Office for National Statistics & Public Health

Dr Azeem MajeedOffice for National Statistics & University College London

Structure of session

• Structure & function of ONS• Recent developments in

government statistics & analysis• Small group work on primary care

data

Learning objectives

• ONS - structure & function• Health related data• Future developments in

government statistics• Opportunities for training &

collaborative work• DH review of primary care data

What is the ONS?

• Formed in 1996 by the merger of Office of Population Censuses and Surveys & Central Statistical Office

• Main arm of the government statistical service

• Responsible for publication of wide range of government statistics

Public health related work

• Health & Care• Population & vital statistics

Health & Care

• Mortality• Morbidity• Child Health• Cancer• Longitudinal survey• Geographical variations

Publications

• Health Statistics Quarterly• Population Trends• Ad-hoc publications• Web site (www.statistics.gov.uk)

Opportunities for training

• ONS approved location for SpR training• Previous projects include accidents,

deaths from overdose, atrial fibrillation, epilepsy.

• Development of analytical skills, knowledge of routine data sources & publication of work encouraged

• SpRs from other specialties

Supporting public health I

• Collection & analysis of routine statistics

• Decennial census• Population estimates• Deprivation measures• Birth & death rates• Cancer incidence & survival• Teenage conception rates

Supporting public health II

• Primary care• Health inequalities• Measuring the burden of disease• Reducing suicide• New methods of measuring case-

mix

Primary care

• Prevalence of chronic diseases• Prescribing rates• Time trends• Variations

– Regional, socio-economic, practice

• Provide information for planning health services for DOH, PCTs etc.

Prevalence of atrial fibrillation per 1,000 among 1,4 million patients from 211 general practices in 1998

0

20

40

60

80

100

120

0-34 35-44 45-54 55-64 65-74 75-84 85+ All ages

Age Group

Prev

alenc

e per

1,00

0

Percentage of men with atrial fibrillation prescribed oral anticoagulants in 1994 and 1998

0

5

10

15

20

25

30

35

40

45

0-34 35-44 45-54 55-64 65-74 75-84 85+ All ages

Age Group

Perc

entag

e pre

scrib

ed or

al an

ticoa

gulan

ts 1994

1998

Percentage of men and women with AF prescribed anticoagulants in 1998

0

5

10

15

20

25

30

35

40

45

35-44 45-54 55-64 65-74 75-84 85+ All ages

Age Group

Perc

enta

ge Men

Women

Relative risks in AF patients

45-64 yrs 65-74 yrs 75+ yrs

IHD 4.5 2.6 2.5

Heart failure 33.5 7.5 3.7

Raised BP 2.5 1.4 1.5

Diabetes 1.6 1.4 1.1

Stroke 8.6 3.2 2.9

Prevalence of IHD & use of statins in E & W in 1998

Group 1(affluent)

Group 2 Group 3 Group 4 Group 5(deprived)

ASR per1,000

24.7 27.0 28.8 29.4 34.8

% treatedwithstatins

29.7 26.5 24.7 25.4 22.2

Some other diseases examined• Heart failure• Hypertension• Asthma• Epilepsy• Schizophrenia• Peptic ulceration

Annual No. of contacts with GPs Group 1

Affluent

Group 2 Group 3 Group 4 Group 5 Deprived

Mean No. of contacts

4.01 4.28 4.52 4.79 4.74

Referral rates per 1,000 (males)

Group 1 Affluent

Group 2 Group 3 Group 4 Group 5 Deprived

Total 131.9 120.4 118.6 120.4 115.9

Medical 20.0 17.3 16.6 17.4 16.8

Surgical 29.2 27.0 27.8 28.1 26.9

Paeds 42.9 31.0 30.5 31.0 27.6

Referral rates per 1,000 (females) Group 1

Affluent

Group 2 Group 3 Group 4 Group 5 Deprived

Total 170.6 158.2 161.6 159.8 160.4

Medical 20.3 17.9 17.4 18.3 18.9

Surgical 32.7 27.4 29.5 28.0 29.2

Paeds 37.9 30.8 29.7 29.7 28.7

Reducing deaths from suicide• Reducing deaths from overdose an

important component• GPs will play an important role• New database of deaths from

overdose developed by ONS• Allows more sophisticated and

flexible analyses than previously

Deaths from opiate overdose and poisoning per million population, England and Wales 1993-1998

05

10

15202530

3540

1993 1994 1995 1996 1997 1998

Year

Rate

per m

illion

Males

Females

Toxicity index for antidepressants

Drug Deaths per 100,000 prescriptions

Tricyclic antidepressantsDothiepin 7.1Amitriptyline 5.8

Newer antidepressantsCitalopram 0.7Fluoxetine 0.4Sertraline 0.4Paroxetine 0.2

Deaths from overdose & poisoning in England & Wales by area deprivation, 1993-1998

0

1000

2000

3000

4000

5000

6000

1 2 3 4 5

Enumeration district group

Numb

er of

death

s Males

Females

Measuring case-mix in primary care• Comparing performance• Examining use of resources• Adjusting referral rates• Case mix measurement based on

patients’ medical history• Budget setting

Percentage referred in one year

Case mix group A 2.7

Case mix group B 10.1

Case mix group C 16.1

Case mix group D 28.9

Case mix group E 36.3

Case mix group F 45.4

Burden of disease

• Measuring the burden of disease• GP consultations• Prescribing• Referrals• Admissions• Projections

Hip fracture admissions among over 65 year olds in England

1998 2022 Increase

Men 11,562 16,410 +42%

Women 45,984 53,126 +12%

Total 57,546 69,536 +21%

Other areas

• Teenage pregnancy• Social & regional variations• Health surveys• Linkage studies• Child health• E-Strategy (www.statistics.gov.uk)

Conclusions

• Work of ONS & ONS data important to people working in public health

• Learn how to use data to help plan & monitor health services and the health of the public

Primary care data

• Department of Health reviewing primary care data

• Workshop in August/September• Report later this year

Issues to be considered

• Who are the users of primary care data?

• What data are currently available?• What are the strengths & limitations

of these data?• How can primary care data be used?• How can data from primary care be

improved?