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Long Term Conditions - Data

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Impact Assessments

 

What the data tells us

 

Cancer

There are more than 200 different types of cancer.  

1 in 2 people in the UK born after 1960 will be diagnosed with some form of cancer in their lifetime. About 4 in 10 cases could potentially be prevented each year.  The number of people diagnosed with cancer is likely to rise as the proportion of older people in the population increases. Older people with cancer are likely to have another long term condition.

Over the last twenty years, the majority of cancers have shown improvement in survival rates five years post-diagnosis. In Scotland during 2013 to 2017 (excluding non-melanoma skin cancers) 43% of men and 51% of women survived for at least five years. Evidence that socio-economic deprivation can influence cancer survival shows that patients in a more deprived area can be diagnosed at a later stage when survival is poorer.

Cancer continues to be a national clinical priority for the Scottish Government and the NHS.

Screening uptake rates show a 62% uptake for bowel cancer from 2017 to 2019 in Midlothian, same uptake rate as Scotland. In 2018/19, cervical cancer screening uptake in Midlothian was 78% (71% for Scotland) for women aged 25-49 and 80% for women aged 50-64 (77% for Scotland). 

 

Number of Cancer Registrations in Midlothian (3- year aggregate)

 The number of cancer registrations in Midlothian is reasonably stable, varying between 515 and 553 registrations for each period (3 year aggregate). The latest figure, for 2017-2019, is 533.

 

Age-sex standardised rate of cases diagnosed per annum (per 100,000 population)

Comparing Cancer Diagnosis Trends from 2013 to 2019 (in 3 year aggregates), there is a downward trend in Midlothian and both localities. The trend in Midlothian decreased from 681 cases per 100,000 to 614 over the time period. During the same period, Midlothian (East) decreased from 673 to 614 and Midlothian (West) from 686 to 617.

 


In Lothian the cancers with the highest incidence (in order and excluding non-melanoma skin cancer) are:

  • basal cell carcinoma of the skin,
  • breast,
  • trachea,
  • bronchus and lung,
  • squamous cell carcinoma of the skin
  • colorectal cancer.


Cancer Prevalence Projection in Midlothian 2018 to 2038

Cancer Prevalence is projected to increase substantially over the next two decades, with an expected increase from 3,374 in 2018 to 3,840 by 2028 and a further increase to 4,237 by 2038.

 

  

In Midlothian, there was between 220 and 260 deaths from all cancers (excluding non-melanoma skin cancers) each year (2011 to 2019)


All Age Cancer Mortality Rates, Midlothian Locality, NHS Lothian and Scotland

  There has been a gradual decline in mortality rates in Scotland, NHS Lothian and Midlothian between 2011 and 2019.  Midlothian localities have seen more fluctuation but still follow a downward trend. Since 2012, Midlothian and Lothian have consistently had lower mortality rates than Scotland, with 296 mortalities per 100,000 in Midlothian compared with 313 in Scotland in 2019.

 

Lung Cancer European age-standardised mortality rates, Midlothian Locality, NHS Lothian and Scotland

There has been a gradual decrease in lung cancer mortality rates in Scotland, NHS Lothian and Midlothian between 2011 and 2019. Midlothian East has been consistently higher than Midlothian West, with mortality rates in Midlothian East higher than Scottish rates until 2019, when they fall below. Mortality rates in Midlothian and Lothian have been lower than in Scotland since 2015, with Midlothian having 64 mortalities per 100,000 in 2019 compared with 77 in Scotland.

Lung cancer – there has been a downward trend in deaths with a wide range between East and West Midlothian. Deaths in East Midlothian remain above the Scottish average. The Midlothian rate closely follows the Lothian and Scotland averages.

Colorectal cancer – there has been an increase in deaths and is now in line with Scotland and NHS Lothian. 

Breast cancer - in both East and West localities has been close to that of the Scottish average.

The Covid-19 Pandemic has had an impact on services and treatment. People with specific cancers were placed on the shielding list including those with cancer of the blood or bone marrow and anyone undergoing active chemotherapy. Initial studies show that patients with cancer are more vulnerable to Covid-19 and have higher risks in all severe outcomes.

During the Covid-19 lockdowns, in the UK, there was a fall in referrals of urgent suspicion of cancer and the number of cancer patients starting treatment between April and July 2020 reduced by 26%.

 

 

Respiratory Conditions

Asthma

In 2018/19 there was 6,421 people living with asthma. The prevalence rate is 6.65 (per 100 population). The Scottish rate is 6.39.
 

COPD

In 2018/19 around 2,600 people were living with COPD in Midlothian.  The number and prevalence of COPD has been increasing over the last decade.

Midlothian ranks 10th highest out of the 31 HSCPs for COPD prevalence, has the highest prevalence rate among the Lothian HSCPs, and a higher prevalence rate than the Scotland average.

COPD patient hospitalisation data indicates there are a higher number of people admitted with COPD in areas where people are more likely to experience disadvantage. For example, 81.42 per 100,000 population in Penicuik North and 457.89 per 100,000 population in Dalkeith (3-year aggregate figure 2017/18-2019/20).  There were 151 potentially preventable admissions to hospital in 2019/20 for COPD.

People with severe COPD were placed on the shielding list and studies show that patients with pre-existing COPD appear more vulnerable to Covid-19 and have higher risks in severity of illness and mortality. Midlothian’s Community Respiratory Team expanded to Midlothian Community Respiratory Team +. This includes COVID oxygen weaning, early facilitation from hospital for bronchiectasis/ Idiopathic pulmonary fibrosis and COVID alongside developed Scottish Ambulance Service pathways.  

 

 

 

Neurological Conditions

Neurological conditions, disorders and syndromes affect the brain, spinal cord, nerves and muscles. 

There is no reliable data on the number of people with a neurological condition and most services are co-ordinated at a Lothian level. A purely statistical estimates suggests there are 5,300 people with a condition, 530 of whom will be disabled by the condition. Around 17% of GP consultations are for neurological symptoms.

The Astley Ainslie hospital in Edinburgh provides neuro-rehabilitation services and there are Lothian wide nurse and care adviser specialists for the main neurological conditions. At present data is not available on the Midlothian use of Astley Ainslie services, however there are plans to re-provision the hospital. This will be an opportunity to increase our understanding of how neuro-rehabilitation services are used by Midlothian residents. There is no local respite facilities for adults with a neurological conditions, Leuchie House in North Berwick in the closest specialist resource.

MS

209 per 100,000 – Scottish prevalence rate - this would suggest 188 people have MS in Midlothian.

Scotland has one of the highest rates of MS in the world compared to a worldwide prevalence rate of 2577.

The proportion of women being diagnosed with MS is increasing - between two and three women have been diagnosed with MS for every man with the condition.
 

Parkinson’s

1 in every 375 adults – Scottish rate. This would suggest 240 people have Parkinson’s in Midlothian.

People with Parkinson’s have a particularly high risk of hospital admission and are 6x more likely to develop dementia as people of the same age without the condition. Nationally numbers are continuing to rise for both MS and Parkinson’s Disease. This is linked to people living longer with these conditions.
 

Huntington’s Disease

16 people in every 100,000 – Scottish rate. This would suggest 14 people have Huntington’s Disease in Midlothian. The Scottish Huntington's Association reported a 55% increase in diagnoses between 2012 and 2015.
 

Motor Neurone Disease

2.4 per 100,000 – Scottish standardised incidence of people being diagnosed.(7.3 per 100,000 for people over 80) – This would suggest 2 people have Motor Neurone Disease in Midlothian

In Scotland incidence rates are higher than reported elsewhere and survival rates are lower. The median survival time for motor neurone disease in Scotland is 25 months.

 

 

Stroke

The raw prevalence rate (the number of people registered at one particular point in time) for stroke/TIA is 2.43 per 100 patients which equates to around 2,200 people. This is above the Scottish average prevalence rate (2.20). Nationally the death rate for cerebrovascular disease in the most deprived areas was 46% higher than in the least deprived areas in 2019.

74% of people were discharged to their own homes after admission to hospital for a stroke/TIA and 16% were discharged to a care home. 50% of people were discharged within 3 days or less (April 19-Aug 20).

Stroke Mortality (all ages)

All ages stroke mortality has been in steady decline in Scotland and Lothian over the period 2010 to 2019. In contrast, Midlothian and its localities experienced a considerable upsurge in 2012, increasing from less than 40 per 100,000 to a peak of over 60 per 100,000 by 2015. However, rates in Midlothian have been in decline since 2015, with Midlothian East declining most rapidly, and by 2019 mortality rates in Midlothian were substantially lower than in Scotland, with 24.7 mortalities per 100,000 in comparison to 39.5 in Scotland.

 

Early (under 75) Stroke Mortality

Early stroke mortality (for under 75s) has been in steady decline in Scotland and Lothian over the period 2010 to 2019. In contrast, Midlothian and its localities experienced a considerable upsurge in 2011, with Midlothian rates increasing from less than 6 mortalities per 100,000 in 2011 to a peak of over 15 per 100,000 by 2015. However, excluding 2018, rates in Midlothian and its localities have been in decline since 2015 and were substantially lower than in Scotland by 2019, with 4.6 mortalities per 100,000 in comparison to 9.2 in Scotland.

 

 

There is evidence in the UK of fewer stroke admissions to hospital during the COVID-19 Pandemic, particularly for ischemic stroke and stroke with less severe outcomes. Initial evidence also suggests that Covid-19 may be an important modifier of the onset, characteristics and outcome of acute ischaemic stroke. It is associated with greater severity of illness.

The pandemic has changed some behaviours for example people are meeting up less and say they are feeling lonelier. Loneliness is associated with an increased risk of stroke. 

 

 

Coronary Heart Disease

There are around 3,900 people in Midlothian living with Coronary Heart Disease. The prevalence rate is 4.30 per 100 population, and is consistently higher in males. 

Nationally chances of surviving for 30 days after being admitted to hospital as an emergency after your first heart attack has increased over the last decade from 90% to 93% in 2019/20.  There has been a downward trend in deaths over the last 10 years. However, this has not been at the pace of decline in neighbouring northern European countries. It is still a leading cause of death and a major public health problem in Scotland. There were 105 potentially preventable admissions to hospital in 2019/20 for congestive heart failure.

Coronary Heart Disease Mortality

There has been a gradual decrease in the mortality rate for Coronary Heart disease between 2010 and 2019 in NHS Lothian and Scotland. Mortality rates in Midlothian and its localities have fluctuated but have still seen an overall reduction over the period. Mortality rates in Midlothian East were consistently higher than those in Midlothian West between 2010 and 2015, after which they reduced to a similar level. Midlothian West mortality rates jumped up in 2016 and again in 2018 and 2019, which had an impact on the Midlothian rate, pushing it above the rates in both NHS Lothian and Scotland. By 2019, Midlothian had a mortality rate of 145 per 100,000 compared with 130 per 100,000 in Scotland.

 

 

Early (under 75) Coronary Heart Disease Mortality

There has been a gradual decrease in the early (under 75s) mortality rates for Coronary Heart disease between 2012 and 2020 in NHS Lothian and Scotland. In contrast to this, rates in Midlothian have remained fairly stable due to a steady rise in Midlothian West coupled with a steady decline in Midlothian East. Midlothian mortality rates were lower than those in Scotland at the start of the time period but the gap is closing and mortality rates in Midlothian and Scotland were 45.7 per 100,000 and 50.6 per 100,000 respectively by 2020.

 

 

Early (under 75) Coronary Heart Disease Mortality by Locality (2018-20 3yr aggregate)
West = light green, East = dark green

Early mortality rates for Coronary Heart Disease varied greatly across Midlothian’s intermediate zones in the 2018 to 2020 period. Penicuik North in Midlothian West had the highest rate, with 88.7 per 100,000 followed by Dalkeith in Midlothian East with 77.8 and Mayfield in Midlothian East with 72.7. Intermediate zones with the lowest rates in Midlothian are Pentland with 0 deaths per 100,000, North Gorebridge in Midlothian East with 11.2, and Pathhead and Rural East Midlothian with 16.2.

 

The standardised mortality rates for Coronary Heart Disease in those under 75 between 2012-2014 and 2017-2019 has been reasonably steady in Midlothian. The West locality has lower mortality than other parts of Lothian and Scotland but rates for areas are all very similar from 2015 to 2019. For all age mortality the West has increasing rates which are higher than other parts of Lothian and Scotland.

Pre-existing cardiovascular disease is associated with worse outcomes in patients with Covid-19 and it is believed that Covid-19 can cause some cardiovascular disorders.

The pandemic has changed some behaviours for example people are meeting up less and say they are feeling lonelier. Loneliness is associated with an increased risk of heart disease. 

 

Type 2 Diabetes & Obesity

Approximately 80% of diabetes complications are preventable or can be significantly delayed through early detection, good care and access to appropriate self-management tools and resources. 

Being overweight or obese is the main modifiable risk factor for type 2 diabetes. In England, obese adults are five times more likely to be diagnosed with diabetes than adults of a healthy weight.  90% of adults with type 2 diabetes are overweight or obese.

Diabetes care accounts for around 10% of all NHS expenditure. If no changes are made to the way diabetes is treated by 2035 ⁄ 2036, this will rise to around 17% of NHS expenditure.

Number of Midlothian residents diagnosed with type 2 diabetes by age group and gender (2015/16 - 2020/21)

In Midlothian, more males were diagnosed with type 2 diabetes than females, across all age groups, in the period 2015/16 to 2020/21. There were more people diagnosed with type 2 diabetes in the over 65s group than in any other age group, with 367 females and 428 males. This was closely followed by the 45 to 64 age group which had 310 females and 435 males diagnosed. The number of 18 to 44 year olds diagnosed was substantially lower, with 71 females and 87 males.

 

As of July 2017, 5,533 Midlothian residents had been diagnosed with Type 2 diabetes, 65% of which were males.

Number of Midlothian residents diagnosed with type 2 diabetes by deprivation (2015/16 - 2020/21)

The number of Midlothian residents diagnosed with type 2 diabetes during the period 2015/16 to 2020/21 is substantially higher in SIMD 2 than in any other quintile, with 655 diagnoses. This is followed by SIMD 3, with 410 residents and SIMD 4 with 290. SIMD 1 and SIMD 5 had the lowest numbers of diagnoses, with 160 and 179 respectively.

 

There is a known association between deprivation and type 2 diabetes. Approximately a third of Midlothian’s population lives in a SIMD 2 area. When looked at as a rate (per 100,000) the group with the highest rate of diagnosis are those in SIMD 5.

Type 2 diabetes is most prevalent in older people, increasing numbers of younger people are being diagnosed.

People with type 2 diabetes are at increased risk of severe illness if they contract Covid-19.