Transcript Document

Profiling health equity using
routinely gathered data: eye
health in the minority ethnic
population in Glasgow
Lucy Thompson
Senior Researcher, Public Health Resource Unit
Paul Burton
Information Manager (Public Health), Information Services
Background
• RNIB five year strategy
– 5 geographically-based Community
Engagement Projects
– specific goal within each CEP to
produce an eye health equity profile
to inform and serve as a baseline for
subsequent community
development work
“Scotland’s health is improving. But there are
big differences between rich and poor. In
2006, men could on average expect 67.9
years of healthy life and women 69 years.
In the most deprived 15% of areas in
Scotland, though, men could only expect
57.3 years of healthy life and women 59
years” (Scottish Executive, 2008).
Policy context
• Better Health, Better Care (2007)
• Equally Well (2008)
• Review of Community Eye Care Services
(2004)
• New GOS contract (2006)
• Scottish Vision Strategy (2008)
Priority Action:
Removing barriers to eye health and sight
loss services, prioritising groups whose
uptake of services is low and who may be at
higher risk of sight loss. This includes those
from Black and Minority Ethnic groups.
Objectives (1)
• To profile the eye health needs of adults in the black
and minority ethnic (BME) community of Glasgow in
terms of:
– Prevalence of four main conditions – age-related macular
degeneration (AMD), diabetic retinopathy (DR), cataract
and glaucoma (normative need);
– Uptake of optometry and ophthalmology services
(including DR screening) (expressed need).
• To describe the availability of optometry and
ophthalmology services (including DR screening),
and to compare this to assessed need;
Objectives (2)
• To review the outcomes of local qualitative
research studies to ascertain the views of members
of the community on their need (felt need) and
their perception of services;
• To make recommendations for:
– further research to augment the above information;
– amendments to routine data collection to enhance
available information;
– local action to be developed as part of the Community
Engagement Project;
– influencing local commissioning and care pathways.
Ethnicity in Glasgow - 2001
• Scotland: just over 5 million people, 2%
minority ethnic groups (2001 census data)
• Glasgow:
– Estimate 5% minority ethnic groups
– Mainly resident in:
• Pollokshields East (47.8%)
• Pollokshields West (30.2%)
• Govanhill (19%)
• Hillhead and Woodlands (15.1%)
• Yorkhill and Anderston (12%)
Ethnicity in Glasgow - 2008
• Scotland: just over 5 million people, 2%
minority ethnic groups (2001 census data)
• Glasgow:
– Estimate 8% minority ethnic groups @2008
– Mainly resident in:
• Pollokshields East (47.8%) (52%)
• Pollokshields West (30.2%) (38%)
• Govanhill (19%) (29%)
• Hillhead and Woodlands (15.1%) (17%)
• Yorkhill and Anderston (12%) (15%)
From: Glasgow City Council (2010) Population by ethnicity in Glasgow.
New areas of interest:
•
•
•
•
•
•
•
•
•
Pollokshields East (47.8%) (52%)
Pollokshields West (30.2%) (38%)
Govanhill (19%) (29%)
Nitshill and Darnley (9%) (18%)
Ibrox and Kingston (11%) (18%)
Sighthill (11%) (17%)
Hillhead and Woodlands (15.1%) (17%)
Yorkhill and Anderston (12%) (15%)
Arden and Carnwadric (5%) (10%)
SIMD 09
• NHSGGC comprises 23% of national population =
1,199,026 (2009)
• NHSGGC contains most deprived (Parkhead /
Barrowfield) dz in Scotland
• 30% of NHSGGC dzs are of 15% most deprived in
Scotland (local share)
• 46% of 15% most deprived dzs in Scotland lie
within NHSGGC (national share)
• 349,621 NHSGGC residents live in these
datazones
QOF 2009/10
Raw prevalence rate (per 100 patients)
CHP / CHCP
CHD
Diabetes
Hypertension
Smoking
Scotland
4.38
4.1
13.35
23.65
NHS Greater Glasgow & Clyde
4.31
3.95
12.61
22.88
East Dunbartonshire
4.28
3.63
14.36
24.15
East Glasgow
5.05
4.19
12.53
23.14
East Renfrewshire
3.79
3.52
12.23
21.4
Inverclyde
5.44
4.12
13.6
25.89
North Glasgow
4.62
4.07
12.37
23.13
North Lanarkshire
4.74
4.42
13.32
23.78
Renfrewshire
4.63
4.18
13.63
24.1
South East Glasgow
3.7
4
11.76
21.37
South Lanarkshire
4.41
4.27
13.51
24.35
South West Glasgow
4.38
4.28
12.02
23.36
West Dunbartonshire
4.57
4.32
14.18
24.68
West Glasgow
3.24
3.27
10.46
19.45
Quality & Outcomes Framework (QOF): voluntary; measures
achievement against a range of evidence-based indicators.
Free Eye Examinations
Numbers NHSGGC Eye Examinations* 2007-9 By Type (Source: OPTIX)
* Free NHS eye examinations were extended to all on 1st April 2006
55000
50000
Number Eye Examinations
45000
40000
35000
30000
25000
20000
15000
10000
5000
0
2007
2008
2009
Year
Visually impaired
Cataracts
Diabetic
Over 40 glaucoma sufferer relative
External eye disease
AMD
Glaucoma or ocular hypertension
CLINICS
DRS
(2009)
Weeks
Days
Sessions
Appointments
Glasgow Royal Infirmary
102
400
675
11500
Gartnavel General Hospital
102
250
500
8500
Victoria Infirmary
102
250
500
5800
New Sneddon Street, Paisley
97
245
490
6750
Southern General Hospital
97
170
295
5150
Greenock Health Centre
46
130
250
3570
Vale of Leven Hospital
12
60
120
1740
Dumbarton Health Centre
24
72
132
1596
Cambuslang Clinic
17
68
125
2000
Clydebank Health Centre
14
70
140
1500
Johnstone Surgeries
13
60
120
1900
Kirkintilloch Health Centre
10
45
85
1500
Barrhead Health Centre
6
27
54
900
Renfrew Health Centre
5
20
40
650
Easterhouse Health Centre
5
20
40
650
Baillieston Health Centre
5
20
40
650
Drumchapel Health Centre
5
25
50
525
Castlemilk Health Centre
5
23
45
650
Milngavie Clinic
5
25
50
525
Jamieson Medical Practice,
Muirhead
4
16
30
500
Clarkston Medical Practice
2
7
14
250
Lennoxtown Clinic
1
5
10
120
Interpreting services
• NHS GGC figures 2008/9 interpretation
services requests
– From 11 optometrists: 89 (79 assignments)
– Most common languages:
• Mandarin
• Turkish
• Singhalese (although these were from a single
practice)
– Urdu and Punjabi only one request each
Eye epidemiology
• There are no good prevalence data for eye
health in minority ethnic groups in the UK
• Will require a bespoke data gathering
exercise
• Indicative data from NEHEM:
NEHEM
• National Eye Health Epidemiological Model (NEHEM)
• Expert systematic review of epidemiological population-based
studies of the prevalence of glaucoma, age-related macular
degeneration, low vision and cataracts.
• Prevalence rates from combinations of research studies (most
relevant to the UK population) applied to age/sex population
estimates in local areas (2001 Census resident populations).
• Appropriate adjustments were made where prevalence rate
estimates were significantly different between sub-groups such
as the black or Asian populations.
• Where age groupings incompatible or not quoted, statistical
regression techniques were used to estimate prevalence (also
where open-ended age ranges e.g. 80+).
NEHEM: NHSGGC
Local Authority
AMD
Cases
%
NV-AMD
Cases
%
Geographic
Atrophy
Cases
%
Drusen
Cases
%
East Dunbartonshire
775
2.07%
547
1.46%
269
0.72%
3913
10.46%
East Renfrewshire
693
2.31%
489
1.63%
243
0.81%
3269
10.89%
Glasgow City
4491
2.54%
3161
1.79%
1585
0.90%
20366
11.51%
Inverclyde
692
2.36%
487
1.66%
243
0.83%
3235
11.04%
North Lanarkshire
2045
2.04%
1441
1.44%
713
0.71%
10410
10.39%
Renfrewshire
1274
2.19%
899
1.54%
445
0.76%
6199
10.66%
South Lanarkshire
2174
2.17%
1532
1.53%
760
0.76%
10688
10.67%
West Dunbartonshire
727
2.36%
512
1.66%
256
0.83%
3401
11.04%
Local Authority
Glaucoma
%
Impaired
Vision
%
Low Vision
%
Severe Sight
Impairment
%
East Dunbartonshire
916
1.32%
1299
3.47%
1114
2.98%
182
0.49%
East Renfrewshire
773
1.35%
1148
3.82%
979
3.26%
165
0.55%
Glasgow City
4829
1.38%
7415
4.19%
6312
3.57%
1072
0.61%
Inverclyde
755
1.40%
1146
3.91%
977
3.33%
165
0.56%
North Lanarkshire
2448
1.24%
3422
3.42%
2936
2.93%
475
0.47%
Renfrewshire
1456
1.31%
2119
3.64%
1812
3.12%
301
0.52%
South Lanarkshire
2509
1.31%
3623
3.62%
3100
3.09%
511
0.51%
West Dunbartonshire
797
1.36%
1203
3.91%
1026
3.33%
173
0.56%
Ophthalmology SMR01 (1)
Mean Admission Rates Per 100 Population 2007-9
Glaucoma
Cataracts
AMD
Age
Males
Females
Males
Females
Males
Females
<50
0.005958
0.003167
0.034739
0.026250
0.001259
0.001750
50-54
0.021070
0.019534
0.231774
0.212533
0.005057
0.014846
55-59
0.056720
0.026391
0.497542
0.441114
0.012936
0.014138
60-64
0.074724
0.057744
0.745106
0.735741
0.025620
0.031859
65-69
0.110020
0.116579
1.473990
1.605938
0.028210
0.072565
70-74
0.143981
0.145262
2.356059
2.725219
0.166888
0.209823
75-79
0.353419
0.268268
3.305894
3.989951
0.313906
0.323625
80+
0.515837
0.484930
4.346251
4.633438
0.500917
0.698750
Total
0.045806
0.054999
0.457882
0.679000
0.032272
0.065763
• Admission rates (Source: SMR01, 2007-9) have been calculated for
three of the four conditions; glaucoma, cataracts or AMD will have
been one of potentially six diagnoses for each admitted patient.
Ophthalmology SMR01 (2)
Relative
Ratio
Q1
Q2
Q3
Q4
Q5
Glaucoma
1.5
1.7
1.4
1.2
1
Cataracts
1.3
1.3
1
1
1
AMD
1.1
1.2
0.8
1.1
1
• Standardising the admission rates for relative distributions of age
and sex across the quintiles, reveals a relationship with deprivation
for all three conditions.
• There would appear to be a greater likelihood of admission for one
of these conditions for residents of the more deprived areas.
Ophthalmology SMR00 (1)
Age Range
Appointments
DNA
DNA Rate
<50
6935
1584
22.84%
50-54
1331
235
55-59
1297
60-64
SIMD09
Appointments
DNA
DNA Rate
1
8267
1536
18.58%
17.66%
2
3536
534
15.10%
158
12.18%
3
2427
329
13.56%
1582
190
12.01%
4
2313
269
11.63%
65-69
1717
167
9.73%
5
3643
290
7.96%
70-74
2067
178
8.61%
Total
20186
2958
14.65%
75-79
2190
192
8.77%
80+
3067
254
8.28%
Total
20186
2958
14.65%
Relative Ratio
Q1
Q2
Q3
Q4
Q5
2.16
1.79
1.53
1.36
1
• For patients not attending their (Ophthalmology) outpatient appointment
during 2009, there would appear to be a decreasing trend associated with
increasing age; and increasing deprivation (Source: SMR00, 2009).
• Standardising the non-attendance rates for relative distributions of age and
sex across the quintiles, reveals a relationship with deprivation (RR = 2.16
for most deprived; RR = 1 for least deprived).
Ophthalmology SMR00 (2)
Days
SIMD09
<30
%
30-59
%
60-89
%
90-119
%
120+
%
Total
1
1387
20.61
2669
39.65
2058
30.57
381
5.66
236
3.51
6731
2
613
20.42
1170
38.97
940
31.31
190
6.33
89
2.96
3002
3
483
23.02
803
38.27
622
29.65
121
5.77
69
3.29
2098
4
433
21.18
815
39.87
624
30.53
110
5.38
62
3.03
2044
5
766
22.85
1249
37.25
1051
31.35
198
5.91
89
2.65
3353
Total
3682
21.37
6706
38.93
5295
30.73
1000
5.80
545
3.16
17228
• The majority (91.03%) of patients attending an (Ophthalmology)
outpatient appointment during 2009, were seen within three months.
• Although not formally analysed, there would appear to be no
discernible difference in waiting times for an (Ophthalmology)
outpatient appointment (Source: SMR00, 2009) across the quintiles.
Lessons
• We are not in a position to say we have
assessed need
• Need for better use of existing data systems
• Bespoke data collection as short-term option
– Audit of GP practices complete
• Talk to service users and stakeholders
directly
– This is underway as part of Community
Engagement Project
Acknowledgements
•
•
•
•
•
Gozie Joe Adigwe, RNIB
Ken O’Neill and the CEP advisory group
Paula Barton, Information Services – maps
Anna Matthews – literature work
Merav Kliner, NHS Bradford and Airedale –
policy and literature input