Hull Public Health 

The Deep, Hull The Guildhall, Hull King William Statue, Market Place, Hull City Hall, Hull Spurn Lightship, The Marina, Hull

 

 

Mortality


Documents

The main documents providing information on mortality are as follows:

JSNA
Hull JSNA Toolkit: Mortality
JSNA Ward Profiles 2013
JSNA Hull Atlas

The Health Equity Audits all examine mortality overall and in relation to age, gender and deprivation. The Director of Public Health Annual Reports report mortality rates for some key diseases, including:

Cardiovascular disease
Coronary heart disease
Stroke
Cancer
Lung cancer

Mortality rates are indicators 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.

For associated information on life expectancy, also see Life Expectancy.

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Definitions

Explanations of standardisation, indirectly standardised mortality ratios (SMRs), directly standardised mortality rates (DSRs) and other measures and associated issues are given in the Glossary and Hull JSNA Toolkit: Mortality. Another document on Standardisation gives further information including worked examples of indirect and direct standardisation.

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Background

Information on all deaths is available locally from the Public Health Mortality File which is provided by the Office for National Statistics (ONS). Using this file in conjunction with the GP registration file, mortality rates and life expectancy figures can be calculated locally. The locally calculated figures will differ slightly from the nationally produced figures from the ONS because ONS use a different estimate of the population. Their estimate of the population is available for Hull, but not for smaller geographical areas or groups, such as at ward level or for different deprivation groups. So the local analysis can only use the GP registration file as this is the only available estimate of resident population at smaller geographies.

Mortality information is available in the relevant topic-specific Hull JSNA Toolkit reports for the following causes of death:

All cardiovascular diseases combined, as well as individually for:

Abdominal aortic aneurysm
Coronary heart disease
Heart failure
Stroke

Air pollution
Alcohol-related causes
All cancers combined, as well as individually for:

Breast cancer
Colorectal cancer
Lung cancer
Prostate cancer

All causes combined
All respiratory diseases combined, as well as individually for:

Chronic obstructive pulmonary disease

Causes amenable to surgery
Diabetes
Mental health conditions, including:

Dementia
Substance abuse
Suicide

As well as for:

Preventable deaths
Infants
Winter deaths

The main causes are also presented separately for deprivation, and deaths are presented by location of death.

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Age

Age-specific mortality rates have been presented within Hull JSNA Toolkit: Mortality as well as disiease-specific Hull JSNA Toolkit reports and the Director of Public Health Annual Reports for the main diseases, including:

Cardiovascular disease
Coronary heart disease
Stroke
Cancer
Lung cancer

Mortality has also been examined in relation to age within the 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)

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Air Pollution

The fraction of mortality attributable to particulate air pollution 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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All Age All Cause Mortality Rate / AAACMR

A discussion of the problems with achieving all age all cause mortality rate (AAACMR) targets is given in Hull JSNA Toolkit: Mortality. Historically there were targets related to AAACMR, but this is no longer the case. However, most of the same arguments apply to life expectancy as a target, and this remains the case. Some of the discussion relates to AAACMR and life expectancy, but there is also some discussion of these targets specifically in relation to Hull.

Modelling has been undertaken to assess the effect of changes to age-specific mortality rates on the all age all cause mortality rates (AAACMR) and standardised mortality ratios (SMR). Details are given in Hull JSNA Toolkit: Mortality.

AAACMR figures are given within Hull JSNA Toolkit: Mortality. It is also examined for each ward and in relation to deprivation (and Hull City Council's Customer Profiles (housing types) is given for under 75s rather than all age).

The AAACMR is not presented within JSNA Hull Atlas, but the under 75 all cause mortality rate is presented.

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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 JSNA Toolkit and 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 JSNA Toolkit. 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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Causes of Death

Hull JSNA Toolkit: Mortality gives the causes of death by age using cumulative mortality plots. These charts illustrate the pattern of the number of deaths across the age groups and the differences between males and females. The different causes of death are also illustrated across the different age groups. The number of deaths from a list of detailed causes for under 75 deaths and all deaths are also presented. Pie charts also show the main causes of death as well as the main cancer sites for cancer mortality.

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Cumulative Mortality Plots

Hull JSNA Toolkit: Mortality gives the causes of death by age using cumulative mortality plots. These charts illustrate the pattern of the number of deaths across the age groups and the differences between males and females. The different causes of death are also illustrated across the different age groups.

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Customer Profiles

The Hull City Council Customer Profiles were produced using the methodology from a Leeds University PhD project, which involved cluster analysis of a number of 2001 Census variables at lower layer super output area level. The ten classifications that were produced were largely defined by housing tenure and age. Life expectancy and under 75 all cause mortality rates have been examined within Hull JSNA Toolkit: Life Expectancy and Hull JSNA Toolkit: Mortalityrespectively in relation to these Customer Profile types. These are currently being updated using information from the 2011 Census.

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Deaths

Information relating to the number of deaths, detailed causes of death, cumulative mortality figures for each main cause of death by age at death, location of death (home, hospital, nursing or residential homes, etc), winter deaths and mortality rates are all given within Hull JSNA Toolkit: Mortality.

Deaths are generally defined in relation to time period in which the death was registered rather than when the death actually occurred. For example, mortality rates for 2009-2011 involve deaths registered during the calendar years 2009 to 2011 inclusive. Further discussion of this is given in the Glossary and in Hull JSNA Toolkit: Mortality.

Information is given at ward level in the JSNA Hull Atlas.

Higher tier local authorities were also ranked on premature mortality rates as part of Public Health England's Longer Lives project. Details are given in the Longer Lives Briefing Report.

Excess winter deaths 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.

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Deaths at Home

The number of deaths occurring at home and other locations including at hospital and in nursing homes is given within Hull JSNA Toolkit: Mortality.

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Deaths in Hospital

The number of deaths occurring at home and other locations including at hospital and in nursing homes is given within Hull JSNA Toolkit: Mortality.

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Deaths Registration

Deaths should be registered within five days of the death. However, delays can occur if the death needs to be investigated by the local coroner. In these cases, which involve unexplained or suspicious deaths including suicides, the registration date of the death can be several months after the date of the death, as it is necessary to have an official cause of death prior to registering a death. As most deaths are registered within a week, the year of the death and the year of the registration of the death will be within the same calendar year for the majority of deaths. The deaths which occur within the last few days of one calendar year could well be registered during the next calendar year.

National and local numbers of deaths and mortality rates use the calendar year when the death was registered rather than the calendar year when the death occurred, so that delays in registration do not influence mortality rates (which they would for specific causes such as suicides). Further discussion is given in Hull JSNA Toolkit: Mortality and Glossary.

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Deprivation

Mortality rates are analysed by deprivation both overall and for a number of diseases within the JSNA and disease-specific Hull JSNA Toolkit reports. The diseases covered include:

Cancer, all combined as well as individually for :

Breast cancer
Colorectal cancer
Lung cancer
Prostate cancer

Cardiovascular disease, all combined as well as individually for:

Coronary heart disease (CHD)
Stroke

Diabetes
Mental health:

Dementia
Substance abuse
Suicide and undetermined injury

Respiratory diseases, all combined as well as individually for:

Chronic obstructive pulmonary disease (COPD)

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 quintiles which can be compared with the indicators mapped at ward level which include some indicators relating to mortality.

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Directly Standardised Mortality Rate (DSR)

For an explanation see Glossary. DSRs for the main diseases are given within the JSNA and Hull JSNA Toolkit: Mortality.

There are a number of indicators within Public Health Outcomes Framework related to mortality which are DSRs 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. These indicators which are DSRs include mortality from causes considered preventable, premature mortality from cardiovascular disease and cardiovascular disease considered preventable, premature mortality from all cancer and cancers considered preventable, premature mortality from liver disease and liver disease considered preventable, premature mortality from respiratory disease and respiratory disease considered preventable, mortality from communicable diseases, and the suicide rate. DSRs for these mortality rates are also given at ward level in the JSNA Hull Atlas.

Modelling has been undertaken to assess the effect of changes to age-specific mortality rates on the all age all cause mortality rates (AAACMR) which is an example of a DSR and standardised mortality ratios (SMR). Details are given in Hull JSNA Toolkit: Mortality.

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Excess Winter Mortality

Excess winter mortality is calculated as winter deaths (deaths occurring in December to March) minus the average of non-winter deaths (April to July of the current year and August to November of the previous year).

Information relating to the excess winter mortality rate is given within Hull JSNA Toolkit: Mortality.

Excess winter deaths 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.

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Gender

In most cases, information has been presented separately by gender within the JSNA, JSNA Toolkit, Director of Public Health Annual Reports and Health Equity Audits.

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Home Deaths

The number of deaths occurring at home and other locations including at hospital and in nursing homes is given within Hull JSNA Toolkit: Mortality.

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Hospital Deaths

The number of deaths occurring at home and other locations including at hospital and in nursing homes is given within Hull JSNA Toolkit: Mortality.

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Indirectly Standardised Mortality Ratio (SMR)

For an explanation see Glossary. SMRs for the main diseases are given within the JSNA and Hull JSNA Toolkit: Mortality. SMRs are also given at ward level in the JSNA Hull Atlas.

Modelling has been undertaken to assess the effect of changes to age-specific mortality rates on the all age all cause mortality rates (AAACMR) and standardised mortality ratios (SMR). Details are given in Hull JSNA Toolkit: Mortality.

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Infant Mortality

Infant mortality rates are given within Hull JSNA Toolkit: Mortality and Hull JSNA Toolkit: Children and Young People.

Infant mortality 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.

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Location of Deaths

The number of deaths occurring at home and other locations including at hospital and in nursing homes is given within Hull JSNA Toolkit: Mortality.

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Longer Lives

Higher tier local authorities were also ranked on premature mortality rates as part of Public Health England's Longer Lives project. Details are given in the Longer Lives Briefing Report.

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Modelling

Modelling has been undertaken to assess the effect of changes to age-specific mortality rates on the all age all cause mortality rates (AAACMR) and standardised mortality ratios (SMR). Details are given in Hull JSNA Toolkit: Mortality.

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Palliative Care

The prevalence and modelled prevalence for each general practice are given in Hull JSNA Toolkit: Palliative Care. The prevalence is also given in relation to deprivation. Information on the location of deaths, including deaths at home, is given.

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Pie Charts

Pie charts have been used to illustrate the percentage of deaths in Hull from different causes for all causes, and by cancer site for all cancer deaths. These are presented in Hull JSNA Toolkit: Mortality and Hull JSNA Toolkit: All Cancers respectively.

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Premature Mortality

As everybody dies, in order to assess poor health and mortality premature mortality is often used, which is defined as dying before the age of 75 years.

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Preventable Mortality

The Public Health Outcomes Framework includes a number of indicators related to preventable mortality, including:

All causes
Cardiovascular disease
Cancers
Liver disease
Respiratory disease

The selection of causes that are considered preventable are defined on the basis of the International Classification of Diseases (ICD) version 10. More information about this classification is given in the Glossary andHull JSNA Toolkit: Mortality. The ICD 10 codes of diseases that are considered preventable are given within the Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here).

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Public Health Outcomes Framework

There are a number of indicators within Public Health Outcomes Framework related to mortality 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. These indicators include percentage of mortality attributable to air pollution, infant mortality, mortality from causes considered preventable, premature mortality from cardiovascular disease and cardiovascular disease considered preventable, premature mortality from all cancer and cancers considered preventable, premature mortality from liver disease and liver disease considered preventable, premature mortality from respiratory disease and respiratory disease considered preventable, mortality from communicable diseases, suicide rate and excess winter mortality rate. Life expectancy is also an indicator as well as the life expectancy "slope index of inequality" which is a measure of inequality comparing life expectancy among different deprivation groups, and further analyses of these two indicators may be found in 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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Registration of Deaths

Deaths should be registered within five days of the death. However, delays can occur if the death needs to be investigated by the local coroner. In these cases, which involve unexplained or suspicious deaths including suicides, the registration date of the death can be several months after the date of the death, as it is necessary to have an official cause of death prior to registering a death. As most deaths are registered within a week, the year of the death and the year of the registration of the death will be within the same calendar year for the majority of deaths. The deaths which occur within the last few days of one calendar year could well be registered during the next calendar year.

National and local numbers of deaths and mortality rates use the calendar year when the death was registered rather than the calendar year when the death occurred, so that delays in registration do not influence mortality rates (which they would for specific causes such as suicides). Further discussion is given in Hull JSNA Toolkit: Mortality and Glossary.

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Smoking

Estimated mortality rates from smoking-related diseases and medical conditions is given in Hull JSNA Toolkit: Smoking and the Smoking Report 2013. The numbers are also presented at ward level within the JSNA Hull Atlas.

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SMR (Standardised Mortality Ratio)

For an explanation see Glossary. SMRs for the main diseases are given within the JSNA and Hull JSNA Toolkit: Mortality. SMRs are also given at ward level in the JSNA Hull Atlas.

Modelling has been undertaken to assess the effect of changes to age-specific mortality rates on the all age all cause mortality rates (AAACMR) and standardised mortality ratios (SMR). Details are given in Hull JSNA Toolkit: Mortality.

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Standardisation

Generally, mortality rates are compared to assess the health status and mortality from different causes of death. As geographical areas with older populations will have higher mortality rates, it is standard practice to examine age-specific mortality rates (i.e. mortality rates among a specific age group, say, 65-74 year olds) or report standardised mortality rates. Indirect and direct standardisation can be used, and details are given in the Glossary and Hull JSNA Toolkit: Mortality with another document on Standardisation providing more detailed including worked examples.

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Under 75 Year Mortality

As everybody dies, in order to assess poor health and mortality premature mortality is often used, which is defined as dying before the age of 75 years.

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Wards

The mortality rates overall and for different diseases at ward level are given in JSNA Ward Profiles 2013 and JSNA Hull Atlas.

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