Hull Public Health 

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Deprivation


Documents

Deprivation is very important when assessing the health needs of the population and as a result, most local reports contain information on deprivation. Hull has high levels of deprivation in relation to other local authorities (within most deprived 5% of local authorities).

The main documents providing information on deprivation are as follows:

JSNA
Hull JSNA Toolkit: Deprivation and Associated Measures
Index of Multiple Deprivation 2010 Report
JSNA Ward Profiles 2013
JSNA Hull Atlas

The majority of the other documents include information on deprivation. All the local Adult and Young People Health and Lifestyle Surveys and Social Capital Surveys reports examine the health status and the prevalence of lifestyle and behavioural risk factors in relation to deprivation. The Health Equity Audits all examine deprivation in relation to prevalence, inpatient admissions and mortality of the disease. The Director of Public Health Annual Reports all discuss deprivation and the effect on health, life expectancy and mortality rates. The local analysis of the Public Health Outcomes Framework indictors, detailed within the Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here), assesses deprivation in relation to each indicator where information is available. The 2011 Census includes some measures of deprivation such as household deprivation, overcrowding, etc, and the distribution of the Index of Multiple Deprivation are included within the JSNA Hull Atlas. The JSNA Hull Atlas also includes the values of the indicators for the most deprived and least deprived quintile which can be compared with the indicators mapped at ward level.

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Background

Deprivation can be measured in a number of ways. There are a number of indicators or indices which have been generated to measure deprivation. The main index used in the local analyses is the Index of Multiple Deprivation. However, there are a number of other measures that give an indication of the levels of deprivation and poverty, such as percentages of children in poverty, benefit claimants, homelessness, poor housing, employment and income, lack of qualifications, etc (see Environmental Factors and Housing and the Index List for more information about where to find information on these measures). There are also geo-demographic segmentations such as ACORN, Sport England, Healthy Foundations and Hull City Council's Customer Profiles (housing types) which incorporate an element of deprivation (see Geo-demographic Segmentation for more information). For details of where to find the information on the prevalence of behaviour and lifestyle risk factors and the prevalence of diseases in relation to deprivation, see Prevalence).

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Index of Multiple Deprivation

The Index of Multiple Deprivation (IMD) (London, Communities and Local Government 2015, www.communities.gov.uk.) score is a measure of deprivation derived for Lower-layer Super Output Areas (LSOAs). The IMD scores were first derived in 2004, and have been updated in 2007, 2010 and 2015. These geographical areas had a minimum population size of 1,000 and a mean population size of 1,500 when they were generated following the 2001 Census. They were revised after the 2011 census in order to take into account population changes since 2001. The IMD 2015 index is based on seven domains which are weighted according to their relative importance in relation to the overall score (weights in brackets):

Income deprivation (22.5%)
Employment deprivation (22.5%)
Education, skills and training deprivation (13.5%)
Health deprivation and disability (13.5%)
Barriers to housing and services (9.3%)
Living environment deprivation (9.3%)
Crime (9.3%)

The IMD 2015 score measures deprivation, but is not such a good measure of affluence. As it is applied to a geographical area, it relates to average levels of deprivation within an area. Therefore, there may be some residents of the area who are very much more deprived than the average and some very much better-off relative to the average.

The IMD 2015 can be calculated for other larger geographical areas, such as wards or for GP practices, by weighting the scores by the population to produce a weighted-average IMD score. The scores are also frequently combined into groups, often quintiles, for example, to look at the bottom 20% (bottom fifth) in terms of deprivation and compare the health characteristics with the group in the top 20% (highest fifth) in terms of deprivation. The Glossary contains more information about quintiles and about the IMD. Another more detailed document provides information about the individual domains of the Index of Multiple Deprivation 2015, and details changes in the IMD scores between the IMD 2010 and the IMD 2015.

A summary of the key points for Hull from the Index of Multiple Deprivation 2015 report is given below:

From the IMD 2015, Hull is ranked as the 3rd most deprived local authority in England (out of 326 local authorities), having been ranked the 10th most deprived local authority in 2010.

This means that Hull is relatively more deprived in 2015, compared to other local authorities, than it was in 2010.

However, this does not necessarily mean that deprivation in Hull has got worse – it may just be that reductions in deprivation in Hull have been smaller than in local authorities.

Similarly, Hull Clinical Commissioning Group (CCG) is ranked as having the 5th most deprived population out of the 209 CCGs. The ranking is different to the Local Authority ranking as the two most deprived CCGs, Bradford City and North Manchester; cover the more deprived parts of their respective local authorities.

The IMD 2015 is calculated for small geographical areas, called lower layer super output area (LSOAs), which have an average population of around 1,500, and of which there are 32,844 across England, including 166 in Hull.

85 of the 166 LSOAs in Hull (52%) are amongst the most deprived fifth of LSOAs in England, a similar proportion to the 2010 IMD. However, only one LSOA in Hull in 2015 was among the least deprived fifth of LSOAs nationally, compared with 5 LSOAs in 2010.

125 LSOAs (79%) of the 159 LSOAs in Hull (where the boundaries did not change between IMD 2010 and IMD 2015) saw their national rank deteriorate in 2015.

Only for two of the seven domains that constitute the IMD, the 'Education, skills and training' and 'Living environment' domains, was the number of LSOAs in Hull improving their rank in 2015 relative to 2010 greater than the number whose rank deteriorated.

Locally produced population-weighted ward IMD 2015 scores shows Orchard Park and Greenwood remains the most deprived ward in Hull, and the 5th most deprived ward in England (out of 7,529 wards).

Seven of Hull's wards are amongst the 1% most deprived wards in England, with a further seven Hull wards among England's most deprived 10% of wards.

Holderness swapped places with Kings Park to be become the least deprived ward in Hull in IMD 2015, although it remains more deprived than 53% of wards in England.

Population-weighted mean GP practice IMD 2015 scores have been produced locally. These show a greater increase in IMD scores in 2015 compared with 2010 for those practices with relatively more deprived patients.

Further details relating to the IMD scores locally are given the JSNA and Hull JSNA Toolkit: Deprivation and Associated Measures. The IMD is also illustrated graphically within the JSNA, Hull JSNA Toolkit: Deprivation and Associated Measures and JSNA Hull Atlas.

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Benchmarking

Comparator Areas gives details of the comparator areas which are similar to Hull and have been used for benchmarking within the topic-specific Hull JSNA Toolkit reports, as well as other local reports. Various factors such as population, ethnicity, deprivation, housing stock, etc are examined in relation to the characteristics of Hull in the Comparator Areas and topic-specific Hull JSNA Toolkit reports. These comparator areas are also used within the local analysis of the Public Health Outcomes Framework indicators (and the list can be seen within the Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here).

The general practices in Hull differ with regard to their registered population in terms of deprivation and age of patients. Whilst general practices can be compared, it is better and easier to try to compare like-with-like. As a result, the general practices in Hull have been grouped according to the average deprivation score of their patients and the average age of their patients. The General Practice Comparator Groupings document provides further details.

For associated information, also see Geo-demographic Segmentation.

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Benefit Claimants

Figures on the number of benefit claimants are available from the Department for Work and Pensions, and are presented within Hull JSNA Toolkit: Deprivation and Associated Measures.

DWP provides the number of claimants by main reason for claim by ward for those people claiming benefits who are working age. There is also information at ward level for the number of claimants of specific benefits such as Attendance Allowance, Disability Living Allowance, Employment and Support Allowance (ESA), Incapacity Benefit (IB) and Severe Disablement Allowance (SDA), Income Support, Jobseekers Allowance, Pension Credit and State Pension. There is also a separate data file which includes claimants of working-age, and this includes benefit claimants relating to the following benefits: JSA, ESA or IB, lone parents, carer, other income-related benefits, disabled and bereaved benefits.

The numbers claiming out-of-work benefits is also given in Hull JSNA Toolkit: Deprivation and Associated Measuresby age (18-24, 25-49 and 40-64 years) and length of time out of work (up to 6 months, over 6 months and up to one year and over one year).

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Census

Information is given at ward level in the JSNA Hull Atlas for various deprivation measures associated with housing from the 2011 Census, such as access to a car or van, highest educational attainment, socio-economic status, lone parents households, tenure, central heating, overcrowding, household composition and household deprivation.

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Changes

The changes in the Index of Multiple Deprivation in Hull between 2007 and 2010 has been examined in the Index of Multiple Deprivation 2010 Report, are summarised within Hull JSNA Toolkit: Deprivation and Associated Measures.

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Children in Poverty

A measure of child poverty is an indicator within Public Health Outcomes Framework and further analysis is given within the Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here) and Public Health Outcomes Framework Summary. This information is also displayed within the JSNA Hull Atlas.

Some information is also given in Hull JSNA Toolkit: Deprivation and Associated Measures.

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Health / Health Status

Measures of physical and mental health were collected as part of the local Surveys, and are examined within the reports in relation to deprivation. Results are summarised within the topic-specific Hull JSNA Toolkit reports and detailed within the survey reports:

Young People Health and Lifestyle Survey 2012 Main Report
Young People Health and Lifestyle Survey 2008-09 Main Report
Young People Health and Lifestyle Survey 2002 Main Report
Adult Health and Lifestyle Survey 2014 Main Report
Adult Health and Lifestyle Survey 2011-12 Main Report
BME Health and Lifestyle Survey 2011-12 Main Report
Adult Health and Lifestyle Survey 2007 Main Report
BME Health and Lifestyle Survey 2007 Main Report
Gypsy and Traveller Health and Lifestyle Survey 2007 Main Report
Adult Health and Lifestyle Survey 2009 Main Report
Veteran Health and Lifestyle Survey 2009 Main Report
Adult Health and Lifestyle Survey 2003 Main Report
Adult Health and Lifestyle Survey 2003 Eastern Hull Tables
Adult Health and Lifestyle Survey 2003 West Hull Tables
Social Capital Survey 2009 Main Report
Social Capital Survey 2004 Main Report

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Health Equity Audits

The health equity audits also examined 'need' in relation to deprivation and details are given in the following reports:

Stroke Equity Audit – September 2011
Hypertension Equity Audit – February 2011
Chronic Obstructive Pulmonary Disease Equity Audit – December 2010
Diabetes Equity Audit – October 2008
Mental Health Equity Audit – March 2007
Cancer Equity Audit – July 2006
Coronary Heart Disease Equity Audit – September 2005

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Inequity

Owing to the relationship between deprivation and ill health, one would expect 'need' for healthcare to increase as deprivation increases, and that a positive relationship would be obtained say between rates of hospital admissions or treatment and deprivation. If such a relationship did not exist, then it could mean that treatment is not reflecting 'need' and that there may be inequity present. This has been examined in more detail within the Health Equity Audits.

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Inpatient Admissions

Admission rates are analysed by deprivation for a number of diseases, including accidents, alcohol-related, asthma, atrial fibrillation, breast cancer, all cancers, cardiovascular disease, chronic obstructive pulmonary disease, colorectal cancer, coronary heart disease, diabetes, injuries due to falls, heart failure, hip fractures, obesity, lung cancer, mental health (substance abuse, self-harm and dementia), prostate cancer, respiratory disease, and stroke.

For further information see Inpatient Admissions.

Admission rates are also analysed in to relation to deprivation within the following health equity audits:

Stroke Equity Audit – September 2011
Hypertension Equity Audit – February 2011
Chronic Obstructive Pulmonary Disease Equity Audit – December 2010
Diabetes Equity Audit – October 2008
Mental Health Equity Audit – March 2007
Cancer Equity Audit – July 2006
Coronary Heart Disease Equity Audit – September 2005

The JSNA Hull Atlas also includes the values of the indicators for the most deprived and least deprived quintile which can be compared with the indicators mapped at ward level which includes some indicators relating to hospital admissions.

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Life Expectancy

Life expectancy at birth is calculated for different deprivation quintiles with rates presented in the JSNA and Hull JSNA Toolkit: Life Expectancy.

The JSNA Hull Atlas also includes the values of the indicators for the most deprived and least deprived quintiles which can be compared with the indicators mapped at ward level which include life expectancy.

Life expectancy and the "slope index of inequality", which measures the difference in life expectancy between deprivation groups, are both indicators within Public Health Outcomes Framework and further analysis is given within the Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here) and Public Health Outcomes Framework Summary. This information is also displayed within the JSNA Hull Atlas.

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Lower Layer Super Output Areas / LLSOAs

Lower Layer Super Output Areas (LLSOA) are geographical areas that were generated following the 2001 Census. They have a minimum population size of 1,000 and a mean population size of 1,500. There were 163 LLSOAs within Hull. The Index of Multiple Deprivation 2010 is based on measuring deprivation at this geographical level. Following the 2011 Census, and population changes, the boundaries for a small number of LLSOAs within Hull have changed slightly and there are now 166 LLSOAs within Hull.

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Mortality

Mortality rates are analysed by deprivation both overall and for a number of diseases within the JSNA, Hull JSNA Toolkit: Mortality and topic-specific Hull JSNA Toolkit reports. The diseases include breast cancer, all cancers, cardiovascular disease, chronic obstructive pulmonary disease, colorectal cancer, coronary heart disease, diabetes, lung cancer, mental health (substance abuse, dementia, and suicide and undetermined injury), prostate cancer, respiratory disease, and stroke.

Mortality rates are also analysed in to relation to deprivation within the following health equity audits:

Stroke Equity Audit – September 2011
Hypertension Equity Audit – February 2011
Chronic Obstructive Pulmonary Disease Equity Audit – December 2010
Diabetes Equity Audit – October 2008
Mental Health Equity Audit – March 2007
Cancer Equity Audit – July 2006
Coronary Heart Disease Equity Audit – September 2005

The JSNA Hull Atlas also includes the values of the indicators for the most deprived and least deprived quintile which can be compared with the indicators mapped at ward level which includes some indicators relating to mortality.

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Need

For diseases where equity audits have been undertaken and numbers of events (admissions and deaths) were sufficiently high for results to be reliable, health need in relation to deprivation has been examined by comparing 'need' using different measures to assess if similar levels of need are evident for each measure across the deprivation quintiles. For example, if prevalence is the same across all five local deprivation quintiles but mortality rates are higher in the most deprived quintile this suggests that there is inequity present or differences in diagnosis rates (higher rates of undiagnosed disease). Prevalence, hospital admissions and mortality were three of the measures of need used consistently, but with cancer information on incidence was also available and for coronary heart disease information on angiography and revascularisation (which are used diagnostically and for treatment respectively) was available. These measures of need were examined to assess if inequity was present. The results are summarised within the relevant disease-specific Hull JSNA Toolkit reports and detailed within the equity audit reports:

Stroke Equity Audit – September 2011
Chronic Obstructive Pulmonary Disease Equity Audit – December 2010
Diabetes Equity Audit – October 2008
Cancer Equity Audit – July 2006
Coronary Heart Disease Equity Audit – September 2005

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Prevalence of Disease

As part of the Quality and Outcomes Framework (QOF), practices need to have registers of patients who have had a diagnosis of that specific disease. More information about QOF is given in the disease-specific Hull JSNA Toolkit reports and Glossary. The QOF general practice disease registers cover a range of medical conditions and diseases, and the prevalence of the disease is reported within the relevant disease-specific Hull JSNA Toolkit reports for the following diseases:

Asthma
Cancer
Cardiovasular diseases:

Coronary heart disease (CHD)
Stroke and transient ischaemic attack(TIA)
Left ventricular function (2004/05 and 2005/06 only)
Heart failure
Atrial fibrillation
Hypertension

Chronic kidney disease
Chronic obstructive pulmonary disease (COPD)
Diabetes
Epilepsy
Hypothyroidism disease
Mental Health:

Dementia
Learning disabilities
Severe mental health

Palliative care

These are also presented by general practice and by deprivation, as well as examining trends over time among GP practices.

Disease prevalence rates are also analysed in to relation to deprivation within the following health equity audits:

Stroke Equity Audit – September 2011
Hypertension Equity Audit – February 2011
Chronic Obstructive Pulmonary Disease Equity Audit – December 2010
Diabetes Equity Audit – October 2008
Mental Health Equity Audit – March 2007
Cancer Equity Audit – July 2006
Coronary Heart Disease Equity Audit – September 2005

As well as summarising the prevalence rates of these diseases by deprivation quintile (based on postcode of the practice), the prevalence rates were examined in relation to general practice (with practices grouped based on their mean deprivation levels of their patients). The General Practice Comparator Groupings document provides further details of the practice groupings.

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Prevalence of Lifestyle Risk Factors

The local Surveys collected information on lifestyle and behavioural risk factors, such as smoking, obesity, exercise, diet (5-A-DAY, healthy diet) and alcohol consumption. All information is examined in relation to deprivation. Results are summarised within Hull JSNA Toolkit: Smoking, Hull JSNA Toolkit: Overweight and Obesity, Hull JSNA Toolkit: Exercise, Hull JSNA Toolkit: Diet and Hull JSNA Toolkit: Alcohol Consumption, and detailed within the survey reports:

Young People Health and Lifestyle Survey 2012 Main Report
Young People Health and Lifestyle Survey 2008-09 Main Report
Young People Health and Lifestyle Survey 2002 Main Report
Adult Health and Lifestyle Survey 2014 Main Report
Adult Health and Lifestyle Survey 2011-12 Main Report
BME Health and Lifestyle Survey 2011-12 Main Report
Adult Health and Lifestyle Survey 2007 Main Report
BME Health and Lifestyle Survey 2007 Main Report
Gypsy and Traveller Health and Lifestyle Survey 2007 Main Report
Adult Health and Lifestyle Survey 2009 Main Report
Veteran Health and Lifestyle Survey 2009 Main Report
Adult Health and Lifestyle Survey 2003 Main Report
Adult Health and Lifestyle Survey 2003 Eastern Hull Tables
Adult Health and Lifestyle Survey 2003 West Hull Tables
Social Capital Survey 2009 Main Report
Social Capital Survey 2004 Main Report

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Public Health Outcomes Framework

A measure of child poverty is an indicator within Public Health Outcomes Framework and further analysis is given within the Public Health Outcomes Framework Domain 1 Report and Public Health Outcomes Framework Summary. This information is also displayed within the JSNA Hull Atlas.

The "slope index of inequality" (SII) measures the difference in life expectancy between deprivation groups. The SII is an indicator within the Public Health Outcomes Framework and further analysis is given within the Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here) and Public Health Outcomes Framework Summary.

Where local data is available, the indicators in the Public Health Outcomes Framework have been examined in relation to deprivation and across the wards in Hull and further analysis is given within the Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here) and Public Health Outcomes Framework Summary.

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Quintiles

Percentiles divide a distribution of ordered numerical values into groups. The 10th percentile is the value of a numerical variable for which 10% of the people or sample of values fall below. For example, if from a survey of employees at a particular company the 10th percentile for annual income is £10,000, then this would mean that 10% of the employees for this particular company were earning £10,000 or less (and 90% were earning £10,000 or more). Deciles, quintiles and quartiles are alternative names for specific percentiles. Deciles divide the observations into 10 groups as illustrated in the example above which presents one of these (10%). The quintiles divide the sample or observations or people into five groups (20% in each group) whereas the quartiles divide the observations into four groups (25% in each group).

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Screening

Uptake rates for screening for breast cancer, cervical cancer and colorectal cancer have been examined in relation to general practice (with practices grouped based on their mean deprivation levels of their patients) in the JSNA Toolkit. The General Practice Comparator Groupings document provides further details of the practice groupings. Factors influencing screening rates including deprivation have also been examined within Hull JSNA Toolkit: Screening, Hull JSNA Toolkit: Breast Cancer and Hull JSNA Toolkit: Colorectal Cancer.

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Slope Index of Inequality (SII)

The "slope index of inequality" (SII) measures the difference in life expectancy between the bottom and top deciles of deprivation based on the Index of Multiple Deprivation. This index has been calculated nationally for each local authority. Further details and trends are given in Hull JSNA Toolkit: Life Expectancy. The Life Expectancy Briefing Note 2009-11 presents the latest (2009-11) data for life expectancy data and latest (2006-10) data for the "slope index of inequality". The "slope index of inequality" is an indicator within the Public Health Outcomes Framework and further analysis is given within the Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here) and Public Health Outcomes Framework Summary.

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Survival

Cancer survival is examined in relation to deprivation by examining the difference in incidence and mortality. Results are summarised within the Cancer Equity Audit which was completed July 2006.

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Treatment

Angiography is an investigation of coronary heart disease (CHD) undertaken to assess whether one of two common treatments are necessary: percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Angiography rates are given within Hull JSNA Toolkit: Coronary Heart Disease and Coronary Heart Disease Equity Audit, as well as in relation to deprivation.

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Wards

Other information on deprivation and associated measures is given at ward level in the JSNA Hull Atlas.

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