State of the South West (WEB VERSION)

Major Diseases and Cause of Death

8.30 This section looks at the major diseases and causes of death and highlights differences within the region and between the South West and the country as a whole. Whilst the incidence of certain diseases reflects that of the country as a whole, there are specific diseases where the South West differs from the national average. Incidence of many diseases varies between socio-economic strata and within different areas of the region. In 2005 the major causes of death nationally were circulatory disease, cancer and respiratory disease (ONS).

Measuring and Comparing Mortality

8.31 The Standardised Mortality Ratio (SMR) is a method of comparing mortality levels in different years, or for different sub-populations in the same year, while taking account of differences in population structure.

8.32 An SMR is calculated by comparing an observed number of deaths to an expected number, multiplied conventionally by 100. Thus, if mortality levels are higher in the population being studied than would be expected the SMR will be greater than 100.  Similarly, the Standardised Registration Ratio (SRR) is calculated in the same way but using the number of disease registrations rather than mortality.

8.33 The Compendium of Clinical Indicators provides the majority of the data in this section. The compendium uses the population of England as a reference and therefore the SMR for England is always 100. Consequently, if an SMR is below 100 the study population has lower rates of mortality than England as a whole.

8.34 Confidence Intervals (CIs) for SSRs and SMRs provide information regarding the precision of estimated values since they take into account the variability of the SMR estimate. Throughout this section two numbers in brackets following an SMR, e.g. 93 (92-94), denote the lower and upper values of a 95% confidence interval for the SMR estimate. These lower and upper values define a range of values within which we can be 95% sure the real value for the SMR lies. An SMR is significantly high if both lower and upper values of the CI are above 100, and low if both are below 100.

All Causes of Mortality

8.35 The overall mortality rate in the South West is lower than the average for England. However, there are variations in all cause mortality across the region. A few places, such as Bristol and Plymouth, have rates significantly higher than England. Although rates in Gloucester and the Forest of Dean are higher than England, they are not significant. As with many of the individual causes of mortality, both nationally and within the South West, all cause mortality rates are highest amongst the disadvantaged socio-economic groups,  as shown in ‘Geographic Variations in Health’ (ONS).

Circulatory Diseases

8.36 Circulatory diseases are mainly strokes and heart disease. These are the largest single cause of death in the South West, accounting for about 38% of deaths from all causes in 2004. Prevention involves controlling high blood pressure, controlling obesity, taking adequate exercise and most importantly, not smoking. Over 20,000 people living in the South West died of circulatory disease during 2004. However, the South West had a lower SMR than England.

8.37 The standardised mortality rate for circulatory diseases fell by 37% in the South West between 1993 and 2004 and the number of deaths from circulatory disease fell by 26% between 1993 and 2004. Both stroke and heart disease have similar socio-demographic profiles, with higher rates in more disadvantaged groups. This is linked to health-related behaviour amongst lower socio-economic groups, such as a higher prevalence of smoking.

Cancers

8.38 Cancers are a group of diverse diseases which collectively accounted for around 26% of deaths in the South West in 2004. However, the mortality rate for all cancers in the South West is lower than compared to England as a whole (see table).

8.39 Cancers must be tackled on two fronts. The first is to reduce incidence, the number of people contracting the disease. The second is to reduce mortality, the number of people dying from the disease. Different cancers are susceptible to different strategies, but it is recognised that giving up smoking is the single most useful strategy for the individual.

Malignant Melanoma

8.40 The South West region has the highest incidence and mortality of malignant melanoma of any area of the UK. Both incidence and mortality rates are rising. However survival rates are higher than average for England. The South West is one of the sunniest parts of the UK, and approximately a quarter of its population are beyond retirement age. People who like the sun are believed to preferentially retire to coastal parts of the South West region. This implies that there is a concentration of elderly people with a long history of UV exposure along the South West coast. Yet to be published research by the South West Public Health Observatory examining the geographic distribution of melanoma cases has shown that the incidence of melanoma is significantly higher on the South West coast, particularly in more rural regions. Melanoma affects a younger age group than most cancers, and deaths from melanoma (see table) are almost entirely preventable. Prevention is possible either by taking precautions against exposure to excess UV, or by reporting suspicious skin lesions early. Public education is a key factor in encouraging both.

Mesothelioma

8.41 Mesothelioma is a rare cancer of the lining of the lung or abdomen. Approximately 8 out of 10 cases are caused by exposure to asbestos. The cancer has a long latency period with an average time from initial exposure to development of the disease of between 35 and 40 years, but is nearly always fatal within a year of diagnosis.

8.42 The rate of mesothelioma in the South West is significantly above that of England as a whole. Asbestos use was particularly high in the dockyard industry and the majority of cases that occur in the South West are clustered in and around Plymouth, though other cities with a history of shipbuilding also suffer similarly high rates. High levels of mesothelioma are also discernable around Bristol and Swindon, reflecting the industrial use of asbestos in these cities in the last century.

8.43 As might be expected, mesothelioma is most prominent in men who were of working age throughout the period in the 1950s and 1960s when asbestos use was at a peak. The incidence of mesothelioma is still rising and is not expected to peak until approximately 2014, nearly 40 years after regulations on environmental exposure to asbestos were first enforced.

Prostate Cancer

8.44 In the South West as well as England as a whole, prostate cancer is the most commonly diagnosed cancer in men and the second most common cause of cancer death. Despite this the progress of the disease and the best way of managing it clinically are not well understood.

8.45 The number of men diagnosed with prostate cancer per year increased abruptly with the widespread access to PSA testing in the late 1990’s. However the mortality due to prostate cancer has not changed significantly in the last decade. For men in their sixties, prostate cancer increasingly is treated with radical surgery. The number of operations performed has more than doubled between 1997/98 and 2004/05. This operation has serious and well known side effects, and only a modest chance of curing the cancer before the patient dies from unrelated causes. Recent research has shown that affluent men are more commonly diagnosed with prostate cancer although there is no evidence of an association with mortality. This indicates that affluent men may receive more testing for prostate cancer and also undergo more surgery. However this does not lead to a significantly reduced mortality.

Mental Health

8.46 Poor mental health has been associated with poor socio-economic status, poor education, poor opportunities for employment and general 'social exclusion'. Mental health and physical health are also interlinked; poor physical health may increase the likelihood of developing poor mental health, and poor mental health may increase risks of developing or not recovering from serious physical health problems. It is, however, very difficult to measure mental health. Two measures are used as a proxy: hospital admissions and deaths by suicide and undetermined injury.

8.47 There were 20,122 psychiatric admissions in the South West in the financial year 2003/04, with numbers split almost equally between men and women. Compared with England as a whole, the South West had a similar rate of admissions for neurosis (severe forms of normal experiences such as anxiety, with 1,621 admissions in those aged 16 years and over) and a lower rate of admissions for schizophrenia and related psychoses (severe distortion of a person’s perception of reality, with 2,331 admissions in those aged 16-63 years). There were 1,396 deaths from suicide and undetermined injury in the combined years 2002-04 and the region’s rate is similar to England as a whole. Neurosis admission rates are higher in women, whereas schizophrenia admission rates and rates of mortality from suicide and undetermined injury are higher in men.

Infant Mortality

8.48 Infant mortality is defined as death within the first year of life. Infant mortality is influenced, amongst other things by smoking during pregnancy, breast feeding and good neonatal care.

8.49 Deaths under one year of age per 1,000 live births have been falling in England and in the South West. In 1981 there were 10.9 deaths per 1,000 live births in England and by 2005 this had dropped to 5 deaths per 1,000 live births. Similarly in the South West, the infant death rate dropped from 10.4 deaths per 1,000 live births in 1981 to 4.5 in 2005. However, as elsewhere ‘Geographic Variations in Health’ (ONS) showed higher rates amongst the least affluent in the South West.

Accident Injury

8.50 The death rate from land transport accidents, which are predominantly road traffic collisions (RTCs), is average in the South West compared with the rest of England, but there is considerable local variation across the region. In 2002-2004, Local Authorities with resident death rates from land transport accidents significantly above the England rate were: West Dorset, Mendip, Tewkesbury, North Dorset, South Somerset and West Somerset.

8.51 Over half of road deaths are to people aged under 30 and road traffic collisions are a significant contributor to premature mortality, causing 5% of all years of life lost before the age of 75 in the region. A further 24,000 people are injured each year, with around 10% sustaining serious injury and requiring treatment in hospital. Of particular concern is the established association between socio-economic deprivation and accidental road injury, particularly for children. People living in the most deprived areas are much more likely to be killed or injured on the road, particularly as a pedestrian. 

8.52 It is also important to view road safety in a wider context. People in the South West are currently extremely dependent on private transport, particularly in rural areas. Alongside the improvement of the relative safety of vehicles, local transport planning should encourage the use of and make provision for modes of transport that are environmentally sustainable and increase physical activity. Road danger is a strong disincentive to use of 'active transport' (walking and cycling) and therefore can indirectly contribute to rising levels of obesity.

Sexually Transmitted Infections

8.53 Sexual health is identified as one of the key national public health priorities for action due to concern about increasing diagnosed HIV and sexually transmitted infections, and also the continued high level of teenage conceptions. Sexually transmitted infections are common and associated with serious long-term complications such as pelvic inflammatory disease, chronic abdominal pain, infertility, ectopic pregnancy, stillbirth and genital cancers. Sexual ill health particularly affects women, young people, certain minority ethnic groups and men who have sex with men. There is also a strong link with social deprivation.

8.54 The HIV infection incidence rate in the South West more than doubled between 2000 and 2005 and this increase is greater than that observed in England as a whole. Diagnoses of chlamydia, syphilis, herpes and genital warts also continued to increase in the South West in 2005. The increase in diagnosed chlamydia between 2004 and 2005 was greater in the South West than England as a whole. However this could be due to increased awareness and testing for this condition which often has no symptoms in the early stages. Diagnoses of gonorrhoea, in contrast, have reduced over the past three years in England and the South West. The reasons for this are not clear.

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