or Y_MOD = ‘200505’
or Y_MOD = ‘200506’
or Y_MOD = ‘200507’
or Y_MOD = ‘200508’
or Y_MOD = ‘200509’
or Y_MOD = ‘200510’
or Y_MOD = ‘200511’
or Y_MOD = ‘200604’
or Y_MOD = ‘200605’
or Y_MOD = ‘200606’
or Y_MOD = ‘200607’
or Y_MOD = ‘200608’
or Y_MOD = ‘200609’

Health Profiles 2009  The Indicator Guide 217
Section 6: life expectancy and cause of death

or Y_MOD = ‘200610’
or Y_MOD = ‘200611’
or Y_MOD = ‘200704’
or Y_MOD = ‘200705’
or Y_MOD = ‘200706’
or Y_MOD = ‘200707’

UPDATE P25xx_Winterdeaths_LA
SET Y_MOD = ‘W’
WHERE
Y_MOD = ‘200412’
or Y_MOD = ‘200501’
or Y_MOD = ‘200502’
or Y_MOD = ‘200503’
or Y_MOD = ‘200512’
or Y_MOD = ‘200601’
or Y_MOD = ‘200602’
or Y_MOD = ‘200603’
or Y_MOD = ‘200612’
or Y_MOD = ‘200701’
or Y_MOD = ‘200702’
or Y_MOD = ‘200703’

--------------------------------------------------------

Select LAcode, Y_MOD, sum(deaths) as [Sum]

into P25xx_Winterdeaths_EWDI

from P25xx_Winterdeaths_LA
group by LAcode, Y_MOD
order by LAcode, Y_MOD

----------------------------------------------------
CREATE TABLE P25xx_Winterdeaths_LA_W
(Y_MOD varchar(10),
LACode varchar(4),
LAName varchar(50),
W_Deaths int)

Insert into P25xx_Winterdeaths_LA_W
(Y_MOD,
LACode,
LAName,
W_Deaths)

select
Y_MOD,
LACode,
LAName,
Sum(2*Deaths)
from P25xx_Winterdeaths_LA
where Y_MOD = ‘W’
group by
LACode,
LAName

was then calculated in excel as part of the EWM Index calculation (see below). sum(Deaths) from P25xx_Winterdeaths_LA where Y_MOD = ‘S’ group by LACode.04-31. P25xx_Winterdeaths_LA_W. LAName. excess winter deaths.Apr-Jul) for the period 1. EWDI) select P25xx_Winterdeaths_LA_W. EWDI decimal(8. which is calculated: Winter deaths (Dec-Mar). LAName varchar(50).07 3 .0. W_deaths/S_deaths from P25xx_Winterdeaths_LA_W join P25xx_Winterdeaths_LA_S on P25xx_Winterdeaths_LA_W. The numerator published in the template is the average (yearly) excess winter deaths for the three year period.LACode.LAName.LACode. S_deaths int.Health Profiles 2009  The Indicator Guide 218 Section 6: life expectancy and cause of death CREATE TABLE P25xx_Winterdeaths_LA_S (Y_MOD varchar(10).LAName. [W_deaths_times_2]. S_deaths. LAName varchar(50). S_deaths. P25xx_Winterdeaths_LA_W. S_Deaths int) Insert into P25xx_Winterdeaths_LA_S (Y_MOD. [W_deaths_times_2] int.LACode = P25xx_ Winterdeaths_LA_S. LAName. S_Deaths) select Y_MOD.07.4)) Insert into P25xx_Winterdeaths_EWDI (P25xx_Winterdeaths_LA_W. LACode varchar(4). LACode.08. W_deaths.LAcode The numerator. LAName ----------------------------------------------- CREATE TABLE P25xx_Winterdeaths_EWDI (LACode varchar(4).5 summer deaths (Aug-Nov. LACode.

The Isles of Scilly and the City of London were included in the and City of London higher geographies.5 non-winter deaths (Aug–Nov. Wiltshire. Small Populations: Isles of Scilly and the City of London were excluded from local authority How Isles of Scilly calculations. and Durham have the same boundaries as the counties of the same name so have been allocated these data. Apr-Jul) The last arrangement of the formula was used in this calculation.5 non-winter deaths (Aug–Nov.Health Profiles 2009  The Indicator Guide 219 Section 6: life expectancy and cause of death Numerator: The LA/UA data was aggregated up to new UA.Apr–Jul) = 2 * winter deaths (Dec-Mar) -1 non-winter deaths (Aug-Nov.0. populations have been dealt with Disclosure Control Not relevant . county. Shropshire. Data for five other new unitary Authorities have been calculated from the aggregation of previous Local Authorities (see table below) New UA name Old LA name Bedford Bedford Central Bedfordshire Mid Bedfordshire South Bedfordshire Cheshire East Congleton Crewe and Nantwich Macclesfield Cheshire West and Chester Chester Ellesmere Port & Neston Vale Royal Cornwall  Caradon Carrick Kerrier North Cornwall Penwith Restormel Numerator data caveats Denominator data caveats Methods used to Method to calculate the EWM Index was as defined by ONS: calculate indicator excess winter deaths value expected number of deaths based on the non-winter death rates = winter deaths (Dec-Mar). region. allocation In April 2009 new Unitary Authorities have been created. SHA and aggregation/ national level. The new Unitary Authorities of Northumberland.Apr–Jul) 0.

C (2003) Essential Medical Statistics. 2 is a constant and therefore does not need to be included in the confidence interval calculation as a constant has no variance.Health Profiles 2009  The Indicator Guide 220 Section 6: life expectancy and cause of death Confidence The EWM index is treated as an odds (a/b) Intervals i. 95% CI = odds/EF to odds x EF Where EF = exp[1.R. and all causes in warm and cold regions in Europe.091 1 The Eurowinter group (1997) Cold exposure and winter mortality from ischaemic heart disease.164 . and Sterne J. and -1 is also a constant and can be subtracted at the end.(log odds)] And s. 2nd Edition.e.8% confidence intervals the Standard Error was changed to 3.e. b = number of summer deaths. 2 x a/b -1 calculation method Where: a = number of winter deaths. 1341-1346 2 Curwen M (1990/91) Excess winter mortality: a British phenomenon? Health Trends 4. respiratory disease. p. The formula for a calculation of 95% confidence intervals was taken from Kirkwood and Sterne3. 169-75 3 Kirkwood B.96 x s.e. The Lancet 349.A.(log odds) = √[1/a+1/b] For 99. cerebrovascular disease.

5. 2005–07. Are particular tests needed such as The data point is green or red when the figure in standardisation. The populations used for the calculation of the figures for this indicator are based on the 2001 Census. social classes and ethnic groups. between genders. e. males. 10. all ages. How accurate and complete will the data Data on deaths are considered to be complete and be? robust. What is being measured? Life Expectancy 2. LIFE EXPECTANCY – MALE INDICATOR Basic Information 1. proportions? 7. How is this indicator actually defined? Life expectancy at birth. Table 1 – Indicator Description Information Pg 4 Health Summary – Indicator No. Where does the data actually come Office for National Statistics (ONS). 9. 6. Who does it measure? Males. 4. Are there any caveats/warnings/ Death records without a valid area code are problems? excluded. When does it measure it? This indicator is updated annually.g. Life expectancy at birth is chosen as the preferred summary measure of all cause mortality as it quantifies the differences between areas in units (years of life) that are more readily understood and meaningful to the audience than those of other measures.Health Profiles 2009  The Indicator Guide 221 Section 6: life expectancy and cause of death 26. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. years. 3. 26 component Subject category/ Life expectancy and causes of death domain(s) . Differences in levels of all-cause mortality reflect health inequalities between different population groups. but the number of such records is negligible. and are estimates. Will it measure absolute numbers or Measures life expectancy in years. or a local authority is statistically significantly better statistical process control to test the or worse respectively than the England average. Why is it being measured? All cause mortality is a fundamental and probably the oldest measure of the health status of a population. all ages. from? 8. significance tests.

Rationale: Life expectancy at birth is a summary measure of the all cause mortality rates What this indicator in an area in a given period. 2005–07. County Districts. males Geography England. social classes and ethnic groups. • Quality of life indicators .Health and social well-being . Life expectancy at birth is chosen as the preferred summary measure of all cause mortality as it quantifies the differences between areas in units (years of life) that are more readily understood and meaningful to the audience than those of other measures. Timeliness ONS produced data are updated annually in the Autumn of the following year. and the effectiveness of interventions and treatment. Also life expectancy is an indicator in the following: • Local basket of inequalities indicators . inclusion of the indicator Rationale: There is a national health inequalities target for life expectancy which aims to Policy relevance increase average life expectancy at birth in England to 78. Metropolitan County Districts. It is the average number of years a new-born baby purports to would survive. Rationale: Purpose To help reduce premature mortality and facilitate planning of health services at behind the local level.12. London Boroughs. Rationale: All cause mortality is a fundamental and probably the oldest measure of Public Health the health status of a population.Indicator 39. all ages. were he or she to experience the particular area’s age-specific measure mortality rates for that time period throughout his or her life. the longer the estimated expectation of life for What a high/low males living in that area at that time. Differences in levels of all-cause mortality reflect health inequalities between different population groups. GOR. It represents the cumulative effect of Importance the prevalence of risk factors. e. Local Authority: Counties. prevalence and severity of disease. level of indicator value means . and to reduce health inequalities by 10% by 2010 as measured by life expectancy at birth (Department of Health PSA priority 1).g.Health Profiles 2009  The Indicator Guide 222 Section 6: life expectancy and cause of death Indicator name Life expectancy – male (*Indicator title in health profile) PHO with lead LHO responsibility Date of PHO February 2009 dataset creation Indicator definition Life expectancy at birth. years.5 years for women.Communities .Indicator 13. • Opportunity for all .6 years for men and to 82.Indicator 33 Interpretation: The higher the life expectancy. between genders. Unitary Authorities.

for example. Life expectancy at birth is also not a guide to the remaining expectancy of life at any other given age. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. In the case of indicators based on a sample of the population. Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. As these homes are unevenly distributed across due to bias and the country. the interval can be used to test whether the value is statistically significantly different to the national. If the interval does not include the national value. Confidence intervals quantify the uncertainty in this estimate and. whereas survival from birth is based on mortality rates for all ages. This reflects the fact that survival from a particular age depends only on the mortality rates beyond that age. . In Health Profiles 2009 this is 95%. generally speaking. If the interval includes the national value. but chance had led to a different set of data. a mortality and purpose rate. uncertainty also arises from random differences between the sample and the population itself. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. Confidence intervals are given with a stated probability level. The confidence intervals have also been used to make comparisons against the national value. For example. describe how much different the point estimate could have been if the underlying conditions stayed the same. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. if female life expectancy at birth was 80 years for a particular area. Interpretation: Older people living in nursing homes tend to be in poorer health than those Potential for error not living in nursing homes. under these conditions. These occurrences result in random fluctuations in the indicator value between different areas and time periods. The wider the confidence interval. a higher death rate – consequently lower life expectancy level – in confounding one area could simply be the result of migration of frail older people moving into nursing homes in that area. the difference is not statistically significant and the value is shown on the health summary chart with a white symbol. the life expectancy of women aged 75 in that area would exceed 5 years. The use of 95% is arbitrary but is conventional practice in medicine and public health.Health Profiles 2009  The Indicator Guide 223 Section 6: life expectancy and cause of death Interpretation: The figures reflect the contemporary mortality among those living in the area Potential for error in each time period. both because the death rates measurement of the area are likely to change in the future and because many of those born method in the area will live elsewhere for at least some part of their lives. the greater the uncertainty in the estimate. They are not the number of years a baby born in the area due to type of in each time period could actually expect to live. and so we say that there is a 95% probability that the interval covers the true value. the difference is statistically significant and the value is shown on the health summary chart with a red or amber symbol depending on whether it is worse or better than the national value respectively.

Health Profiles 2009  The Indicator Guide 224 Section 6: life expectancy and cause of death TABLE 2 – INDICATOR SPECIFICATION Indicator definition: Life expectancy at birth Variable Indicator definition: Number of years Statistic Indicator definition: Males Gender Indicator definition: All ages age group Indicator definition: 2005–2007 period Indicator definition: Years life expectancy scale Geography: England & Wales. males definition Denominator: Office for National Statistics (ONS).uk/statbase/Product. UK and constituent countries. counties and local geographies authorities available for this Available from the Office for National Statistics (ONS) indicator from other providers Dimensions Social Class. • Mid-year population estimates for 2007 – 21 August 2008. available from source http://www. all ages.asp?vlnk=15106 (See mid-year estimates for 2005 to 2007) The population estimates used for the calculation of figures for this indicator are based on the 2001 Census. . all ages.asp?vlnk=8841 source URL (See “Results for England and Wales”) Data extraction: January 2009 date Numerator: Deaths from all causes. • Mid-year population estimates for 2006 – 25 October 2007.gov. The population estimates used to calculate the LE figures were published on the following dates: • Mid-year population estimates for 2005 – 22 August 2007.statistics. of inequality: Available from the Office for National Statistics (ONS) subgroup analyses of this dataset available from other providers Data extraction: Office for National Statistics (ONS) Source Data extraction: http://www. GORs.statistics. mid-year.gov. males definition Numerator: source Office for National Statistics (ONS) Denominator: Estimated resident population estimates.uk/statbase/Product.

introduced in April 2009. and Cornwall).asp?vlnk=6949 Data for some new Unitary Authorities. Denominator data caveats Denominators are estimates of mid-year populations. Two authorities.uk/viewResource.uk/statbase/ssdataset. Shropshire.statistics. Isles of Scilly and City of London data are all included in the regional figures for the South West and London. Numerator data caveats Source material used to calculate LE: Area of residence is allocated by ONS using the postcode and the National Statistics Postcode Directory – records without a valid area code are excluded but the number of such records is negligible.gov.asp?vlnk=8841 Numerator: aggregation / Deaths were assigned to local authority boundaries by ONS using the allocation National Statistics Postcode Directory. A life table template which illustrates the method used to calculate the life expectancy results is available on the ONS website: http://www. The figures are three- Accuracy and year averages so as to provide large enough numbers to ensure that the completeness presented figures are sufficiently robust.  Disclosure Control Not applicable . Northumberland. based on results of the 2001 Census. City of London and Isles of Scilly. Central Bedfordshire.uk/statbase/Product. Methods used to calculate The figures are rolling three-year averages produced by aggregating indicator value deaths and population estimates for 2005–2007. The tables were created using annual mid-year population estimates and deaths registered in each year. Results for these areas were calculated using the South East Public Health Observatory life expectancy calculator: http://www.org. All figures presented are for life expectancy at birth.gov.statistics.sepho. Isles of London populations have Scilly has not been included in the new UA for Cornwall and City of been dealt with London has not been included with Hackney.  However. Table 3 – Indicator Technical Methods Numerator: extraction Extraction of the completed indicator from ONS http://www.Health Profiles 2009  The Indicator Guide 225 Section 6: life expectancy and cause of death Data quality: Mortality data quality and coverage is extremely high. Separate tables were constructed for males and females. are excluded from the results because of small numbers of deaths and populations in these areas. Small Populations: How City of London and Isles of Scilly are excluded from the results because Isles of Scilly and City of of small numbers of deaths and populations in these areas. and Wiltshire). Cheshire West and Cheshire. did not correspond with existing geographies (Cheshire East.aspx?id=8943 This was also used to calculate figures for the two Strategic Health Authorities in the South East: South Central and South East Coast. and England figures. Abridged life tables were constructed using standard methods. Results for the other new UAs were taken from published data for local authorities (Bedford) or counties (County Durham.

Health Profiles 2009  The Indicator Guide 226 Section 6: life expectancy and cause of death Confidence Intervals The calculation of the confidence intervals was made using the calculation method method developed by Chiang. The Life Table and its Construction. Chiang CL. Reza R. 1968: 189-214.asp The SEPHO calculator however also includes an adjustment to include a term for the variance associated with the final age interval as developed by Silcocks. Silcocks PBS. This report. In: Introduction to Stochastic Processes in Biostatistics. John Wiley & Sons. “Life expectancy at birth: methodological options for small populations”. Life expectancy as a summary of mortality in a population: statistical considerations and suitability for use by health authorities.gov. also presents research carried out to establish if there is a minimum population size below which the calculation of life expectancy may not be considered feasible. 55: 38-4 .statistics. J Epidemiol Community Health 2001.uk/methods_quality/publications. New York. A report which details research undertaken by the Office for National Statistics on comparing methodologies to enable the calculation of confidence intervals for life expectancy at birth has now been published as No 33 in the National Statistics Methodological Series. A copy of the report can be found on the NS website at: http://www. It concludes with a summary of methodological conclusions and considers how these could be applied to the calculation of life expectancy at birth for wards in England and Wales. Jenner DA.

What is being measured? Life Expectancy 2. Are there any caveats/warnings/ Death records without a valid area code are problems? excluded. 3. Will it measure absolute numbers or Measures life expectancy in years. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. 4. years. or a local authority is statistically significantly better statistical process control to test the or worse respectively than the England average. 9. social classes and ethnic groups. 27 component Subject category/ Life expectancy and causes of death domain(s) . Where does the data actually come Office for National Statistics (ONS) from? 8. 2005–07. all ages. When does it measure it? This indicator is updated annually. Differences in levels of all-cause mortality reflect health inequalities between different population groups. How accurate and complete will the data Data on deaths are considered to be complete and be? robust. Why is it being measured? All cause mortality is a fundamental and probably the oldest measure of the health status of a population. 10. LIFE EXPECTANCY – FEMALE INDICATOR Basic Information 1. between genders. proportions? 7. Are particular tests needed such as The data point is green or red when the figure in standardisation. Who does it measure? Females. all ages. 5. e. The populations used for the calculation of the figures for this indicator are based on the 2001 Census. and are estimates. How is this indicator actually defined? Life expectancy at birth. Table 1 – Indicator Description Information Pg 4 Health Summary – Indicator No.Health Profiles 2009  The Indicator Guide 227 Section 6: life expectancy and cause of death 27. females. significance tests. 6.g. but the number of such records is negligible. Life expectancy at birth is chosen as the preferred summary measure of all cause mortality as it quantifies the differences between areas in units (years of life) that are more readily understood and meaningful to the audience than those of other measures.

Life expectancy at birth is chosen as the preferred summary measure of all cause mortality as it quantifies the differences between areas in units (years of life) that are more readily understood and meaningful to the audience than those of other measures. 2005–07. Differences in levels of all-cause mortality reflect health inequalities between different population groups.Health Profiles 2009  The Indicator Guide 228 Section 6: life expectancy and cause of death Indicator name (* Life expectancy – female Indicator title in health profile) PHO with lead LHO responsibility Date of PHO February 2009 dataset creation Indicator definition Life expectancy at birth.g. It represents the cumulative effect of Importance the prevalence of risk factors. Rationale: All cause mortality is a fundamental and probably the oldest measure of Public Health the health status of a population. County Districts. Timeliness ONS produced data are updated annually in the Autumn of the following year. and to reduce health inequalities by 10% by 2010 as measured by life expectancy at birth (Department of Health PSA priority 1). Also life expectancy is an indicator in the following: • Local basket of inequalities indicators . Rationale: Purpose To help reduce premature mortality and facilitate planning of health services at behind the local level. Metropolitan County Districts. the longer the estimated expectation of life for What a high/low females living in that area at that time. • Opportunity for all .5 years for women.Indicator 13.Indicator 39. e. years. Local Authority: Counties. inclusion of the indicator Rationale: There is a national health inequalities target for life expectancy which aims to Policy relevance increase average life expectancy at birth in England to 78. were he or she to experience the particular area’s age-specific measure mortality rates for that time period throughout his or her life. It is the average number of years a new-born baby purports to would survive. level of indicator value means . • Quality of life indicators . and the effectiveness of interventions and treatment.Indicator 33 Interpretation: The higher the life expectancy. London Boroughs. social classes and ethnic groups. between genders.12. GOR.6 years for men and to 82. all ages. prevalence and severity of disease.Communities .Health and social well-being . Rationale: Life expectancy at birth is a summary measure of the all cause mortality rates What this indicator in an area in a given period. females Geography England. Unitary Authorities.

Health Profiles 2009  The Indicator Guide 229 Section 6: life expectancy and cause of death Interpretation: The figures reflect the contemporary mortality among those living in the area Potential for error in each time period. The wider the confidence interval. a higher death rate – consequently lower life expectancy level – in confounding one area could simply be the result of migration of frail older people moving into nursing homes in that area. for example. For example. the interval can be used to test whether the value is statistically significantly different to the national. Confidence intervals are given with a stated probability level. As these homes are unevenly distributed across due to bias and the country. Confidence intervals quantify the uncertainty in this estimate and. both because the death rates measurement of the area are likely to change in the future and because many of those born method in the area will live elsewhere for at least some part of their lives. Interpretation: Older people living in nursing homes tend to be in poorer health than those Potential for error not living in nursing homes. and so we say that there is a 95% probability that the interval covers the true value. the greater the uncertainty in the estimate. In the case of indicators based on a sample of the population. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. a mortality and purpose rate. Life expectancy at birth is also not a guide to the remaining expectancy of life at any other given age. These occurrences result in random fluctuations in the indicator value between different areas and time periods. uncertainty also arises from random differences between the sample and the population itself. the difference is not statistically significant and the value is shown on the health summary chart with a white symbol. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. If the interval includes the national value. the life expectancy of women aged 75 in that area would exceed 5 years. They are not the number of years a baby born in the area due to type of in each time period could actually expect to live. The use of 95% is arbitrary but is conventional practice in medicine and public health. This reflects the fact that survival from a particular age depends only on the mortality rates beyond that age. . describe how much different the point estimate could have been if the underlying conditions stayed the same. but chance had led to a different set of data. under these conditions. the difference is statistically significant and the value is shown on the health summary chart with a red or amber symbol depending on whether it is worse or better than the national value respectively. If the interval does not include the national value. if female life expectancy at birth was 80 years for a particular area. Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. whereas survival from birth is based on mortality rates for all ages. In Health Profiles 2009 this is 95%. generally speaking. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. The confidence intervals have also been used to make comparisons against the national value.

asp?vlnk=8841 URL (See “Results for England and Wales”) Data extraction: date January 2009 Numerator: definition Deaths from all causes. females Denominator: source Office for National Statistics (ONS). GORs. all ages. mid-year. Two authorities.uk/statbase/Product. are excluded from the results because of small numbers of deaths and populations in these areas.gov. available from http://www. City of London and Isles of Scilly.statistics. The figures are and completeness three-year averages so as to provide large enough numbers to ensure that the presented figures are sufficiently robust. The population estimates used to calculate the LE figures were published on the following dates: • Mid-year population estimates for 2005 . counties and available for this local authorities indicator from other Available from the Office for National Statistics (ONS) providers Dimensions of inequality: Social Class. females Numerator: source Office for National Statistics (ONS) Denominator: definition Estimated resident population estimates. UK and constituent countries.gov. • Mid-year population estimates for 2006 – 25 October 2007. Data quality: Accuracy Mortality data quality and coverage is extremely high.22 August 2007.asp?vlnk=15106 (See mid-year estimates for 2005 to 2007) The population estimates used for the calculation of figures for this indicator are based on the 2001 Census.uk/statbase/Product.statistics. all ages. . • Mid-year population estimates for 2007 – 21 August 2008. subgroup analyses of this Available from the Office for National Statistics (ONS) dataset available from other providers Data extraction: Source Office for National Statistics (ONS) Data extraction: source http://www.Health Profiles 2009  The Indicator Guide 230 Section 6: life expectancy and cause of death Table 2 – Indicator Specification Indicator definition: Life expectancy at birth Variable Indicator definition: Number of years Statistic Indicator definition: Females Gender Indicator definition: age All ages group Indicator definition: 2005–2007 period Indicator definition: scale Years life expectancy Geography: geographies England & Wales.

aspx?id=8943 This was also used to calculate figures for the two Strategic Health Authorities in the South East: South Central and South East Coast. based on results of the 2001 Census. All figures presented are for life expectancy at birth. Numerator data caveats Source material used to calculate LE: Area of residence is allocated by ONS using the postcode and the National Statistics Postcode Directory – records without a valid area code are excluded but the number of such records is negligible. Isles of London populations have Scilly has not been included in the new UA for Cornwall and City of been dealt with London has not been included with Hackney. Denominator data caveats Denominators are estimates of mid-year populations.uk/statbase/ssdataset. Separate tables were constructed for males and females. A life table template which illustrates the method used to calculate the life expectancy results is available on the ONS website: http://www. Northumberland. Isles of Scilly and City of London data are all included in the regional figures for the South West and London. did not correspond with existing geographies (Cheshire East. Results for the other new UAs were taken from published data for local authorities (Bedford) or counties (County Durham.  Disclosure Control Not applicable . and Wiltshire).sepho. Shropshire. The tables were created using annual mid-year population estimates and deaths registered in each year. Cheshire West and Cheshire. Small Populations: How City of London and Isles of Scilly are excluded from the results because Isles of Scilly and City of of small numbers of deaths and populations in these areas. and England figures. Central Bedfordshire.gov.statistics. Results for these areas were calculated using the South East Public Health Observatory life expectancy calculator: http://www.asp?vlnk=6949 Data for some new Unitary Authorities. Methods used to calculate The figures are rolling three-year averages produced by aggregating indicator value deaths and population estimates for 2005–2007.uk/viewResource.uk/statbase/Product.org. Abridged life tables were constructed using standard methods.statistics.  However. introduced in April 2009. and Cornwall).Health Profiles 2009  The Indicator Guide 231 Section 6: life expectancy and cause of death Table 3 – Indicator Technical Methods Numerator: extraction Extraction of the completed indicator from ONS http://www.gov.asp?vlnk=8841 Numerator: aggregation / Deaths were assigned to local authority boundaries by ONS using the allocation National Statistics Postcode Directory.

New York. Reza R. 1968: 189-214.statistics.uk/methods_quality/publications. Chiang CL. Silcocks PBS. John Wiley & Sons. A report which details research undertaken by the Office for National Statistics on comparing methodologies to enable the calculation of confidence intervals for life expectancy at birth has now been published as No 33 in the National Statistics Methodological Series. In: Introduction to Stochastic Processes in Biostatistics. Jenner DA. A copy of the report can be found on the NS website at: http://www.gov.asp The SEPHO calculator however also includes an adjustment to include a term for the variance associated with the final age interval as developed by Silcocks. It concludes with a summary of methodological conclusions and considers how these could be applied to the calculation of life expectancy at birth for wards in England and Wales.Health Profiles 2009  The Indicator Guide 232 Section 6: life expectancy and cause of death Confidence Intervals The calculation of the confidence intervals was made using the calculation method method developed by Chiang. “Life expectancy at birth: methodological options for small populations”. This report. The Life Table and its Construction. J Epidemiol Community Health 2001. also presents research carried out to establish if there is a minimum population size below which the calculation of life expectancy may not be considered feasible. 55: 38-4 . Life expectancy as a summary of mortality in a population: statistical considerations and suitability for use by health authorities.

Where does the data actually come Office for National Statistics (ONS) from? 8. Will it measure absolute numbers or Proportions: numbers per 1. Deaths occurring during the first 28 days of life (the neonatal period) in particular. When does it measure it? This indicator is updated annually. Table 1 – Indicator Description Information Page 4 Health summary – Indicator no. 9.Health Profiles 2009  The Indicator Guide 233 Section 6: life expectancy and cause of death 28. 6. 4. social and environmental conditions. It reflects the relationship between causes of infant mortality and upstream determinants of population health such as economic. Are there any caveats/warnings/ Records without a valid area code are excluded but problems? the number of such records is negligible. proportions? 7.000 live births. What is being measured? Infant Deaths 2. 2005–07.000 live births. 5. How accurate and complete will the data Data on births and deaths are considered to be be? complete and robust. aged less than 1 year. Are particular tests needed such as The data point is green or red when the figure in standardisation. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. significance tests. 10. Who does it measure? Infants aged less than 1 year. Why is it being measured? Infant mortality is an indicator of the general health of an entire population. persons. 28 component Subject category/ Life expectancy and causes of death domain(s) Indicator name Infant deaths (*Indicator title in health profile) PHO with lead LHO responsibility Date of PHO February 2009 dataset creation . 3. or a local authority is statistically significantly better statistical process control to test the or worse respectively than the England average. How is this indicator actually defined? Infant deaths. crude rate. INFANT DEATHS INDICATOR Basic Information 1. per 1. are considered to reflect the health and care of both mother and newborn.

Interpretation: A high indicator value (red circle in health summary chart) represents a What a high/low statistically significant higher level of infant deaths for that local authority level of indicator when compared to the national value. Unitary Authorities. as the number of infant deaths in any given area is small. Local Authority: Counties.000 live births Geography England.Health Profiles 2009  The Indicator Guide 234 Section 6: life expectancy and cause of death Indicator definition Infant deaths. Rationale: Purpose There is a national health inequalities target for infant mortality which aims behind the to reduce the gap between the infant mortality rate in the ‘routine and inclusion of the manual classes’ and the population as a whole. County Districts. Therefore we have chosen to include overall infant mortality as an indicator. crude rate. 2005–07. London Boroughs. However. per 1. Timeliness The Compendium infant mortality indicator is updated annually. relative to the number of live births. Rationale: There is a national health inequalities target for infant mortality which aims to Policy relevance reduce the gap between the infant mortality rate in the ‘routine and manual classes’ and the population as a whole. are considered to reflect the health and care of both mother and newborn. What this indicator purports to measure Rationale: Infant mortality is an indicator of the general health of an entire population. social and environmental conditions. . this target is difficult indicator to monitor at local level as the number of infant deaths in any given local authority or primary care trust (PCT) among a particular social class group is very small and subject to random fluctuations from year to year. fluctuations from year to year are possible and may not indicate a statistically significant trend. Interpretation: Coverage can be considered to be complete as the registration of deaths Potential for error is a legal requirement. A reduction in the infant death rate indicates a reduction in the number of deaths. however. usually around September of the following year. Metropolitan County Districts. There are wide inequalities in infant mortality rates by local authority in England and monitoring these inequalities is essential to understanding trends in inequalities in infant mortality. However. and Strategic Health Authorities for the South East. Even with pooled rates. Rationale: This indicator measures the level of infant deaths in the area. GOR. Public Health It reflects the relationship between causes of infant mortality and upstream Importance determinants of population health such as economic. persons. aged less than 1 year. value means A low indicator value (green circle in health summary chart) represents a statistically significant lower level of infant deaths for that local authority when compared to the national value. Data quality for the relevant fields (age and area of due to type of residence) is extremely high. measurement The small number of infant deaths at a local authority level means that pooling method of three years data is required. Deaths occurring during the first 28 days of life (the neonatal period) in particular. numbers may still be small and large random fluctuations possible.

In Health Profiles this is 95%. the difference is statistically significant and the value is shown on the health summary chart with a red or amber symbol depending on whether it is worse or better than the national value respectively. TABLE 2 – INDICATOR SPECIFICATION Indicator definition: Infant deaths Variable Indicator definition: Crude rate Statistic Indicator definition: Persons Gender Indicator definition: Less than 1 year age group Indicator definition: 2005–2007 period Indicator definition: Per 1. and so we say that there is a 95% probability that the interval covers the true value. The use of 95% is arbitrary but is conventional practice in medicine and public health. generally speaking. Whether or due to bias and not such variables need to be considered depends on the purpose to which the confounding indicator is being put. under these conditions. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. the greater the uncertainty in the estimate.000 live births scale . the interval can be used to test whether the value is statistically significantly different to the national. The wider the confidence interval. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. but chance had led to a different set of data. for example. Confidence intervals are given with a stated probability level. If the interval includes the national value. uncertainty also arises from random differences between the sample and the population itself. In the case of indicators based on a sample of the population. a mortality and purpose rate. The confidence intervals have also been used to make comparisons against the national value. the difference is not statistically significant and the value is shown on the health summary chart with a white symbol. Confidence intervals quantify the uncertainty in this estimate and. describe how much different the point estimate could have been if the underlying conditions stayed the same. If the interval does not include the national value.Health Profiles 2009  The Indicator Guide 235 Section 6: life expectancy and cause of death Interpretation: The rates are not standardised or adjusted to take into account any potential Potential for error confounding variables such as the age or ethnicity of the mother. These occurrences result in random fluctuations in the indicator value between different areas and time periods.

uk indicator from other providers Dimensions Infant death rates by the National Statistics Socio-Economic of inequality: Classification (based on father’s occupation at death registration) are subgroup analyses available at a national level from the Office for National Statistics. Data on births and deaths are considered to be largely complete. Table 3 – Indicator Technical Methods Numerator: extraction Infant mortality counts by area were extracted by ONS and supplied to NCHOD.uk or nww.nchod. . ONS area classification. Strategic Health Authority.uk/ source URL Data extraction: Data extracted from source as at Jan 2009 date Numerator: The number of infant deaths aged under 1 year registered in 2005–07 definition Numerator: source Office for National Statistics (ONS).uk) Source of data: National Statistics Data extraction: http://www. Denominator data caveats Live births were assigned to geographical areas by ONS using the postcode of residence and the National Statistics Postcode Directory (NSPD). The Office for National Statistics complete a variety of completeness quality checks on the data before making them available for analysis. of this dataset As only a 10 per cent sample of live births are coded for father’s available from occupation. Numerator: aggregation / Deaths were assigned to geographical areas by ONS using the allocation postcode of residence and the National Statistics Postcode Directory (NSPD). other providers Infant death rates are available at a national level by mother’s country of birth from ONS. geographies Primary Care Organisation available for this Available from: www. Records without a valid area code are excluded but the number of such records is negligible.Health Profiles 2009  The Indicator Guide 236 Section 6: life expectancy and cause of death Geography: England & Wales.nhs.nhs. local infant death rates by NS-SEC are not available.nchod. source Data quality: Statistics on births and deaths are derived from the registration of births Accuracy and and deaths.nhs. Numerator data caveats Records without a valid area code are excluded but the number of such records is negligible.nchod. Denominator: The number of live births registered in 2005-07 definition Denominator: Office for National Statistics (ONS).nchod.nhs. Data extraction: Compendium of Clinical and Health Indicators/Clinical and Health Source Outcomes Knowledge Base (www.

000 are given by:   r   1. Confidence Intervals Within the Compendium the 95% confidence intervals for crude calculation method rates and percentages are calculated using the likelihood-based method described by Aitken et al. Data were sourced from NCHOD except for the new Unitary Authorities. For example lower and upper limits for a rate expressed per 1. Aitken M et al. and Cornwall). Results for these areas were calculated by the LHO.000    r   1.000 live births: The number of infant deaths is indicator value divided by the number of live births in the same area and multiplied by 1. Cheshire West and Cheshire. and Wiltshire). however. Central Bedfordshire. Oxford: Oxford University Press.96    1 + exp ln −      1 − r   nr (1 − r )          r   1. Results for the other new UAs were taken from published data for local authorities (Bedford) or counties (County Durham. which is a good approximation of the exact method.Health Profiles 2009  The Indicator Guide 237 Section 6: life expectancy and cause of death Methods used to calculate Crude rate per 1.000. Shropshire. data for regions (South West populations have been dealt and London) and for England do include these data. Disclosure Control None applied.96       1 − r   nr (1 − r )        where: r is the crude rate. Northumberland. introduced in April 2009. Data for the with Isles of Scilly have not been included in the new Cornwall unitary authority.000    1 + exp ln r  +  1. 1990. .96   exp ln +    1 − r   nr (1 − r )      rUL = × 1. Statistical Modelling in GLIM.96   exp ln −    1 − r   nr (1 − r )      rLL = × 1. which did not correspond with existing geographies (Cheshire East. n is the population-years at risk. Small Populations: How Isles Data for Isles of Scilly and City of London have not been included of Scilly and City of London due to small populations.

significance tests. a local authority is statistically significantly better or statistical process control to test the or worse respectively than the England average. Are particular tests needed such The data point is green or red when the figure in as standardisation. 9.000 proportions? population. attributable to smoking. How is this indicator actually defined? Deaths attributable to smoking per 100. 5. 35 years +. 3. Where does the data actually come Office of National Statistics. directly age standardised rate. 7. 2005–07. How accurate and complete will the Although the input data is very reliable. Table 1 – Indicator Description Information Page 4 Spine Chart – Indicator 29 component Subject category/ Life expectancy and causes of death domain(s) Indicator name (* Smoking attributable mortality (“Deaths from smoking”) Indicator title in health profile) PHO with lead ERPHO responsibility Date of PHO 5 Feb 2009 dataset creation Indicator definition Deaths attributable to smoking. Are there any caveats/warnings/ No problems? 10. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. Will It measure absolute numbers or Proportions: number of cases per 100. DEATHS FROM SMOKING INDICATOR Basic Information 1. . the results data be? also depend on estimated (ex-) smoking rates and the estimated proportion of causes of death which can be attributed to smoking. When does it measure it? 1/1/2005–31/12/2007 6. 4.000 population.Health Profiles 2009  The Indicator Guide 238 Section 6: life expectancy and cause of death 29. Why is it being measured? Because smoking is the single biggest cause of death and there are big inequalities between and within communities in smoking and in death rates due to smoking. rates are calculated using (ex-) smoking rates and estimates for smoking attributable fractions of various causes of deaths. Who does it measure? Input data are annual death files provided by ONS. persons. What is being measured? Rates of deaths. 2. from? 8.

indicator To promote better measurement of smoking prevalence. and accounts for about half of the inequality in death rates between Importance spearhead and non-spearhead areas. Assuming measurement that the contribution of smoking to deaths in Americans in the 1980’s is the method same as its contribution to an English population in 2005-07. High smoking attributable death rates are indicative of poor population health and high smoking rates. behind the To focus action on tackling smoking related disease and to help prioritise inclusion of the actions to tackle health inequalities. Interpretation: The method relies on the use of estimates of the contribution of smoking to a Potential for error range of causes of death derived from the American Cancer Prevention Society due to type of II study. A zero rate is unachievable but lower rates than the best in England are seen in California and Scandinavian countries. GOR. due to bias and These figures are not available at local authority level. Interpretation: Smoking prevalence rates for England were used because the model required Potential for error estimates of ex-smoking and non-smoking as well as current smoking rates. Rationale: Purpose To encourage smoking prevention. London Boroughs Timeliness Annual updates available from erpho Rationale: Rate of deaths that can be attributed to smoking in persons 35 and over What this indicator purports to measure Rationale: Smoking still accounts for between 1 in 6 and 1 in 10 of all deaths in Public Health England. Rationale: Smoking Kills Policy relevance Choosing Health Smokefree England Interpretation: An indicator value better than average (green circle in health summary What a high/low chart) represents a statistically significant better level of smoking attributable level of indicator mortality for that local authority when compared to the national value. The method will confounding tend to overestimate smoking related deaths in low prevalence areas and underestimate in high prevalence areas. . These estimates do not take into account any degree of uncertainty meaning the estimates will be over precise. Local Authority: Counties. value means An indicator value worse than average (red circle in health summary chart) represents a statistically significant worse level of smoking attributable mortality for that local authority when compared to the national value.Health Profiles 2009  The Indicator Guide 239 Section 6: life expectancy and cause of death Geography England. Metropolitan County Districts. Smoking related deaths is a powerful proxy measure of overall health and predictor of health care demand. It presumes a degree of generalisability of these estimates. Unitary Authorities. County Districts. It remains the biggest single cause of preventable mortality and morbidity in the world.

Health Profiles 2009  The Indicator Guide 240 Section 6: life expectancy and cause of death Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. a mortality and purpose rate. The use of 95% is arbitrary but is conventional practice in medicine and public health. the difference is statistically significant and the value is shown on the health summary chart with a red or green symbol depending on whether it is worse or better than the national value respectively. Table 2 – Indicator Specification Indicator Deaths attributable to smoking definition: Variable Indicator Directly age-standardised rate definition: Statistic Indicator Persons definition: Gender Indicator 35 and over definition: age group Indicator 2005–07 definition: period . The wider the confidence interval is the greater is the uncertainty in the estimate. If the interval does not include the national value. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. for example. describe how much different the point estimate could have been if the underlying conditions stayed the same. If the interval includes the national value. generally speaking. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. the interval can be used to test whether the value is statistically significantly different to the national. These occurrences result in random fluctuations in the indicator value between different areas and time periods. The confidence intervals have also been used to make comparisons against the national value. Confidence intervals are given with a stated probability level. uncertainty also arises from random differences between the sample and the population itself. under these conditions. the difference is not statistically significant and the value is shown on the health summary chart with an amber symbol. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. Confidence intervals quantify the uncertainty in this estimate and. In the case of indicators based on a sample of the population. and so it is said that there is a 95% probability that the interval covers the true value. but chance had led to a different set of data. In Health Profiles 2009 this is 95%.

aspx?id=18243 analyses of this dataset available from other providers Data ONS for mortality data and population estimates. Sammec) extraction: December 2008 (mortality data) date .uk/statistics-and-data-collections/health- and-lifestyles-related-surveys/health-survey-for-england/health-survey-for-england- 2005-latest-trends Data December 2008 (HSE. See for example http://www.cdc.erpho.Health Profiles 2009  The Indicator Guide 241 Section 6: life expectancy and cause of death Indicator Per 100.org. ex-smoking and non-smoking derived from Health Survey for Source England 2003–05 SAMMEC website (for relative risks from the American Cancer Prevention Society II Study 1982-1988) Data http://apps.uk/ subgroup viewResource.nccd. extraction: Prevalence of smoking. and aggregated into deprivation quintiles of inequality: to calculate within area inequalities.gov/sammec/ extraction: ONS mortality extracts are supplied to PHOs under a non-disclosure agreement and source URL the provisions of the Health Act 2000.ic. Health Survey for England http://www.nhs.000 European Standard population definition: scale Geography: SHAs geographies Available from erpho on request available for this indicator from other providers Dimensions Data can be calculated at MSOA level.

ONS Mid year population estimates 2006.0 Cardiovascular Diseases Ischemic Heart Disease I20–I25 Other Heart Disease I00–I09. The 3 years data is pooled. Mortality data – because this is cause specific there may be coding variation between places although for the key contributors e. cancer deaths. source ONS Mid-year population estimates 2007. Smoking prevalence is estimated using national survey data.g. Emphysema J40–J42. Pharynx C00–C14 Oesophagus C15 Stomach C16 Pancreas C25 Larynx C32 Trachea.Health Profiles 2009  The Indicator Guide 242 Section 6: life expectancy and cause of death Numerator: Disease Category ICD10 definition Malignant Neoplasms Lip. . Data quality: The accuracy of these estimates is contingent on the underlying accuracy of the three Accuracy and components: completeness 1. The relative risks are unpublished and only made available through the SAMMEC website 3. J43 Chronic Airway Obstruction J44 Numerator: Death extracts from ONS: source ONS PHO death extract 2005 ONS PHO death extract 2006 ONS PHO death extract 2007 Denominator: Mid-year local authority population estimates definition Denominator: ONS Mid-year population estimates 2005. Estimates are as published for Persons rounded. Influenza J10–J18 Bronchitis. Future updates will prove how accurate these assumptions are. 2. this is less likely. Lung. I26–I51 Cerebrovascular Disease I60–I69 Atherosclerosis I70 Aortic Aneurysm I71 Other Arterial Disease I72–I78 Respiratory Diseases  Pneumonia. Bronchus C33–C34 Cervix Uteri C53 Kidney and Renal Pelvis C64–C65 Urinary Bladder C67 Acute Myeloid Leukemia C92. Oral Cavity.

1.[LA Code] LEFT JOIN HES.A_NationalPostcodes_Feb08 ON M_Deaths2001to2007.1.A_LACounty. [FiveYearTo85].1.1. COUNT(*) FROM M_Deaths2001to2007 LEFT JOIN A_DeathAgeBands ON M_Deaths2001to2007.3) = ‘C05’ OR SUBSTRING([Und COD (non-neo)].3) = ‘C02’ OR SUBSTRING([Und COD (non-neo)]. ICDCode varchar(4).Health Profiles 2009  The Indicator Guide 243 Section 6: life expectancy and cause of death Table 3 – Indicator Technical Methods Numerator: CREATE TABLE P2564_HPSAMMEC_LA_ICD10 extraction (RegPeriod varchar(8).3) = ‘C06’ OR SUBSTRING([Und COD (non-neo)].dbo. SUBSTRING([Und COD (non-neo)].ResCty + M_ Deaths2001to2007.3) = ‘C00’ OR SUBSTRING([Und COD (non-neo)]. Sex varchar(1).ResLAUA = HES.3)) INSERT INTO P2564_HPSAMMEC_LA_ICD10 (RegPeriod.[pcd2] WHERE YEAR([Reg Date]) > 2004 AND YEAR([Reg Date]) < 2008 AND [LA Code now] <> ‘NULL’ AND [LA Code now] <> ‘15UH’ AND ([FiveYearTo85] = ‘35-39’ OR [FiveYearTo85] = ‘40-44’ OR [FiveYearTo85] = ‘45-49’ OR [FiveYearTo85] = ‘50-54’ OR [FiveYearTo85] = ‘55-59’ OR [FiveYearTo85] = ‘60-64’ OR [FiveYearTo85] = ‘65-69’ OR [FiveYearTo85] = ‘70-74’ OR [FiveYearTo85] = ‘75-79’ OR [FiveYearTo85] = ‘80-84’ OR [FiveYearTo85] = ‘85+’) AND (SUBSTRING([Und COD (non-neo)].A_LACounty ON M_Deaths2001to2007. LACode.dbo.1.3) = ‘C09’ .Age = A_ DeathAgeBands. AgeGroup.3) = ‘C04’ OR SUBSTRING([Und COD (non-neo)].1. AgeGroup varchar(5).Units LEFT JOIN HES. Deaths) SELECT ‘2005-07’. [LA name].1.1. LACode varchar(4).AgeInUnits AND M_Deaths2001to2007.dbo. Pcode_8dig = HES. Sex.3) = ‘C08’ OR SUBSTRING([Und COD (non-neo)].3) = ‘C03’ OR SUBSTRING([Und COD (non-neo)].[Age Unit] = A_ DeathAgeBands.3) = ‘C07’ OR SUBSTRING([Und COD (non-neo)]. LAName varchar(30). Deaths decimal(8. LAName. Sex.3). SAFAgeGrp varchar(5).A_NationalPostcodes_Feb08.dbo. [LA Code now].1.1.1.3) = ‘C01’ OR SUBSTRING([Und COD (non-neo)]. ICDCode.

3) = ‘C11’ OR SUBSTRING([Und COD (non-neo)].1.3) = ‘C32’ OR SUBSTRING([Und COD (non-neo)].3) = ‘C67’ OR [Und COD (non-neo)] = ‘C920’ OR SUBSTRING([Und COD (non- neo)].1.2) = ‘I3’ OR SUBSTRING([Und COD (non-neo)].1.3) = ‘I74’ OR SUBSTRING([Und COD (non-neo)]. [FiveYearTo85]. [LA Name].1.3) = ‘C10’ OR SUBSTRING([Und COD (non-neo)].1.1.1.1.3) = ‘I73’ OR SUBSTRING([Und COD (non-neo)].3) .1.1.1.1.2) = ‘I4’ OR SUBSTRING([Und COD (non-neo)].1.3) = ‘C64’ OR SUBSTRING([Und COD (non-neo)].3) = ‘J41’ OR SUBSTRING([Und COD (non-neo)].1.3) = ‘C33’ OR SUBSTRING([Und COD (non-neo)].3) = ‘C25’ OR SUBSTRING([Und COD (non-neo)].3) = ‘I77’ OR SUBSTRING([Und COD (non-neo)].1. [FiveYearTo85] .1.3) = ‘I51’ OR SUBSTRING([Und COD (non-neo)].1. Sex.3) = ‘C15’ OR SUBSTRING([Und COD (non-neo)].1.3) = ‘C65’ OR SUBSTRING([Und COD (non-neo)].1.1.3) = ‘I50’ OR SUBSTRING([Und COD (non-neo)].3) = ‘J43’ OR SUBSTRING([Und COD (non-neo)]. SUBSTRING([Und COD (non-neo)].3) = ‘C53’ OR SUBSTRING([Und COD (non-neo)].1.1.3) = ‘I71’ OR SUBSTRING([Und COD (non-neo)].3) = ‘I70’ OR SUBSTRING([Und COD (non-neo)].3) = ‘C34’ OR SUBSTRING([Und COD (non-neo)].2) = ‘J1’ OR SUBSTRING([Und COD (non-neo)].3) = ‘C13’ OR SUBSTRING([Und COD (non-neo)].3) = ‘J42’ OR SUBSTRING([Und COD (non-neo)].Health Profiles 2009  The Indicator Guide 244 Section 6: life expectancy and cause of death OR SUBSTRING([Und COD (non-neo)].3) = ‘C12’ OR SUBSTRING([Und COD (non-neo)].2) = ‘I6’ OR SUBSTRING([Und COD (non-neo)]. SUBSTRING([Und COD (non-neo)].1.1.1.2) = ‘I0’ OR SUBSTRING([Und COD (non-neo)].1.1.3) = ‘J40’ OR SUBSTRING([Und COD (non-neo)].1.1.1.2) = ‘I2’ OR SUBSTRING([Und COD (non-neo)]. Sex.3) = ‘I76’ OR SUBSTRING([Und COD (non-neo)].1.1.3) = ‘C14’ OR SUBSTRING([Und COD (non-neo)].3) = ‘C16’ OR SUBSTRING([Und COD (non-neo)].1.3) ORDER BY [LA Code now].3) = ‘I72’ OR SUBSTRING([Und COD (non-neo)].1.3) = ‘I78’ OR SUBSTRING([Und COD (non-neo)].1.1.1.1.1.3) = ‘J44’) GROUP BY [LA Code now].3) = ‘I75’ OR SUBSTRING([Und COD (non-neo)].

Shropshire. New UA name Old LA name Bedford Bedford Central Bedfordshire Mid Bedfordshire South Bedfordshire Cheshire East Congleton Crewe and Nantwich Macclesfield Cheshire West and Chester Chester Ellesmere Port & Neston Vale Royal Cornwall Caradon Carrick Kerrier North Cornwall Penwith Restormel Numerator data caveats Denominator data Population estimates used are Persons rounded and pooled across the 3 caveats years. Data for five other new unitary Authorities have been calculated from the aggregation of previous Local Authorities. . according to the age of the deceased (see allocation below). and Durham have the same boundaries as the counties of the same name so have been allocated these data. This may produce slight differences in rate calculations from those done locally. Since the 2001 census new Unitary Authorities have been created.Health Profiles 2009  The Indicator Guide 245 Section 6: life expectancy and cause of death Numerator: Deaths in the smoking related ICD10 categories were multiplied by the aggregation/ Smoking Attributable Fraction (SAF). Population estimates of higher geographies are aggregated from LA populations. Wiltshire. The new Unitary Authorities of Northumberland.

22 1.07 7.1) + p2(RR2 .14 Cerebrovascular Disease Persons Aged 35–64 3.1) + p2(RR2 .83 1.55 Larynx 14.08 2.30 Persons Aged 65+ 1.6 6.25 1.40 5.64 3.78 1. The following relative risks for each disease-age-sex group were used.78 Obstruction .60 1.79 Stomach 1.86 1.00 1.13 1.72 1.29 Pharynx Esophagus 6.07 1.07 2.73 1.02 5.58 6.14 Kidney and Renal 2.76 4.51 1.77 Emphysema Chronic Airway 10.08 1.44 1.00 1.04 1.12 Respiratory Diseases Pneumonia.22 1.34 13.00 1.31 1.89 Acute Myeloid 1. 10. RR1 = relative risk in current smokers and RR2 = relative risk in former smokers.36 1.15 2.80 13.70 12.80 1.09 2.64 12. 17.00 Aortic Aneurysm 6.32 Pancreas 2.21 1.89 3. 23.49 1.20 Other Heart Disease 1.29 1.27 1. p2= ex-smoker prevalence.10 Bronchitis.26 8.59 1.38 Leukemia Cardiovascular Diseases Ischemic Heart Disease Persons Aged 35–64 2.53 Bronchus Cervix Uteri 1.1)]/[1 + p1(RR1 .27 2.04 4.96 1.36 2.33 1.32 Persons Aged 65+ 1.75 2.47 1.75 1.07 Other Arterial Disease 2.46 7. Oral Cavity.17 1. RR Male RR Female Disease Category Current Former Current Former Smoker Smoker Smoker Smoker Malignant Neoplasms Lip.17 1.Health Profiles 2009  The Indicator Guide 246 Section 6: life expectancy and cause of death Methods used to Age-specific attributable deaths were calculated as follows: calculate indicator The SAF multiplier applied to deaths in each smoking related ICD10 category value were determined using the formula: SAF = [p1(RR1 .05 Pelvis Urinary Bladder 3.63 1.21 3.10 15.49 1. Influenza 1.1)] Where p1 = prevalence of current smokers.03 Atherosclerosis 2.16 Trachea.33 1.04 11.08 6.01 2. Lung.69 4.

4% M 55-64 20.1% F 75+ 9.7% M 75+ 8.0% 28.7% 19.4% 36.2% 31.org.uk/standardisedratecalculater.7% 54. Directly age standardised rates were calculated using the batch calculator available from the erpho website http://www.uk/topics/tools/rates. aspx#12474 Small Populations: Isles of Scilly and the City of London were excluded from local authority How Isles of Scilly calculations.6% M 45-54 25.4% F 35-44 28.2% 60.0% The counts of deaths were aggregated by relevant ICD codes.8% F 65-74 14.8% 30.erpho.Health Profiles 2009  The Indicator Guide 247 Section 6: life expectancy and cause of death Together with the following England smoking prevalence estimates Smoking Prevalence Sex Age Smoker Former smoker M 35-44 29.2% F 45-54 26.aspx .yhpho.org. City of London was included in the higher geographies (the Isles and City of London of Scilly were not included in higher geographies).8% 44.9% 16. age and sex groups Relative risks were assumed to be constant within broader age bands Death counts in 5-year age bands were multiplied by the appropriate SAF to give smoking attributable deaths in each age-sex band.8% F 55-64 22. Intervals calculation method See http://www.5% M 65-74 12.9% 21. populations have been dealt with Disclosure Control Not relevant Confidence Confidence intervals have been calculated using Byars method.

reflecting both the incidence of disease and the ability to treat it. under 75. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. the cause of death misclassified. 4. 3. 2. or a local authority is statistically significantly better statistical process control to test the or worse respectively than the England average. persons. therefore. EARLY DEATHS: HEART DISEASE AND STROKE INDICATOR Basic Information 1. 5. What is being measured? Mortality rate from all circulatory diseases (including heart disease and stroke). When does it measure it? Updated annually.Health Profiles 2009  The Indicator Guide 248 Section 6: life expectancy and cause of death 30. Are particular tests needed such as The data point is green or red when the figure in standardisation.000 European Standard population. There is the potential for the underlying cause of death to be incorrectly attributed on the death certificate and. Why is it being measured? Circulatory disease accounts for 40% of all deaths (30% under 75). directly age-standardised rate. Are there any caveats/warnings/ Area of residence is allocated by ONS using the problems? postcode and the National Statistics Postcode Directory – records without a valid area code are excluded but the number of such records is negligible. significance tests. Mortality is a direct measure of health care need and indicates the overall circulatory disease burden on the population. How accurate and complete will the data Mortality counts are derived from an annual be? mortality extract supplied by ONS and are based on the original underlying cause of death for which there is nearly 100% coverage on the mortality register. per 100. Who does it measure? People aged under 75. Will it measure absolute numbers or Directly age-standardised rate. Where does the data actually come Office for National Statistics (ONS). from? 8. 2005- 07 (pooled). 9. proportions? 7. Table 1 – Indicator Description Information Pg 4 Health Summary – Indicator No 30 component Subject category/ Life expectancy and causes of death domain(s) . How is this indicator actually defined? Mortality from all circulatory diseases. 10. 6.

GOR. per 100. behind the To reduce premature deaths from circulatory diseases. . This measure supports delivery of the Department of Health PSA targets and LDP and is relevant to Choosing Health. new 2009 Unitary Authorities as at April 2009). Local Authority: Counties. County Districts. inclusion of the indicator Rationale: The under 75 circulatory disease mortality rate is a key target indicator in Policy relevance the 1999 Public Health White Paper ‘Saving Lives: Our Healthier Nation’.Health Profiles 2009  The Indicator Guide 249 Section 6: life expectancy and cause of death Indicator name Mortality rate from all circulatory diseases (*Early deaths: heart disease & (*Indicator title in stroke) health profile) PHO with lead SEPHO responsibility Date of PHO 05 February 2009 dataset creation Indicator definition Mortality from all circulatory diseases.g. persons. by earlier detection of disease and by more effective treatment. The baseline for monitoring this target was the three year period 1995–97. The target is to reduce the number of deaths from circulatory disease in people aged under 75 years by at least two-fifths by 2010.000 European Standard population Geography England. Timeliness The Compendium mortality from all circulatory diseases indicator is updated annually. 2005–07 (pooled). directly age-standardised rate. Rationale: Early mortality from all circulatory diseases. value means A low indicator value (green circle in health summary chart) represents a statistically significant lower (better) rate of early deaths from circulatory disease when compared to the national value. Interpretation: A high indicator value (red circle in health summary chart) represents a What a high/low statistically significant higher (worse) rate of early deaths from circulatory level of indicator disease when compared to the national value. What this indicator purports to measure Rationale: Circulatory disease accounts for 40% of all deaths (30% under 75). encouraging healthier lifestyles and reducing exposure to smoking). Mortality Public Health is a direct measure of health care need reflecting the overall circulatory disease Importance burden on the population. Coronary Heart Disease NSF and Programme for Action. Unitary Authorities. The mortality rate may be improved by reducing the population’s risk (e. Rationale: Purpose To estimate premature mortality due to circulatory diseases. London Boroughs (boundaries as at April 2008. Metropolitan County Districts. under 75. usually around November/December following the publication by ONS of the new year’s mortality extract (usually in May) and mid-year population estimates (usually August-September). both the incidence of disease and the ability to treat it.

therefore. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. uncertainty also arises from random differences between the sample and the population itself. but chance had led to a different set of data. confounding Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. the cause of death misclassified. by taking into account due to bias and differences in the age structures of the populations being compared. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. a mortality and purpose rate. Confidence intervals are given with a stated probability level. Confidence intervals quantify the uncertainty in this estimate and. In the case of indicators based on a sample of the population. describe how much different the point estimate could have been if the underlying conditions stayed the same. The use of 95% is arbitrary but is conventional practice in medicine and public health. sex. These occurrences result in random fluctuations in the indicator value between different areas and time periods. underlying due to type of cause of death. for example. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. under these conditions. This improves the comparability of rates for Potential for error different areas. area of residence) is extremely high. or between different time periods. the interval can be used to test whether the value is statistically significantly different to the national. and so we say that there is a 95% probability that the interval covers the true value.Health Profiles 2009  The Indicator Guide 250 Section 6: life expectancy and cause of death Interpretation: Coverage can be considered to be complete as the registration of deaths is Potential for error a legal requirement. If the interval does not include the national value. measurement There is the potential for the underlying cause of death to be incorrectly method attributed on the death certificate and. generally speaking. TABLE 2 – INDICATOR SPECIFICATION Indicator definition: Mortality from all circulatory diseases (ICD10 I00 –I99) Variable Indicator definition: Directly age-standardised rate Statistic Indicator definition: Persons Gender . The confidence intervals have also been used to make comparisons against the national value. Interpretation: The rates are age-standardised. the difference is statistically significant and the value is shown on the health summary chart with a red or green symbol depending on whether it is worse or better than the national value respectively. If the interval includes the national value. the difference is not statistically significant and the value is shown on the health summary chart with an amber symbol. The wider is the confidence interval the greater is the uncertainty in the estimate. In Health Profiles 2009 this is 95%. Data quality for the relevant fields (age.

area of residence) is extremely high.nhs. Data quality for the relevant fields (age.fti. Primary Care Organisation.communities. 2008).uk other providers Data can also be found at Neighbourhood Renewal Unit Public Service Agreement Floor Targets (http://www. Denominator: ONS source Data quality: Coverage can be considered to be complete as the registration of deaths is Accuracy and a legal requirement. extraction Numerator: Deaths were assigned to geographical areas using the area code supplied in aggregation / the mortality extract. people aged under 75 (current as at 29 September. Table 3 – Indicator Technical Methods Numerator: Extraction by NCHOD.uk/fti/).gov. Source Data extraction: Data received directly from NCHOD. sex.000 European Standard population scale Geography: England & Wales. registered in the respective calendar years 2005-07. This is derived from postcode of residence by the ONS allocation using the National Statistics Postcode Directory (NSPD). gender available from NCHOD. Dimensions Age. classified by underlying cause of death definition (ICD10 I00 – I99). available for this Available from National Centre for Health Outcomes Development (NCHOD) indicator from website www. underlying completeness cause of death. in people aged under 75. . Strategic Health geographies Authority. Area of residence is allocated by ONS using the postcode and the National Statistics Postcode Directory – records without a valid area code are excluded but the number of such records is negligible. ONS area. source URL Data extraction: 14 January 2009 date Numerator: Deaths from all circulatory disease. Numerator: source Office for National Statistics (ONS) Denominator: 2001 census based mid-year population estimates for respective calendar years definition 2005 to 2007.nchod. of inequality: subgroup analyses of this dataset available from other providers Data extraction: NCHOD.Health Profiles 2009  The Indicator Guide 251 Section 6: life expectancy and cause of death Indicator definition: Under 75 age group Indicator definition: 2005–07 (pooled**) period ** average of annual rates Indicator definition: Per 100.

The lower and upper limits for the rates are denoted by DSRLL and DSRUL respectively. 1 wi2 ⋅ rij (1 − rij ) DSR LL / UL = DSR ± 1. in year j. +/. nij is the number of individuals in the subject population in age group i. The age groups used are: Under 1. The rate is expressed per 100.1.…. . or proportion. Methods used to The directly age-standardised rate (DSR) is the rate of events that would calculate indicator occur in a population with a standard age structure if that population were value to experience the age-specific rates of the subject population. 5-9.Health Profiles 2009  The Indicator Guide 252 Section 6: life expectancy and cause of death Numerator data Area of residence is allocated by ONS using the postcode and the National caveats Statistics Postcode Directory – records without a valid area code are excluded but the number of such records is negligible. 80–84. The standard errors are calculation method obtained using the method described by Breslow and Day. and City of London populations have been dealt with Disclosure Control None applied. i. 85+.000 population) where: wi is the number.96 standard errors.000 × ×∑   2 ij nij  ∑ wi     ij  (expressed per 100. hence confidence intervals for rates based on less than 50 cases should be viewed with caution. current as at 29 September 2008. This method is likely to be unreliable when there are fewer than 50 cases in an area. of individuals in the standard population in age group i. The rate for 2005–07 has been calculated as the simple average of the individual annual rates. The lower and upper limits for the rates are denoted by DSRLL and DSRUL respectively.96 × 100. rij is the crude age-specific rate in the subject population in age group i. in year j.000 population. 1–4. Confidence Confidence intervals for the age-standardised rates were calculated using a Intervals normal approximation.e. but modified to use the binomial variance for a proportion to estimate the variances of the crude age-specific rates. Small Populations: Isles of Scilly and City of London are excluded from the lower tier datasets but How Isles of Scilly included in England and Regional figures. Mortality counts are derived from the annual DH mortality extract supplied by ONS and are based on the original underlying cause of death for which there is nearly 100% coverage on the mortality register. The standard population used is the European Standard Population. Denominator data Data are based on the latest revisions of ONS mid-year population estimates caveats for the respective years.

There is the potential for the underlying cause of death to be incorrectly attributed on the death certificate and. Are particular tests needed such The data point is green or red when the figure in as standardisation. 9. and effective treatment can all reduce the burden of cancer morbidity and mortality. early diagnosis. When does it measure it? Updated annually. the cause of death misclassified. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. persons.000 European Standard population. directly age-standardised rate. 4. Will It measure absolute numbers or Directly age-standardised rate. How is this indicator actually defined? Mortality from all cancers. 6. What is being measured? Mortality rate from all cancers. Why is it being measured? Early mortality from cancer is a direct measure of health care need as public health interventions for prevention. 10. per 100. from? 8.Health Profiles 2009  The Indicator Guide 253 Section 6: life expectancy and cause of death 31. Where does the data actually come Office for National Statistics (ONS). TABLE 1 – INDICATOR DESCRIPTION Information Pg 4 Health Summary – Indicator No 31 component Subject category/ Life expectancy and causes of death domain(s) . How accurate and complete will the Mortality counts are derived from an annual data be? mortality extract supplied by ONS and are based on the original underlying cause of death for which there is nearly 100% coverage on the mortality register. Who does it measure? People aged under 75. 3. a local authority is statistically significantly better or statistical process control to test the or worse respectively than the England average. EARLY DEATHS: CANCER INDICATOR Basic Information 1. 2005–07 (pooled). significance tests. proportions? 7. 2. 5. under 75. Are there any caveats/warnings/ Area of residence is allocated by ONS using the problems? postcode and the National Statistics Postcode Directory – records without a valid area code are excluded but the number of such records is negligible. therefore.

early diagnosis. The target is a 20% reduction by the year 2010 from the baseline rate in 1995–97. usually around November/December following the publication by ONS of the new year’s mortality extract (usually in May) and mid-year population estimates (usually August–September). Interpretation: A high indicator value (red circle in health summary chart) represents a What a high/low statistically significant higher (worse) rate of early deaths from cancer for that level of indicator local authority when compared to the national value. If current Importance incidence rates remain the same. What this indicator purports to measure Rationale: Cancer is amongst the three leading causes of death at all ages except for Public Health pre-school age children in the UK. by 2025 there will be an additional 100. 2005–07 (pooled). Rationale: Early mortality from all cancers. inclusion of the indicator Rationale: The directly age-standardised mortality rate from all cancers for persons aged Policy relevance under 75 is a target indicator in the Saving Lives: Our Healthier Nation strategy. Cancer NSF and Programme for Action. under 75. Timeliness The Compendium mortality from all cancers indicator is updated annually. Inequalities exist in cancer rates between the most deprived areas and the most affluent. Unitary Authorities. new 2009 Unitary Authorities as at April 2009). persons.000 cases of cancer diagnosed each year as a result of the ageing population. per 100. London Boroughs (boundaries as at April 2008. value means A low indicator value (green circle in health summary chart) represents a statistically significant lower (better) rate of early deaths from cancer when compared to the national value. . County Districts. Metropolitan County Districts. It accounts for 26% all deaths. Early mortality from cancer is a direct measure of health care need as public health interventions for prevention. Rationale: Purpose To estimate premature mortality due to cancer.Health Profiles 2009  The Indicator Guide 254 Section 6: life expectancy and cause of death Indicator name Mortality rate from all cancers (*Early deaths: cancer) (*Indicator title in health profile) PHO with lead SEPHO responsibility Date of PHO 05 February 2009 dataset creation Indicator definition Mortality from all cancers. effective treatment can all reduce the burden of cancer morbidity and mortality. This measure supports delivery of the Department of Health PSA targets and LDP and is relevant to Choosing Health. directly age-standardised rate. behind the To reduce premature deaths from cancer. GOR. Local Authority: Counties.000 European Standard population Geography England.

Confidence intervals are given with a stated probability level. Data quality for the relevant fields (age. therefore. underlying due to type of cause of death. sex. Interpretation: The rates are age-standardised. a mortality and purpose rate. or between different time periods.Health Profiles 2009  The Indicator Guide 255 Section 6: life expectancy and cause of death Interpretation: Coverage can be considered to be complete as the registration of deaths is Potential for error a legal requirement. If the interval does not include the national value. by taking into account due to bias and differences in the age structures of the populations being compared. but chance had led to a different set of data. for example. the difference is statistically significant and the value is shown on the health summary chart with a red or green symbol depending on whether it is worse or better than the national value respectively. the cause of death misclassified. generally speaking. uncertainty also arises from random differences between the sample and the population itself. the interval can be used to test whether the value is statistically significantly different to the national. If the interval includes the national value. This improves the comparability of rates for Potential for error different areas. describe how much different the point estimate could have been if the underlying conditions stayed the same. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. Confidence intervals quantify the uncertainty in this estimate and. and so we say that there is a 95% probability that the interval covers the true value. measurement There is the potential for the underlying cause of death to be incorrectly method attributed on the death certificate and. under these conditions. These occurrences result in random fluctuations in the indicator value between different areas and time periods. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. The use of 95% is arbitrary but is conventional practice in medicine and public health. The wider is the confidence interval the greater is the uncertainty in the estimate. Table 2 – Indicator Specification Indicator definition: Mortality from all cancers (ICD10 C00-C97) Variable Indicator definition: Directly age-standardised rate Statistic Indicator definition: Persons Gender . the difference is not statistically significant and the value is shown on the health summary chart with an amber symbol. In the case of indicators based on a sample of the population. area of residence) is extremely high. In Health Profiles 2009 this is 95%. The confidence intervals have also been used to make comparisons against the national value. confounding Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us.

Numerator: source Office for National Statistics (ONS) Denominator: 2001 census based mid-year population estimates for respective calendar years definition 2005 to 2007. Strategic Health Authority. Denominator: ONS source Data quality: Coverage can be considered to be complete as the registration of deaths is Accuracy and a legal requirement. . registered in the respective calendar years 2005–07. gender available from NCHOD. This is derived from postcode of residence by the ONS allocation using the National Statistics Postcode Directory (NSPD). Area of residence is allocated by ONS using the postcode and the National Statistics Postcode Directory – records without a valid area code are excluded but the number of such records is negligible. in people aged under 75.uk/fti/). 2008). source URL Data extraction: 14 January 2009 date Numerator: Deaths from all malignant neoplasms.nchod.uk indicator from other providers Data can also be found at Neighbourhood Renewal Unit Public Service Agreement Floor Targets (http://www.communities. Table 3 – Indicator Technical Methods Numerator: Extraction by NCHOD. of inequality: subgroup analyses of this dataset available from other providers Data extraction: NCHOD.Health Profiles 2009  The Indicator Guide 256 Section 6: life expectancy and cause of death Indicator definition: Under 75 age group Indicator definition: 2005–07 (pooled**) period ** average of annual rates Indicator definition: Per 100. sex.nhs.000 European Standard population scale Geography: ONS area. classified by underlying cause of death definition (ICD10 C00-C97). underlying completeness cause of death. Source Data extraction: Data received directly from NCHOD.gov. people aged under 75 (current as at 29 September. Primary Care Organisation. Dimensions Age. extraction Numerator: Deaths were assigned to geographical areas using the area code supplied in aggregation/ the mortality extract. geographies Available from National Centre for Health Outcomes Development (NCHOD) available for this website www.fti. area of residence) is extremely high. Data quality for the relevant fields (age.

Confidence Confidence intervals for the age-standardised rates were calculated using a Intervals normal approximation. This method is likely to be unreliable when there are fewer than 50 cases in an area. hence confidence intervals for rates based on less than 50 cases should be viewed with caution.Health Profiles 2009  The Indicator Guide 257 Section 6: life expectancy and cause of death Numerator data Area of residence is allocated by ONS using the postcode and the National caveats Statistics Postcode Directory . and City of London populations have been dealt with Disclosure Control None applied.96 standard errors.1. The rate for 2005–07 has been calculated as the simple average of the individual annual rates.000 × ×∑   2 ij nij  ∑ wi     ij  (expressed per 100. 80–84.…. 1–4. current as at 29 September. of individuals in the standard population in age group i. i. nij is the number of individuals in the subject population in age group i. rij is the crude age-specific rate in the subject population in age group i. +/. 5-9. Denominator data Data are based on the latest revisions of ONS mid-year population estimates caveats for the respective years. Mortality counts are derived from the annual DH mortality extract supplied by ONS and are based on the original underlying cause of death for which there is nearly 100% coverage on the mortality register. 2008.000 population) where: wi is the number. The lower and upper limits for the rates are denoted by DSRLL and DSRUL respectively. in year j. Methods used to The directly age-standardised rate (DSR) is the rate of events that would calculate indicator occur in a population with a standard age structure if that population were value to experience the age-specific rates of the subject population.000 population. or proportion. 1 wi2 ⋅ rij (1 − rij ) DSR LL / UL = DSR ± 1.records without a valid area code are excluded but the number of such records is negligible.e. 85+. . The age groups used are: Under 1. but modified to use the binomial variance for a proportion to estimate the variances of the crude age-specific rates. The standard errors are calculation method obtained using the method described by Breslow and Day.96 × 100. Small Populations: Isles of Scilly and City of London are excluded from the lower tier datasets but How Isles of Scilly included in England and Regional figures. The standard population used is the European Standard Population. in year j. The rate is expressed per 100.

crude rate per 100. What is being measured? People killed or seriously injured on the road. Will It measure absolute numbers or Proportion: Crude rate of people killed or seriously proportions? injured per 100. ROAD INJURIES AND DEATHS INDICATOR Basic Information 1. Who does it measure? All persons.Health Profiles 2009  The Indicator Guide 258 Section 6: life expectancy and cause of death 32.000 resident population. significance tests. This is likely to affect the results for employment centres and sparsely populated rural areas which have high numbers of visitors or through traffic. 9. Where does the data actually come The data is collected by the Police and published by from? Department for Transport 8. Why is it being measured? To help reduce road traffic collisions which are a major cause of preventable death and serious injury. Are there any caveats/warnings/ Not all road casualties are reported to police. or a local authority is statistically significantly better statistical process control to test the or worse respectively than the England average. all ages. meaning of the data and the variation they based on the 95% confidence intervals of the figure show? compared to the England value. 2. How is this indicator actually defined? People killed or seriously injured on the roads of the area. collecting and collating. Areas with high inflows of people or traffic may have artificially high rates because the at-risk resident population is not an accurate measure of exposure to transport. When does it measure it? Continually reported and data is published annually 6. Table 1 – Indicator Description Information Pg 4 Health Summary – Indicator No 32 component Subject category/ Life expectancy and causes of death domain(s) Indicator name Road injuries and deaths (*Indicator title in health profile) . problems? The figures are for road casualties that occurred within a local authority area irrespective of the home residence of the person involved in the accident. 10.000 resident population 7. 3. 4. 2005–2007. all ages 5. Are particular tests needed such as The data point is green or red when the figure in standardisation. be? Data quality varies as there are differences between police forces in procedures for recording. How accurate and complete will the data Coverage is complete.

GOR. In Saving Lives: Our Healthier Nation. 2005–2007. ‘accidents’. Factors that should be considered when interpreting this indicator include the nature of the road network. volumes of traffic and number of pedestrians. Hyder AA. London:TSO). Sleet D. World report on road traffic injury prevention. For children and for men aged Importance 20–64 years. The vast majority of road traffic collisions are preventable and can be avoided through improved education. 2004. to measure Rationale: Motor vehicle traffic accidents are a major cause of preventable deaths and Public Health morbidity. as the vast majority of road traffic collisions are preventable. Unitary Authorities. Interpretation: A high indicator value (red circle in health summary chart) represents a What a high/low statistically significant higher rate of road injury and death when compared to level of indicator the national value. Scurfield R. Jarawan E et al. London Boroughs. particularly in younger age groups.000 resident population. Local Authority: Counties. County Districts. crude rate per 100. Department of Health. Timeliness The indicator presented in Health Profiles is not routinely updated but may become available in future Health Profiles. For instance. The NHS Plan. However. there would be 600 fewer deaths in men aged 20–64 years from motor vehicle traffic accidents each year if all men had the same death rates as those in social classes I and II combined (Acheson. Geneva: World Health Organisation). Geography England. Mohan D. and the number of children killed or seriously injured by 50% by 2010 compared with the baseline of 1994–8. Tackling Health Inequalities: A Programme For Action included a headline target to reduce road casualty numbers in disadvantaged areas. including road traffic collisions. . all ages. Metropolitan County Districts. were identified as one of the four main priority areas. D. 1998. mortality rates for motor vehicle traffic accidents are higher in lower socioeconomic groups. any number of deaths and injuries greater than zero is undesirable and therefore a low indicator value should not mean that PH action is not needed. The rates and numerators published by DfT are available annually (usually October-December). value means A low indicator value (amber circle in health summary chart) represents a statistically significant rate of road injury and death when compared to the national value. Rationale: Purpose To help reduce road injury and death. London: TSO. road infrastructure and vehicle safety (Peden M.Health Profiles 2009  The Indicator Guide 259 Section 6: life expectancy and cause of death PHO with lead South West Public Health Observatory responsibility Date of PHO January 2009 (revised February 2009 for new April 2009 area boundaries) dataset creation Indicator definition People killed or seriously injured on the roads of the area. Rationale: What this Unintentional deaths and serious injuries on public roads caused by road traffic indicator purports collisions. awareness. behind the inclusion of the indicator Rationale: One of the Department of Transport’s PSA targets is to reduce the number of Policy relevance people killed or seriously injured by 40%. Report of the Independent Inquiry into Inequalities in Health.

Therefore. Confidence intervals are given with a stated probability level. These occurrences result in random fluctuations in the indicator value between different areas and time periods. The use of 95% is arbitrary but is conventional practice in medicine and public health. measurement Districts with low resident populations but which have high inflows of people method or traffic may have artefactually high rates because the at-risk resident population is not an accurate measure of exposure to transport. The confidence intervals have also been used to make comparisons against the national value. and so we say that there is a 95% probability that the interval covers the true value. If the interval includes the national value. describe how much different the point estimate could have been if the underlying conditions stayed the same. with older people more likely to be seriously injured or killed when involved in a road collision.Health Profiles 2009  The Indicator Guide 260 Section 6: life expectancy and cause of death Interpretation: Research has shown that not all road casualties are reported to police. Interpretation: The completeness of reporting road injury to the police has been shown Potential for error to vary by factors such as age. but chance had led to a different set of data. generally speaking. uncertainty also arises from random differences between the sample and the population itself. population structure and mix of traffic in areas may contribute to variation in Local Authority values. the difference is not statistically significant and the value is shown on the health summary chart with an amber symbol. injury severity and type of road user. The wider is the confidence interval the greater is the uncertainty in the estimate. under these conditions. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. There are also differences by age group. with higher reporting rates amongst younger and older people. Potential for error Therefore. the difference is statistically significant and the value is shown on the health summary chart with a red or green symbol depending on whether it is worse or better than the national value respectively. . Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. research suggests that cyclists are less likely to report injury to the confounding police. For due to bias and example. In the case of indicators based on a sample of the population. this indicator may be an under-estimate of the true level of serious due to type of injury. a mortality and purpose rate. This is likely to affect employment centres and sparsely populated rural areas which have high numbers of visitors or through traffic. In Health Profiles 2009 this is 95%. the interval can be used to test whether the value is statistically significantly different to the national. For this purpose the national value has been treated as an exact reference value rather than as an estimate and. Confidence intervals quantify the uncertainty in this estimate and. Age also impacts on injury severity. for example. If the interval does not include the national value.

dft. extraction: Source Data http://www. Unitary Authorities.gov. definition: age group Indicator Numerator 2005–2007.Health Profiles 2009  The Indicator Guide 261 Section 6: life expectancy and cause of death TABLE 2 – INDICATOR SPECIFICATION Indicator People killed or seriously injured on the roads of the area. Local Authority: Counties. available for uk.dft.gov.uk for Counties. definition: Variable Indicator Crude rate. definition: Statistic Indicator Persons. London Boroughs.dft.gov. this indicator from other providers Dimensions Numerator data is available from www. definition: Gender Indicator All ages. Unitary Authorities. denominator mid-2006. geographies Annual rates and numerators are available for these geographies from www.000 resident population. GOR. subgroup analyses of this dataset available from other providers Data Department for Transport. broken down by age group and road user type. definition: period Indicator Per 100. of inequality: London Boroughs. definition: scale Geography: England.uk/pgr/statistics/datatablespublications/accidents/ extraction: casualtieslatables/ source URL Data Data extracted from source as at: 29/12/2008 extraction: date .

concussion. This may cause problems in classification of serious versus slight injury. Serious injury is not recorded on the basis of a clinical diagnosis. collecting and collating. Accuracy and Data quality varies as there are differences between police forces in procedures for completeness recording.uk/pgr/roadsafety/research/rsrr/theme5/trendsfatalcar76. /allocation .dft. Fatal casualties are those who sustained injuries which caused death less than 30 days after the accident.ac. One accident may give rise to more than one casualty. This generally will not reflect the results of a medical examination. whether or not they are admitted to hospital: fractures. This indicator includes only on casualties who are fatally or seriously injured and these categories are defined as follows. or any of the following injuries. confirmed suicides are excluded.gov.pdf There are differences between police data and hospital records of road casualties due to differences in both definitions and reporting. Table 3 – Indicator Technical Methods Numerator: Downloaded from www.uk extraction Numerator: Calculated a 3-year average for 2005–2007 by summing the individual years and aggregation dividing by 3. The match between hospital admissions and police reports of serious injury is discussed comprehensively in recent national reports: http://www.dft.pdf http://eprints.gov.Health Profiles 2009  The Indicator Guide 262 Section 6: life expectancy and cause of death Numerator: 3-year average of the number of people (all ages) killed or seriously injured on the definition roads of a LA in the period 2005–2007. The vehicle need not be moving and accidents involving stationary vehicles and pedestrians or other road users are included.ucl. source Data quality: Coverage is complete. Other sources of data which measure road injury and death are death registrations data (which matches well with police reports of road deaths) and hospital episode statistics. but may be influenced according to whether the casualty is hospitalised or not. A casualty is recorded as seriously or slightly injured by the police on the basis of information available within a short time of the accident. crushings. severe general shock requiring medical treatment and injuries causing death 30 or more days after the accident.uk/archive/00003373/01/3373. There is no information available about the extent of this variation. severe cuts and lacerations. Hospitalisation procedures will vary regionally. burns (excluding friction burns). Seriously injured casualties are those who sustained an injury for which they are detained in hospital as an in-patient. definition Denominator: Office for National Statistics (ONS). Numerator: Department for Transport. internal injuries. The indicator is based on casualties who incur injury on the public highway (including footways) in which at least one road vehicle or a vehicle in collision with a pedestrian is involved and which becomes known to the police within 30 days of its occurrence. source Denominator: 2001 Census based mid-year population estimate for the year 2006.

which can be found at the addresses below: http://www. The police definition of ‘serious’ injury has remained consistent and therefore this data can be used to look at time trends. Methods Calculation of the numerator: Calculated a 3-year average for 2005–2007 by used to summing the individual years and dividing by 3. of Scilly The City of London and Heathrow counts (numerator and denominator) are included and City in the London regional total and the England total. The numerator was then divided by the denominator. regardless of where they occurred. This would be a good measure of the health effects upon the population which lives in the district but would be less useful for targeting of road safety interventions.uk/archive/00003373/01/3373. For this reason.uk/pgr/roadsafety/research/rsrr/theme5/trendsfatalcar76. Control .Health Profiles 2009  The Indicator Guide 263 Section 6: life expectancy and cause of death Numerator Research has shown that not all road casualties are reported to police.pdf These reports suggest that the serious group of casualties could be up to twice as large as indicated by the ‘serious’ category in police records. Populations: consistent with how this data is published by DfT. it should be noted that recording practices may have changed over time.gov. using hospital admissions data. An alternative to using casualties and deaths occurring on the roads in the area would have been to use a measure of resident casualties and deaths. of London populations have been dealt with Disclosure Not applicable as no counts less than 5. DfT published data caveats two papers on the level of under-reporting on 23 June 2006. indicator the resulting value was then multiplied by 100.000 to give a crude rate per 100.ucl. However. Small Any casualties recorded on the Isles of Scilly are included in the Cornwall numerator. Not all of this shortfall in the serious group of casualties is due to under-reporting because in the slight category are casualties which should be in the serious category and have been misclassified or misrecorded. The use of resident population as a denominator is a proxy measure for population exposure and is consistent with how this indicator is presented elsewhere.000 value population. This measure is not available.ac.pdf http://eprints. These could add up to another 25% to the serious category. Denominator count: Mid-2006 calculate population estimates (all ages). Therefore the Isles of Scilly How Isles population is included in the Cornwall denominator. occurring casualties and deaths were used in the Health Profiles. the denominator should include all people travelling on public roads in the data caveats area (in vehicles and as pedestrians) and take account of the distances travelled.dft. Denominator Ideally.

. Reference: Dobson AJ. (100*α) deaths) per unit of time exposed.10:457-462.g. Kuulasmaa K.2(d+1) 2 2 UL = 2 where LL and UL are the lower and upper 100*(1-a) per cent confidence limits and d denotes the number of observed events (e.α . Scherer J. Statistics in Medicine 1991.2(d+1) is the (100*(1-a/2))th percentage point for a chi-squared distribution on 2(d+1) degrees of freedom. Eberle E. Confidence intervals for weighted sums of Poisson parameters. violent offences.2d is the (100*a/2)th percentage point for a chi-   squared distribution with 2d degrees of freedom and χ²(1-α/2). serious injuries.Health Profiles 2009  The Indicator Guide 264 Section 6: life expectancy and cause of death Confidence The confidence intervals for these crude rates were constructed using the three year Intervals total in the following formula that relates the chi-square and Poisson distributions: calculation method χ α .  χ² a/2.2d 2 2 LL = 2 χ 1. The confidence limits for the rates were then obtained by dividing the upper and lower limits for the counts by the person time exposed.

Health Profiles 2009  The Indicator Guide 265 Section 7: Charts and trend graphs .

based on the Indices of Deprivation 2007. The charts are shaded according to the proportion of the relevant population in an area living in neighbourhoods belonging to each national deprivation quintile (where 1 is the most deprived quintile and 5 is the least deprived). What is being measured? Proportion of the population of an area living in each of the five national deprivation quintiles. How is this indicator actually defined? These charts are based on the Index of Multiple Deprivation (IMD) 2007. 2. Are there any caveats/warnings/ The indicators are based on mainly 2005 data and problems? this is therefore at least 4 years out of date.Health Profiles 2009  The Indicator Guide 266 Section 7: charts and trend graphs 33. It is based on an average score of an area and it can’t be assumed to represent all individuals in that area. 9. these dimensions are weighted and an overall deprivation score is given. 3. These are ranked for all 32482 LSOAs in England and divided into five equal groups or ‘national quintiles’. It is underpinned by separate dimensions of deprivation. Each neighbourhood. proportions? 7. (The relevant population is the population estimate used in the construction of the IMD 2007) 4. This may have a larger effect in some areas than others. or Lower Layer Super Output Area (LSOA). When does it measure it? 2007 Based on various indicators from 2005 and 2001 6. . Will It measure absolute numbers or Proportion based on a composite indicator. all ages in the relevant population (otherwise known as the ‘at risk’ population). some aspects of deprivation will not be included in the indices. (This is the population estimate used in the construction of the IMD 2007 – see Table 2) 5. How accurate and complete will the data All indicators included in the IMD 2007 were chosen be? using criteria that included accuracy and completion. Although very comprehensive. Who does it measure? All persons. in England is allocated an IMD score. Where does the data actually come DCLG from? 8. which is a model measuring deprivation at the neighbourhood level. for example if the data is incomplete or not collected. Why is it being measured? The differences in deprivation between areas are a major determinant of health inequality in the UK. DEPRIVATION CHART Basic Information 1.

Metropolitan County Districts. Are particular tests needed such as n/a standardisation. Rationale: Level of deprivation of the relevant population of an area using a composite of What this indicator domains which are made up of a range of indicators. Acheson takes the view that health inequalities are also unlikely to decrease. Local Authority: Counties. Importance Many studies and analyses have demonstrated the association of increasingly poor health with increasing deprivation. these dimensions are weighted and an overall deprivation score is given. component Subject category/ Deprivation domain(s) Indicator name Deprivation: a national perspective (*Indicator title in health profile) PHO with lead Yorkshire & Humber responsibility Date of PHO February 2009 dataset creation Indicator definition This is a measure of the IMD 2007 which is a model measuring deprivation in an area. Published 2004 and 2007. smoking prevalence.Health Profiles 2009  The Indicator Guide 267 Section 7: charts and trend graphs 10. all cause mortality. the definition is not completely consistent due to changes in some of the indicators used. The charts are shaded according to the proportion of the relevant population in an area living in neighbourhoods belonging to each national deprivation quintile (where 1 is the most deprived quintile and 5 is the least deprived). significance tests. Regional. self-reported long standing illness and a diet rich in fruit and vegetables are all positively or negatively correlated with deprivation. or statistical process control to test the meaning of the data and the variation they show? Table 1 – Indicator Description Information Chart on p2 of District and County profiles. County Districts. It is underpinned by separate dimensions of deprivation. Unitary Authorities. For instance. measure (The relevant population is the population estimate used in the construction of the IMD 2007) Rationale: The differences in deprivation between areas are a major determinant of Public Health health inequality in the United Kingdom. London Boroughs Timeliness Indicator is not regularly updated. (The relevant population is the population estimate used in the construction of the IMD 2007) Geography National. . If deprivation inequality does not decrease. LSOA areas are divided purports to into quintiles where 1 is the most deprived quintile and 5 is the least.

• www.pdf • Department of Health. behind the inclusion of the indicator Rationale: • Acheson D. 2000.Health Profiles 2009  The Indicator Guide 268 Section 7: charts and trend graphs Rationale: Purpose To monitor and help reduce health inequalities.communities.dh. due to bias and Although very comprehensive.hm-treasury. Policy relevance London: TSO. • www. 1998. Confidence N/A Intervals: Definition and purpose Table 2 – Indicator Specification Indicator Indices of Deprivation 2007 definition: Variable Indicator National quintile: All LSOAs in England are ranked according to deprivation definition: Statistic score and split into five equal groups Indicator Persons definition: Gender Indicator All ages definition: age group Indicator 2001 and 2005 definition: period .uk/localgovernment/ Interpretation: A high indicator value (dark shading) represents a high level of deprivation by What a high/low national standards. some aspects of deprivation will not be included confounding in the indices.gov.pdf • HM Treasury 2007 PBR CSR: Public service agreements: • http://www. Report of the Independent Inquiry into Inequalities in Health.uk/assetRoot/04/01/93/62/04019362. 2007 http://www. • Department of Health.dh. for example if the data is incomplete or not collected. This may have a larger effect in some area than others.gov.uk/ • Department for Communities and Local Government The New Performance Framework for Local Authorities & Local Authority Partnerships: Single Set of National Indicators Department for Communities and Local Government.uk/assetRoot/04/05/57/83/04055783. The NHS Plan.gov. 2003. Department of Health. Tackling Health Inequalities: A Programme for Action. due to type of measurement method Interpretation: It is based on an average score of an area and can’t be assumed to represent Potential for error all individuals in that area. London: TSO.gov. level of indicator value means Interpretation: The indicators are based on 2005 and 2001 data and this is therefore at least 4 Potential for error years out of date.

uk/communities/neighbourhoodrenewal/ source URL deprivation/deprivation07/ Data extraction: February 2009 date Numerator: Number of the relevant population living in each quintile in England based on definition the IMD 2007 score. The figures have been subject to disclosure control. regional and national level.communities. The figures have been adjusted from the ONS mid-year estimate to exclude the prison population in order to fit the definition of ‘at risk’.gov.uk/communities/neighbourhoodrenewal/deprivation/ deprivation07/ Numerator: The relevant population by national quintile of deprivation was aggregated from aggregation/ Lower Super Output Area to Local Authority.gov. Also.gov.Health Profiles 2009  The Indicator Guide 269 Section 7: charts and trend graphs Indicator Proportion of relevant population in each national quintile.communities.uk/communities/ indicator from neighbourhoodrenewal/deprivation/deprivation07/ other providers Dimensions IMD 2007 individual domains are available at Lower Layer Super Output of inequality: Area (LSOA) level from http://www. Denominator: Office for National Statistics (ONS) and Department of Communities and Local source Government (DCLG).uk/communities/ subgroup analyses neighbourhoodrenewal/deprivation/deprivation07/ of this dataset available from other providers Data extraction: Department of Communities and Local Government source Data extraction: http://www. definition: scale (The relevant population is the population estimate used in the construction of the IMD 2007) Geography: IMD 2007 overall score and individual domains are available at Lower Layer geographies Super Output Area (LSOA) level. . (The relevant population is the population estimate used in the construction of the IMD 2007). Numerator: source Department of Communities and Local Government Denominator: Denominator data – ‘at risk’ mid-2005 population estimates (elsewhere definition referred to as the ‘relevant’ population).communities.gov. allocation (The relevant population is the population estimate used in the construction of the IMD 2007). county.communities. county. region or national level. some summary scores are available available for this at LA and County level from http://www. They are aggregated from LSOA level to the LA. Data quality: Criteria for inclusion of indicators to ID 2004 and ID 2007 included: accuracy and • Up-to-date completeness • Statistically robust • Available for the whole of England at a small level in a consistent form TABLE 3 – INDICATOR TECHNICAL METHODS Numerator: Department of Communities and Local Government website extraction http://www.

not all individuals in the area data caveats will be deprived.Health Profiles 2009  The Indicator Guide 270 Section 7: charts and trend graphs Numerator Deprivation level is based on the average for the area. All LSOAs in England are ranked according used to to deprivation score and split into five equal quintiles. Confidence N/A Intervals calculation method . value (The relevant population is the population estimate used in the construction of the IMD 2007) Small Only included at regional and national level Populations: How Isles of Scilly and City of London populations have been dealt with Disclosure Every effort has been made by the DCLG to ensure that data do not allow the Control disclosure of confidential information. Denominator Census data and mid-year estimates are known to be deficient in their estimates of: data caveats • Non-white populations • Full-time students • Men aged 20-39 • People living in nursing homes etc • Rough sleepers • Inner-city populations • Households of multiple occupation • Migrants Methods From the downloaded file with LSOA data. The relevant population from calculate each LSOA is then aggregated to the area being measured and a proportion calculated indicator for the population within that area in each national quintile.

The populations used for the calculation of figures for this indicator are based on the 2001 Census. statistical process control to test the meaning of the data and the variation they show? . between genders. and are experimental estimates. 5. e. Where does the data actually come Office for National Statistics (ONS). Who does it measure? Males. 9. Are particular tests needed such as 95% confidence intervals should be considered when standardisation. females.000 i. 2. 6. Are there any caveats/warnings/ Death records without a valid area code are excluded problems? but the number of such records is negligible. significance tests. Results are also not presented for areas where the population at risk for the years 2003–07 was less than 5. How is this indicator actually defined? Life expectancy at birth. 10. When does it measure it? Data for this indicator is updated annually. Differences in levels of all-cause mortality reflect health inequalities between different population groups. 4. all ages. These areas are displayed as “n/a” in the data table. Life expectancy at birth is chosen as the preferred summary measure of all cause mortality as it quantifies the differences between areas in units (years of life) that are more readily understood and meaningful to the audience than those of other measures. Results will be missing for areas where a local authority had none of its population living in a particular quintile. from? 8. How accurate and complete will the Data on deaths are considered to be complete and data be? robust.e. 2003–2007. Within every local authority there are different levels of deprivation. Will it measure absolute numbers or Measures life expectancy at birth in years. 3. or making comparisons between areas or genders. all ages. What is being measured? Life expectancy by deprivation quintile. social classes and ethnic groups.Health Profiles 2009  The Indicator Guide 271 Section 7: charts and trend graphs 34. This indicator therefore looks at the within area inequalities in life expectancy. where the total aggregated population for these years fell below this threshold.g. Deprivation quintiles were assigned to Lower Layer Super Output Areas (LSOAs) at a national level. Why is it being measured? All cause mortality is a fundamental and probably the oldest measure of the health status of a population. by national deprivation quintile. LIFE EXPECTANCY BY DEPRIVATION QUINTILE CHART Basic Information 1. years. proportions? 7.

within every local authority there are different levels of deprivation. known as the Spearhead group. Geography England. County Districts. Opportunity for all .Indicator 39. males and females. Rationale: Purpose To help reduce premature mortality and facilitate planning of health services at behind the local level. social classes and ethnic groups. Rationale: Life expectancy at birth is a summary measure of the all cause mortality rates What this indicator in an area in a given period. London Boroughs. Differences in levels of all-cause mortality reflect health inequalities between different population groups. Life expectancy at birth is chosen as the preferred summary measure of all cause mortality as it quantifies the differences between areas in units (years of life) that are more readily understood and meaningful to the audience than those of other measures. Unitary Authorities. were he or she to experience the particular area’s age-specific measure mortality rates for that time period throughout his or her life.6 years for men and to 82. e. by national deprivation quintiles (IMD 2007). years. all ages. and the effectiveness of interventions and treatment.Health and social well-being . It represents the cumulative effect of Importance the prevalence of risk factors. Timeliness ONS produced data are updated annually in the autumn of the following year. 2003–07. between genders. However.Indicator 13. Quality of life indicators .5 years for women.12. This indicator therefore looks at the within area inequalities in life expectancy by national deprivation quintile. and to reduce health inequalities by 10% by 2010 as measured by life expectancy at birth (Department of Health PSA priority 1). Local Authority: Counties. Rationale: All cause mortality is a fundamental and probably the oldest measure of Public Health the health status of a population. It is the average number of years a new-born baby purports to would survive. SHAs in the South East.g. Life expectancy is also an indicator in the following: Local basket of inequalities indicators . GOR. Metropolitan County Districts.Indicator 33 . prevalence and severity of disease. The focus of the life expectancy target is on the quintile with the worst indicators of mortality and highest levels of deprivation.Health Profiles 2009  The Indicator Guide 272 Section 7: charts and trend graphs Table 1 – Indicator Description Information Pg 2 Health Inequalities: life expectancy component Subject category/ Health Inequalities domain(s) Indicator name (* Life expectancy Indicator title in health profile) PHO with lead LHO responsibility Date of PHO March 2009 dataset creation Indicator definition Life expectancy at birth. inclusion of the indicator Rationale: There is a national health inequalities target for life expectancy which aims to Policy relevance increase average life expectancy at birth in England to 78.Communities .

If the confidence intervals don’t overlap. if female life expectancy at birth was 80 years for a particular area. Interpretation: Older people living in nursing homes tend to be in poorer health than those Potential for error not living in nursing homes. In the case of indicators based on a sample of the population. The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. a higher death rate – consequently lower life expectancy level – in confounding one area could simply be the result of migration of frail older people moving into nursing homes in that area. Confidence intervals are given with a stated probability level. The confidence intervals can also be used to make comparisons between deprivation quintiles within each local authority. Life expectancy at birth is also not a guide to the remaining expectancy of life at any other given age. but chance had led to a different set of data. the greater is the uncertainty in the estimate. . Confidence intervals quantify the uncertainty in this estimate and. As these homes are unevenly distributed across due to bias and the country. describe how much different the point estimate could have been if the underlying conditions stayed the same. The wider the confidence interval is. The use of 95% is arbitrary but is conventional practice in medicine and public health. In Health Profiles 2009 this is 95%. and so we say that there is a 95% probability that the interval covers the true value. the longer the estimated expectation of life for What a high/low males and females living in that area and deprivation quintile at that time. generally speaking. both because the death measurement rates of the area are likely to change in the future and because many of those method born in the area will live elsewhere for at least some part of their lives. life expectancy of women aged exactly 75 years in that area would exceed 5 years. Confidence A confidence interval is a range of values that is normally used to describe the Intervals: Definition uncertainty around a point estimate of a quantity. whereas survival from birth is based on mortality rates for all ages. uncertainty also arises from random differences between the sample and the population itself. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. This reflects the fact that survival from a particular age depends only on the mortality rates beyond that age. level of indicator value means Interpretation: The figures reflect the contemporary mortality among those living in the area Potential for error in each time period. this indicates that the difference in life expectancy is statistically significant. They are not the number of years a baby born in the due to type of area in each time period could actually expect to live. These occurrences result in random fluctuations in the indicator value between different areas and time periods. for example. For example.Health Profiles 2009  The Indicator Guide 273 Section 7: charts and trend graphs Interpretation: The higher the life expectancy. a mortality and purpose rate.

Numerator: source Mortality data from Office for National Statistics (ONS). analysed by LHO Denominator: Lower Layer Super Output Area (LSOA) population estimates by age. sex (2003-2007) and deprivation quintile (IMD definition 2007). Deprivation quintiles were assigned to LSOAs at a national level. Local Authority: Counties. Unitary Authorities. This was based on an analysis of estimates from 2004–07 which had shown that populations were evenly distributed. Metropolitan geographies County Districts. sex definition (2003–2007) and deprivation quintile (IMD 2007). County Districts. available for this indicator from other providers Dimensions None of inequality: subgroup analyses of this dataset available from other providers Data extraction: Calculated by LHO Source Data extraction: N/A source URL Data extraction: N/A date Numerator: Number of deaths by age.Health Profiles 2009  The Indicator Guide 274 Section 7: charts and trend graphs Table 2 – Indicator Specification Indicator definition: Life expectancy by national deprivation quintile (IMD 2007) Variable Indicator definition: Life expectancy by national deprivation quintile (IMD 2007) Statistic Indicator definition: Males and Females Gender Indicator definition: All ages age group Indicator definition: 2003 to 2007 period Indicator definition: scale Geography: England. the age group 0–4 was divided into 5. To provide estimates for the age groups under 1 and 1–4 (needed for the life table calculation). at national level. GOR. Population estimates for LSOAs were not available by single year of age from ONS for 2003. across each year of age between 0–4. 2006 populations were revised estimates provided by ONS in February 2009. Population estimates for LSOAs are not published by single year of age by ONS. but are made available to PHOs for analysis purposes. . London Boroughs. Deprivation quintiles were assigned to LSOAs at a national level.

sepho. extraction by LHO. allocation LSOAs were each assigned to a national deprivation quintile and these were then aggregated within each geographical area.Health Profiles 2009  The Indicator Guide 275 Section 7: charts and trend graphs Denominator: Small Area Population Estimates Unit. J Epidemiol Community Health 2001. have not been included in line with ONS recommendations and are displayed as “n/a” in the data table. value aspx?id=8943 Small Populations: City of London and Isles of Scilly are excluded from the results because of small How Isles of Scilly numbers of deaths and populations in these areas. John Wiley & Sons. The Life Table and its Construction. Chiang CL. The figures are five-year Accuracy and averages so as to provide large enough numbers to ensure that the presented completeness figures are sufficiently robust. The SEPHO calculator however also includes an calculation method adjustment to include a term for the variance associated with the final age interval as developed by Silcocks. City of London and Isles of Scilly.000 person years at risk across the period 2003–07. and City of London populations have been dealt with Disclosure Control Not applicable Confidence The calculation of the confidence intervals was made using the method Intervals developed by Chiang. 55: 38-4 . Where a local authority had none of its population living in a particular quintile no bar will be displayed in the chart for that quintile and no value presented in the data table. are excluded from the results because of small numbers of deaths and populations in these areas. Numerator data caveats Denominator data The populations used to calculate life expectancy are experimental estimates. In: Introduction to Stochastic Processes in Biostatistics.Silcocks PBS. However. Life expectancy as a summary of mortality in a population: statistical considerations and suitability for use by health authorities. Reza R. Two authorities. Jenner DA.org.uk/viewResource. Office for National Statistics (ONS) source Centre for Demography. Table 3 – Indicator Technical Methods Numerator: Data from ONS. 1968: 189-214. caveats Methods used to Life expectancy was calculated using the South East Public Health Observatory calculate indicator life expectancy calculator: http://www. areas with a population below 5. New York. Data quality: Mortality data quality and coverage is extremely high. extraction Numerator: Deaths were assigned to Lower Layer Super Output Areas (LSOA) by the LHO aggregation/ using the November 2008 version of the National Statistics Postcode Directory.

directly age-standardised rate. Are particular tests needed such as Data are age-standardised to allow comparisons standardisation. show? . How accurate and complete will the data Data on deaths are considered to be complete and be? robust 9. Differences in levels of all-cause mortality reflect health inequalities between different population groups. prevalence and severity of disease. all ages. and the effectiveness of interventions and treatment. all ages 5. What is being measured? Trend in death rates from all causes 2.000 European Standard Population. 10.Health Profiles 2009  The Indicator Guide 276 Section 7: charts and trend graphs 35. It represents the cumulative effect of the prevalence of risk factors. The populations used for the calculation of the figures for this indicator are based on the 2001 Census. and are estimates. ALL CAUSE MORTALITY Basic Information 1. e. social classes and ethnic groups. Are there any caveats/warnings/ Area of residence is allocated by ONS using the problems? postcode and the National Statistics Postcode Directory .g.records without a valid area code are excluded but the number of such records is negligible. Will it measure absolute numbers or Proportions: numbers of deaths per hundred proportions? thousand European Standard Population 7. Who does it measure? All persons. When does it measure it? This indicator is updated annually 6. Why is it being measured? All cause mortality is a fundamental and probably the oldest measure of the health status of a population. TREND 1: ALL AGE. 4. 95% confidence intervals should statistical process control to test the be considered when making comparisons between meaning of the data and the variation they areas or over time. Where does the data actually come Office for National Statistics (ONS) from? 8. significance tests. 1996–98 to 2005– 07 (average of annual rates) per 100. or between areas. 3. males and females. between genders. How is this indicator actually defined? Mortality from all causes.

Timeliness The Compendium mortality from all causes indicator is updated annually.  It represents the cumulative effect of Importance the prevalence of risk factors. Strategic Health Authorities for the South East. and the effectiveness of interventions and treatment. All age all cause mortality is a good proxy for life expectancy and is being used to measure progress towards meeting the life expectancy target. directly age-standardised rate. 1996-98 to 2005-07 (average of annual rates). Metropolitan County Districts. Rationale: Trend in mortality from all causes. The ten year trend charts presented in the health profiles show the three year moving averages of annual mortality rates from all causes from the 1996–98 to the most recently available years of data (2005–07 average) compared against the national trend. Local Authority: Counties. and to reduce health inequalities by 10% by 2010 as measured by life expectancy at birth (Department of Health PSA priority 1).Health Profiles 2009  The Indicator Guide 277 Section 7: charts and trend graphs TABLE 1 – INDICATOR DESCRIPTION Information Pg 3 Health Inequalities: changes over time component Subject category/ Health inequalities: changes over time domain(s) Indicator name Trend in death rates from all causes. (*Indicator title in health profile) PHO with lead LHO responsibility Date of PHO March 2009 dataset creation Indicator definition Mortality from all causes.g. What this indicator purports to measure Rationale: All cause mortality is a fundamental and probably the oldest measure of Public Health the health status of a population.000 European Standard Population Geography England. usually around November following the publication by ONS of the new year’s mortality extract (usually in May) and mid-year population estimates (usually August-September). The baseline for monitoring this target is the three year period 1995–97. Rationale: Purpose To monitor mortality rates due to all causes over time. between genders. London Boroughs (boundaries as at April 2009). e. per 100.5 years for women. males and females. all ages. social classes and ethnic groups. Earlier trend years are available from previous Health Profiles . behind the inclusion of the indicator Rationale: There is a national health inequalities target for life expectancy which aims to Policy relevance increase average life expectancy at birth in England to 78. GOR.6 years for men and to 82. County Districts. prevalence and severity of disease. Unitary Authorities. Differences in levels of all-cause mortality reflect health inequalities between different population groups.

area of due to type of residence) is extremely high. or between different time periods. This improves the comparability of rates for Potential for error different areas. Indicator definition: Per 100. available for this Available from National Centre for Health Outcomes Development (NCHOD) indicator from website www. and Cornwall. Rates for these areas were based on data pooled for each three-year period. by taking into account due to bias and differences in the age structures of the populations being compared. ONS area classification. Interpretation: Coverage can be considered to be complete as the registration of deaths Potential for error is a legal requirement. Strategic geographies Health Authority. Cheshire West and Chester.uk other providers . If the trend line for the local authority is consistently below the trend line for England then mortality rates from all causes have been consistently lower than those for England for the stated period. If the authority line is above that of England and the gap between the local authority trend line and the England trend line is narrowing then inequalities in mortality rates from all causes are improving. If the local authority line is above that of England and gap between the local authority trend line and the England trend line is widening then inequalities in mortality rates from all causes are worsening. Primary Care Organisation. Central Bedfordshire. confounding TABLE 2 – INDICATOR SPECIFICATION Indicator definition: Mortality from all causes Variable Indicator definition: Directly age-standardised rate Statistic Indicator definition: Male and Female Gender Indicator definition: All ages age group Indicator definition: 1996-98 to 2005-07 -average of annual rates. sex. with the exception of new period 2009 Unitary Authorities: Cheshire East.Health Profiles 2009  The Indicator Guide 278 Section 7: charts and trend graphs Interpretation: An upward sloping trend line indicates that the mortality rate from all causes is What a high/low worsening. measurement method Interpretation: The rates are age-standardised.nhs. level of indicator A downward sloping trend line indicates that the mortality rate from all causes value means is improving.nchod. If the trend line for the local authority is consistently above the trend line for England then mortality rates from all causes have been consistently higher than those for England for the stated period. Data quality for the relevant fields (age.000 European Standard population scale Geography: England & Wales.

people of all ages. . Numerator: source Office for National Statistics (ONS) Denominator: 2001 Census based mid-year population estimates for respective calendar definition years 1996 to 2007. Denominator: ONS source Data quality: Coverage can be considered to be complete as the registration of deaths Accuracy and is a legal requirement. Area of residence is allocated by ONS using the postcode and the National Statistics Postcode Directory .Health Profiles 2009  The Indicator Guide 279 Section 7: charts and trend graphs Dimensions Age. Data quality for the relevant fields (age. and Cornwall. Rates for these areas were calculated by the LHO using annual mortality files.records without a valid area code are excluded but the number of such records is negligible. sex. current as at 21 August 2008. Cheshire West and Chester. supplied to PHOs by ONS. Data extraction: February 2009 date Numerator: Deaths from all causes. of inequality: subgroup analyses of this dataset available from other providers Data extraction: NCHOD. and published ONS mid-year population estimates. area of completeness residence) is extremely high. registered in the respective calendar years 1996–98 to definition 2005–07. gender available from NCHOD. Central Bedfordshire. Source Data extraction: Data received directly from NCHOD with the exception of new 2009 Unitary source URL Authorities: Cheshire East.

and Wiltshire). Cheshire West and Chester. Regional and County figures. The standard population used is the European Standard Population. This is derived from postcode of residence by the ONS using the National Statistics Postcode Directory (NSPD). and Cornwall). Deaths from 1995 to 2007 were assigned to current boundaries using the November 2008 release of the National Statistics Postcode Directory. did not corr