Sources of Demography and Health Information PDF

Sources of demographic and health information Dr Deepak Parashar Associate Professor (Medical Statistics)  Learning Outcomes This lecture will contribute to: Cite the sources of routinely collected demographic information, describe how they are used in service...

Sources of demographic and health information Dr Deepak Parashar Associate Professor (Medical Statistics)  Learning Outcomes This lecture will contribute to: Cite the sources of routinely collected demographic information, describe how they are used in service planning and delivery of care, and contrast their strengths and weaknesses (25e) Cite the sources of routinely collected health information, describe how they are used in service planning and delivery of care, and contrast their strengths and weaknesses (25e) Explain two commonly used clinical coding systems (ICD-10, OPCS4)  Lecture Objectives 1. Demography a) UK Census b) Birth / Death Registration in UK c) Population estimates and projections 2. Sources of Health Information in UK a) Cancer Registration b) Hospital Episode Statistics c) Quality and Outcomes Framework d) Notifications of Infectious Disease  OBJECTIVE 1 What is demography? “The study of the size, structure, dispersement, and development of human populations” To establish reliable statistics on:- - population size and distribution - birth and death rates - life expectancy - migration  Sources of Demographic Information CENSUS Birth Death Registration Registration  Population Census A census is: “the simultaneous recording of demographic data by the government at a particular time pertaining to all the persons who live in a particular territory” (United Nations) – Census describes both households and people  History & process for UK census Office for National Statistics (ONS) in England / Wales Every 10 years since 1841. Legal requirement Complete source of population info - 98% Low enumeration groups Accuracy: Census Coverage Survey Census Quality Survey (interviews) 27th March 2011 £480 million Online completion or post back Population UK = 63.2 million in UK 2021 census - move to primarily online Beyond 2021 – move to Administrative data  Data in UK census Demographic data - age / sex Cultural Characteristics - ethnicity / religion Material deprivation - employment / home ownership / overcrowding / car access / lone parents / lone pensioners Health – General, long-term illness, unpaid care Workplace & Journey to work Census areas – 2011 Output Areas: 200-400 people Super Output Areas: 1000-2000 Electoral wards: 1500 – 15000 Local Authorities Clinical Commissioning Groups http://www.neighbourhood.statistics.gov.uk/dissemination/LeadHome.do? a=7&i=1001&m=0&s=1309260492193&enc=1&extendedList=true&nav=A ‘CART’ for Assessing Quality of Health Information Completeness Accuracy Representativeness / relevance Timeliness [Accessibility] Barry Tennison, Oxford Handbook of Public Health Practice, 2001  Strength & Weakness – UK Census Strengths Weaknesses Completeness 98% complete Low enumeration of some groups Accuracy Check of forms, Self reported – coverage and religion ‘Jedi’ !! quality surveys Representative Data available for Low enumeration /relevance different levels (200 of some groups people to country) Timeliness 10 years. Takes time for release. Access www.ons.gov.uk/census Individual returns Local councils confidential 100yr  UK Census – Data of value to health workers Population size & structure: young, old, ethnic minorities service needs Base population (denominator) rates of disease Measures of material deprivation: identify & target inequalities  Birth Registration Birth Notification – by birth attendant (usually Birth Registration midwife) within 36 hrs – by parent(s) within 42 days - to Health Authority (child health record, health visitor) Local Registrar for Births, Marriages & Deaths Office for National Statistics (ONS) – Birth Statistics https://www.gov.uk/register-birth  Measures of Fertility Crude Birth Rate = live births / 1,000 popl. General Fertility Rate = live births / 1,000 women aged 15-44 yrs (child bearing lifespan) Total Fertility Rate = number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with current age-specific fertility rates (average number of children born per woman). (World Bank) Live Births and Total Fertility Rate, England and Wales, 1938 to 2017 TFR affected by: - Delay in childbearing to older ages Baby - Lower completed family size WWII Abortion boom Act 1968 - Population structure 2.95 2017 1.76 https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ livebirths/bulletins/birthsummarytablesenglandandwales/2017  Death Registration Medical Certificate of Cause of Death issued by Doctor – certifies the fact of death Referral to Coroner: - age, place of death Coroners Certificate - information on cause of death – by informant (usually relative) within 5 days Death Registration - Local Registrar for Births, Marriages & Deaths Office for National Statistics (ONS) – Mortality Statistics - Coded using ICD10 https://www.ons.gov.uk/peoplepopulationandcommunity/birth sdeathsandmarriages/deaths/methodologies/userguidetomor talitystatisticsjuly2017  Underlying Cause of Death I (a) Disease or condition directly leading to death ?--------------------- (b) Other disease or condition, if any, leading to I(a) ?--------------------- (Intermediate cause of death) (c) Other disease or condition, if any, leading to I(b) ?--------------------- (Underlying cause of death)  Underlying cause of death “a) the disease or injury which initiated the train of morbid events leading directly to death, or b) the circumstances of the accident or violence which produced the fatal injury”. Used in Mortality statistics. Preventing the first disease or injury will result in the greatest population health gain. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/de aths/methodologies/userguidetomortalitystatisticsjuly2017 (see Section 9)  Underlying Cause of Death A patient with primary squamous cell carcinoma of the lung died from an intracerebral haemorrhage, which was caused by cerebral metastases from the primary. I (a) Disease or condition directly leading to death ?--------------------- (b) Other disease or condition, if any, leading to I(a) ?--------------------- (Intermediate cause of death) (c) Other disease or condition, if any, leading to I(b) ?--------------------- (Underlying cause of death) http://www.suht.nhs.uk/Media/suhtideal/Doctors/MedicalPersonnelInduction/CauseofDeathCertificate.pdf  Underlying Cause of Death A patient with primary squamous cell carcinoma of the lung died from an intracerebral haemorrhage, which was caused by cerebral metastases from the primary. I (a) Disease or condition directly Intracerebral leading to death haemorrhage (b) Other disease or condition, if any, leading to I(a) Cerebral (Intermediate cause of death) metastases (c) Other disease or condition, if Squamous cell any, leading to I(b) carcinoma of lung (Underlying cause of death) http://www.suht.nhs.uk/Media/suhtideal/Doctors/MedicalPersonnelInduction/CauseofDeathCertificate.pdf  Age-standardised mortality rates for selected broad disease groups, 1911-2003, England & Wales ? Source: Office for National Statistics  Age-standardised mortality rates for the five main broad disease groups, 2001-2017, England & Wales https://www.ons.gov.uk/peoplepopulationandcommunity/ birthsdeathsandmarriages/deaths/bulletins/  Mortality data Strengths Complete coverage in UK (for births as well) Weaknesses Accuracy? e.g. underlying cause of death subject to diagnostic uncertainty, coding issues and variable quality. Ethnicity not collected Derivation of socio-economic status - posthumous inflation of status Latest: Deaths Registered in England and Wales 2018 https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ deaths/bulletins/deathsregistrationsummarytables/2018 Population Estimates & Projections Why needed? Used for planning services / resource allocation In the past: to understand what has been happening to the population The present: to make sense of present activity In the future: to predict what is going to change  Population Estimates Estimate of population size & structure between census Applies what is known on births/deaths/migration to present Census baseline + births – deaths + migration Strengths – more up to date than the census - more accurate than projections Weaknesses - less reliable with time from census - poor information on migration - says nothing about the future  Population Projections Forecast future population size and structure Based on assumptions about: mortality fertility migration Strengths – Can be used for longer term planning Weaknesses - less accurate the further ahead - unforeseen changes of past trends can invalidate projections Projected Age structure of the UK population, mid-2016 to mid-2041 ? What does the pattern show ? ? ? What are the implications to health services? https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/ populationprojections/bulletins/nationalpopulationprojections/2016basedstatisticalbulletin Population Projection 2016 to 2041 What does the What are the pattern show ? implications to health services?  Population Projection 2016 to 2041 What are What the implications toshow? does the pattern health services? 2016 Spike- Post WW2 baby boom at Increased cost of care for the elderly pension age Increased Wideneed for at bulge chronic disease management age 50:1960s Increasedbaby boomhealth issues e.g. dementia mental 2041 See baby booms 25yrs up More people at older ages: - Increased life expectancy as disease management improves - 1960’s baby boomers in 70s Projected increase in number of people with Dementia in UK, by age Projected increase in dementia driven by ageing of population Update to Dementia UK (2014) Alzheimer’s Society / Kings College London / LSE http://www.alzheimers.org.uk/ Interim Summary for Objective 1 on demography For UK census you should know:- Procedures Strengths and weaknesses Uses in NHS For birth and death registrations you should know:- Procedures Three measures of fertility For population estimates & projections you should know:- How estimated, and main differences Projection of ageing population