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Third update bulletin from the Northern Ireland Health and Social Care Inequalities monitoring system

Thursday, 29 October 2009

The Department of Health, Social Services and Public Safety today published the third update bulletin of the Health and Social Care Inequalities Monitoring System.

The bulletin provides an up-to-date picture of health inequalities in relation to area differences in morbidity, mortality, utilisation and access to health and social services. Baseline results were initially presented in Chapter eight of Equality and Inequalities in Health and Social care in Northern Ireland – A Statistical Overview (DHSSPS 2004). Changes in the relative health inequalities gaps since the baseline period are highlighted.

Key Points

Health inequalities in deprived areas

• Health outcomes in deprived areas continue to be generally worse than in Northern Ireland as whole.
• The most sizeable inequality gaps, between deprived areas and Northern Ireland as a whole, were evident in alcohol related mortality (121% higher in deprived areas), drug related mortality (113% higher), admissions to hospital for self-harm (94% higher), teenage birth rates (80% higher), suicide (73% higher), respiratory death rates (66% higher) and lung cancer incidence (65% higher).
• Life expectancy in the most deprived areas was 4.4 years lower for males and 2.6 years lower for females than the respective NI averages in 2006-08(P).

Deprived inequality gaps – comparison over time

• Comparing the change in inequality gaps between deprived areas and NI over time shows that there is a continuing health gap although there have been relative improvements across a number of indicators.
• The relative inequality gap for infant mortality fell by more than half since 1997-01. The all cancer incidence inequality gap also reduced by more than half whilst the lung cancer incidence gap fell by a fifth since 1993-99.
• There were also notable reductions in the gaps in hospital admission rates (all, emergency and elective admissions as well as admissions for both respiratory and circulatory disease). While a relative reduction in admission rates to hospital in deprived areas might be an indication of improved health outcomes, as other health outcomes have remained relatively poorer, it could also be interpreted as a deterioration in access to hospital services for people living in the most deprived areas.
• The small gaps which existed for childhood immunisations have virtually disappeared.
• There has also been a narrowing of the inequality gaps for self-harm admissions, smoking during pregnancy, breastfeeding on discharge from hospital and dental registrations.
• The inequality gap between deprived areas and NI overall has also increased in some instances. This was most evident in circulatory and respiratory death rates as well as suicide rates (where the gap had been decreasing until 2005 but increased sharply afterwards).
• Although life expectancy has been increasing in recent years for both males and females in both deprived areas and NI overall, there is no evidence of a narrowing of the inequality gap.

Health inequalities in rural areas

• Generally, health outcomes in rural areas tend to be much better than in Northern Ireland overall which was most evident for drug related mortality (49% lower in rural areas), admissions to hospital for self-harm (47% lower), alcohol related mortality (45% lower) and teenage birth rates (41% lower).
• Life expectancy in rural areas was 1.3 years and 0.6 years higher for males and females respectively than in NI generally.
• Rural areas also enjoyed considerably lower mortality due to respiratory disease (25% lower) and lung cancer incidence (29% lower) than that experienced in the wider region as well as a lower proportion of mothers that smoked during pregnancy (37% lower).
• Conversely, the average ambulance response time at 12.9 minutes in rural areas was almost double the regional average

Rural inequality gaps – comparison over time

• In general, while health inequalities are not as pronounced as the observed differences between deprived areas and NI, there are noticeable ongoing rural differences for many of the indicators which have generally persisted over the period.
• Since 2001/02, there has been a relative increase in hospital admission rates in rural areas which has resulted in the gaps for all admissions to hospital as well as admissions for respiratory disease all but virtually disappearing. There was also an improvement in the gap for admission rates for circulatory diseases. Again, these might be interpreted as indications of worsening access in urban areas.
• There has also been a relative narrowing of the gap for cancer incidence rates from 13% lower in rural areas in 1993-99 to 9% lower in 2000-06. This was due to the number of new cancer cases increasing faster in rural areas.
• Conversely, there has been a relative widening of the gap for ambulance response times, circulatory mortality rates and elective hospital admission rates (which went from being 3% lower in rural areas than NI overall to 8% higher).
• The gap in the estimated proportion of the population that suffer from mood and anxiety disorders has also increased slightly.

Notes to editors:

1. The Health and Social Care Inequalities Monitoring System (HSCIMS) comprises a basket of indicators which are monitored over time to assess area differences in mortality, morbidity, utilisation of and access to health and social care services in Northern Ireland. Inequalities between the 20% most deprived areas and Northern Ireland as a whole are measured. Results for rural areas are also compared against Northern Ireland overall. This report is the third update of the HSCIMS. The information in the bulletin is the latest available.

2. Inequalities between the 20% most deprived areas (defined using the NISRA 2005 Northern Ireland Multiple Deprivation Measure) and Northern Ireland as a whole are measured. Results for the most rural areas are also compared against Northern Ireland overall. The definitions for rural and urban areas are consistent with those outlined in the “Report of the Inter-Departmental Urban-Rural Definition Group” (NISRA 2005).

3. All the indicators included in the second update bulletin (with the exception of waiting times, as data was no longer collected in the same format) remain. A number of new indicators have also been added including analyses of smoking related deaths, alcohol related deaths, drug related deaths and deaths amenable to healthcare. Analysis of mothers that smoked during pregnancy and also those that were breastfeeding on discharge from hospital have also been added.

4. The results presented in the report are based on data from the General Register Office, Hospital Inpatient System, Child Health System, Northern Ireland Cancer Registry, Business Services Organisation and the Northern Ireland Ambulance Service.

All three update bulletins and the original report are published on the DHSSPS website.

5. Additional Information

Further information on Health and Social Care inequalities Monitoring System is available from:

Public Health Section
Project Support Analysis Branch
Department of Health, Social Services and Public Safety
Annexe 2, Castle Buildings
Stormont, BT4 3SQ

Tel: 028 90 522458 or 028 90 522043

Fax: 028 90 523288

Email:

Internet:

6. For media enquiries please contact the DHSSPS Press Office on 02890 520074. Out of office hours contact the Duty Press Officer via pager number 076 9971 5440 and your call will be returned.