JSNA Healthy People and long term conditions

Data in this summary are correct as at July 2022

Introduction and data summary

Our health is one of the most important assets we have as individuals, communities, and society. Health is a state of physical, mental, and social wellbeing, and can be different for different people. For example, for one person, the most important thing for their health might be whether they are able to spend time with those they love. For another, it might be their ability to work and support their family. Summary statistics can help us describe key aspects of health across different life stages within our communities and population in Hampshire.

Local public health teams work in collaboration with other organisations to empower people to take control of their own health, reduce health inequalities and, ultimately, to prevent people experiencing ill health in the first place. This chapter focuses on the health outcomes of our population, the health inequalities which are evident and the potential impacts of the COVID-19 pandemic.

The JSNA Healthy People data report explores this data in more detail. This link opens a Power BI presentation. Power BI is an interactive data visualization software developed by Microsoft.

Healthy People - Hampshire data summary

Life expectancy and healthy life expectancy

Hampshire’s overall population health is better than England. The latest life expectancy figures published for Hampshire (2018 to 2020) are better than the national average, 81.4 years for men (two years longer) and 84.6 years for women (one and a half years longer). Life expectancy across Hampshire has been increasing over time, however improvements have slowed and this has been particularly noticeable for women and people living in the most deprived areas of the county.

Over the last five to six years healthy life expectancy has decreased for both males and females in Hampshire by 2.3 years and 2.5 years respectively. This suggests people overall are living longer in poor health with a bigger decrease observed in females' healthy life expectancy.

Multimorbidity

Across Hampshire, over 190,000 residents have two or more long terms conditions (multimorbidity), this equates to almost one in seven people (13.6%). Patients with multimorbidity’s have the greatest healthcare needs and generate the highest expenditure in the health system. Multimorbidity was a key risk factor identified during COVID-19. People with multiple conditions were more likely to experience severe health outcomes from COVID-19.

Deprivation may explain some of the variation across Hampshire. The lowest proportion of people with two or more condition is in Hart (6.6%) and the highest proportion in Havant (17.4%) these are the least and most deprived districts respectively. However, age is also a significant contributing factor, almost one third of the population in the New Forest are aged 65 years and over, with 17.4% of the total population having two or more conditions.

In Hampshire, a total of 12,200 children and young people aged under 20 years have at least one long term condition, this is a rate of 0.86 per 100,000 population aged under 20 years. Of these 2.1% have two long term conditions, and less than 1% have three conditions recorded. East Hampshire, Fareham, Havant, New Forest, Winchester have a higher rate than Hampshire overall and analysis suggests that there is only a weak relationship with deprivation.

Note: Care must be taken when interpreting these data, the data extract did not include all practices across Hampshire and therefore data should be used as a proxy, other data sources and intelligence should be considered alongside.

Mental health and wellbeing

COVID-19:

Deterioration and then improvement in mental health and wellbeing coincided with the periods of national lockdown and high COVID-19 cases followed by easing of lockdown and reducing cases. Levels of depression and anxiety were higher amongst younger adults, with older adults showing lower levels and the smallest changes over time. Long-term distress was highest among younger people, women, people living without a partner, those who had no work or lost income, and those with previous health conditions or COVID-19 symptoms.

Common mental health disorders:

Common mental disorders (CMDs) comprise different types of depression and anxiety. In children and young people, girls aged 17 to 23 years, those from White and mixed ethnic groups, those with special educational needs, and long term physical health conditions were also more likely to have a probable mental disorder. Across Hampshire, higher numbers of children with probable mental disorders can be observed in areas around Andover, Winchester city, Aldershot and Odiham.

In people aged 16 and over, around one in six reported experiencing a CMD, in any given week in England, this included any type of anxiety or depression. Women were more likely than men to have reported CMD symptoms. There are 163,500 patients in Hampshire aged 18 and over who have depression recorded on their practice disease register. The prevalence of depression in Hampshire, 14.4%, is higher than the England prevalence of 12.3% and has been increasing over the last nine years.

Severe mental illness:

Severe mental illness (SMI) refers to people with psychological problems that are often so debilitating that their ability to engage in functional and occupational activities is severely impaired. Schizophrenia, bipolar affective disorder and other psychoses are included under SMI. The number of patients with SMI registered with a GP practice is recorded through QOF. Nationally the prevalence of SMI is 0.95% for all ages, and across Hampshire the prevalence is lower at 0.8%. This equates to 11,300 people across Hampshire. Within Hampshire there is a small amount of variation with higher prevalence in Gosport (1.0%) and lower prevalence in Hart (0.6%).

Long COVID

Long COVID is currently defined as people who suffer with poor health for 12 weeks or more beyond the initial acute phase of infection. The prevalence of self-reported long COVID greatest in people aged 35 to 49 years, females, people living in more deprived areas, those working in teaching and education, social care or health care (likely reflecting increased exposure to COVID-19 infection in these sectors), and those with another activity-limiting health condition or disability. Across Hampshire data supports the national findings with working age women, especially those aged 45 to 64, most likely to require on-going support with their health after contracting COVID-19.

Carers

The 2011 Census reported that just over 132,900 people provided some form of unpaid care, equating to one in ten of the total population. Nearly 26,500 residents provided 50 hours or more unpaid care a week in Hampshire. 5,370 (4.0%) of those providing unpaid care were young people aged 16-24 years and a further 2,390 (1.8%) were aged under 16 years. One quarter of these young carers provided 20 hours or more of unpaid care.

Unpaid carers are more than twice as likely to suffer from poor health compared to people without caring responsibilities. Between 2020 and 2040 the number of people aged 65 and over providing between one and 50 hours of unpaid care is estimated to increase by 33%.

People with learning disabilities

People with learning disabilities often have different and complex health care needs leading to increased prescribing and polypharmacy. They also have a higher prevalence of depression, asthma, diabetes and epilepsy. The number of people on the GP learning disability register has slightly increased. However the percentage of the population has remained stable with 0.5% of the population (6,683 people) across Hampshire registered with a learning disability. This is comparable to the national proportion. However, learning disabilities are not well recorded on GP records and in Hampshire it is estimated that only 26% of adults with a learning disability have been identified.

The 2018 Learning Disabilities Mortality Review found that the median age at death for people with learning disabilities (aged 4 years and over) was 60 years for men and 59 years females. This highlights the disparity in the age at death between people with learning disabilities and the general population of 23 years for males and 27 years for females.

Special Educational Needs and Disabilities (SEND)

Special educational needs' is a legal definition and refers to children with learning problems or disabilities that make it harder for them to learn than most children the same age. A child can receive SEN support in school, such as speech therapy, and a child may need an education, health and care (EHC) plan if they need more support than their school provides. Nationally the number of pupils with an EHC plan and the number of pupils with SEN support have increased since 2016. Similar to the national trend, the number of children and young people with a current statement or EHC plan maintained by Hampshire County Council is increasing year on year. Moderate learning difficulty, behaviour, emotional and social development, autism and speech, language and communication need have been the common need type over the six years.

Inclusion Health Groups

Inclusion Health Groups is a ‘catch-all’ term used to describe people who are socially excluded, typically experience multiple overlapping risk factors for poor health (such as poverty, violence and complex trauma), experience stigma and discrimination, and are not consistently accounted for in electronic records (such as healthcare databases). People belonging to inclusion health groups frequently suffer from multiple health issues, which can include mental and physical ill health and substance dependence issues. These factors lead to extremely poor health outcomes, often much worse than the general population, lower average age of death, and it contributes considerably to increasing health inequalities.

Older adults

Older people have higher rates of multimorbidity and health conditions, in addition are also more likely to suffer from conditions which are associated with ageing, such as frailty, reduced mobility, urinary incontinence, sensory impairment, falls and dementia. During the pandemic many older people may have been shielding and unable to get out and about, or simply have reduced activities during periods of social distancing restrictions. This may have resulted in deconditioning. Deconditioning is the syndrome of ‘physical, psychological and functional decline that occurs as a result of prolonged inactivity and associated loss of muscle strength’.

Frailty:

Frailty describes someone’s overall resilience and ability to recover quickly from health problems. Older adults with frailty are characterised by having reduced muscle strength and mass, fatigue, arthritis, poor eyesight or hearing, reduced mobility and adverse reactions to medication. People living with frailty are at greater risk of disability and admission to hospital or care homes. Evidence suggests that there are around 37,500 people in Hampshire with moderate or severe frailty. The area with the highest number of people is the New Forest, where there are a higher proportion of people aged over 65. However, there are pockets of areas in almost all districts where the number of people with frailty are higher.

Reduced mobility:

Closely linked to frailty is reduced mobility. Many older people suffer from reduced mobility, meaning that they are unable to walk as far or for as long, or complete household chores. Research suggests that in Hampshire there are around 60,730 people aged 65 and over with reduced mobility, and again the New Forest is the areas where the highest number of these people live.

Urinary Incontinence:

There is still a significant knowledge gap around urinary incontinence (UI) however this condition could have the third most serious impact on quality of life after stroke and dementia. Research also suggests that UI is a predicting factor for moving into a care home and some psychological conditions such as social isolation. In Hampshire there are an estimated 82,700 people over the aged of 65 experiencing UI. There is some variation across the districts due to the differences in age breakdown across these areas, with the New Forest showing the higher number of people experiencing UI and Rushmoor showing the lowest. As with frailty there are also pockets in all districts where the numbers of people experiencing UI is estimated to be higher.

Sensory Impairment:

Age-related hearing loss is the gradual loss of hearing in both ears and is common in older people. Estimates suggest that around 71% of people aged 70 and over have hearing loss. In Hampshire. this suggests that around 30,600 people experience severe hearing loss whilst over 236,800 people aged over 60 experience some hearing loss. Again those areas with higher proportions of older people in the population are those areas with higher prevalence.

Sight impairment is another condition which increases with age. There are a number of main causes of sight loss including: age related macular degeneration, cataracts, glaucoma and diabetic complications. Moderate or severe sight loss for those aged between 65 and 74 has been estimated as 5.6%, whilst for those aged 75 and over it is 12.4%. Applying these proportions to the Hampshire population suggests that over 28,300 people are experiencing sight loss, with an increase in prevalence in those areas with a higher proportion of older people.

Falls:

People are at increased risk of falling as they get older, and at increased risk of these falls causing more serious injury, including bone fracture. Falls are one of the most common reasons for hospital stays in older adults and falls and fear of falling can result in loss of confidence and activity in older people. Across Hampshire the number of people experiencing a fall in the previous 12 months is estimated to be 86,000. In 2020/21, the rate of emergency hospitalisations after falls in England for those aged 65 and over was 2,023 per 100,00. This rate increases to 5,174 for those aged 80 and over. In Hampshire the rates are slightly lower at 1,958 and 5,168 respectively. The area with the highest rate of admissions in both age categories was Eastleigh and in all areas women show a higher rate of admissions than men. Those areas of higher deprivation across Hampshire have higher rates of admissions.

Dementia:

Dementia is a collection of symptoms which include memory loss, mood changes, and problems with reasoning, perception and communication. It is not an inevitable part of growing old and is caused by diseases of the brain, most commonly Alzheimer’s but also vascular dementia, mixed dementia (both Alzheimer’s and vascular), Lewy body dementia, and a number of rarer conditions. In Hampshire there are 10,450 diagnosed cases of dementia recorded on GP records, however many cases are not diagnosed and it is estimated that the number of people in Hampshire with dementia is around 23,700.

Healthy people full report
Long term conditions - Hampshire data summary

This report provides summary of certain long term conditions. It aims to understand and quantify how many people in Hampshire are affected by the condition and what the outcomes of this condition may be, exploring data such as hospital admission and premature mortality where available. Premature mortality (deaths in people aged under 75 years) is a good high-level indicator of the overall health of a population, being correlated with many other measures of population health: there are significant inequalities between the premature death rates in different areas and population groups, reflecting a wide range of underlying differences.

Where available inequalities in prevalence and outcomes are also discussed. Also where possible data includes children and young people, however, many of these conditions develop later on in life and therefore focuses only on adults.

The data in this report can be explored further by smaller geographies in the JSNA Healthy People data report.

Asthma

Asthma is the most common long term condition. It is a chronic inflammatory condition of the airways, the cause of which is not completely understood. The airways are hyper-responsive and constrict easily in response to a wide range of stimuli. This may result in coughing, wheezing, chest tightness, and shortness of breath. Nationally the prevalence of asthma was 6.4% for all ages in 2020/21, and across Hampshire the prevalence is higher at 6.8%. Within Hampshire there is a small amount of variation in prevalence from higher rates in Havant (7.5%) and the New Forest (7.2% to lower rates in Hart (6.5%) and Rushmoor (5.4%).

Blood borne viruses - HIV

HIV is a virus that attacks the body’s immune system and if not treated can lead to AIDS. Although there is currently no cure for HIV, treatment can now reduce the viral load and means that people undergoing treatment and adopting a healthy lifestyle can live near normal lives. In England the national prevalence of HIV was 2.31 per 1,000 people aged 15 to 59. In Hampshire this rate was significantly lower at 1.17, although in Rushmoor the rate was more similar to the national rate (2.16).

Cardiovascular diseases

Cardiovascular disease (CVD) should be thought of as a family of diseases with have common risk factors, and includes coronary heart disease, stroke, trans ischaemic attack (TIA), heart failure and atrial fibrillation (AF). Hypertension (high blood pressure) along with atherosclerosis and high cholesterol, are a major causes of CVD and are serious, but often hidden medical conditions. In Hampshire the prevalence of CVD rose slightly to 1.3% in 2019/20, the national rate has remained stable at 1.1%. Areas with higher prevalence within Hampshire were Winchester and the New Forest (both 1.4%).

Cancer

Cancer is a disease caused by normal cells changing so that they grow in an uncontrolled way forming a tumour. If untreated, the tumour can cause problems by: spreading into normal tissues nearby, causing pressure on other body structures, spreading to other parts of the body through the lymphatic system or bloodstream. In Hampshire the prevalence of cancer has been increasing steadily since 2016/17, rising from 2.9% to 3.9% in 2020/21. This is higher than England’s prevalence, which rose from 2.6% to 3.2%. There is a large variation in cancer prevalence between Hampshire’s districts; in 2020/21 The New Forest had the highest prevalence (5.6%) and Rushmoor had the lowest prevalence (2.9%).

Chronic Obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease is a group of lung diseases (including emphysema and chronic bronchitis) that are gradual in onset and progressive. The national prevalence of COPD was 1.9% in 2020/21, in Hampshire the prevalence of COPD is slightly lower, at 1.8%, meaning that approximately 25,900 people are impacted across the area. There is variation cross the districts with the highest rates shown in the more deprived districts of Havant (2.7%), Gosport (2.5%) and the New Forest (2.3%), whilst lower rates were shown in Hart, Eastleigh and Winchester (all at 1.4%).

Diabetes

Diabetes is a common and serious life-long health condition where the amount of glucose in the blood is too high. Good diabetes management has been shown to reduce the risk of complications. But when diabetes is not well managed, it is associated with serious complications. Nationally the prevalence of diabetes in people (including type 1 and 2) was 7.1% of the population aged 17 and over in 2020/21. Prevalence in Hampshire was significantly lower at 6.8% and equates to around 78,500 people. There has been a long term increasing rate of diabetes in the England and Hampshire since 2012/13. Within Hampshire there are areas with higher prevalence including Gosport (8.9%), Havant (8.7%) and Rushmoor (8.2%). National modelling suggests that in Hampshire in 2020 there were an additional 17,000 people who had undiagnosed diabetes.

Epilepsy

Epilepsy is a common condition which affects the brain and causes recurrent seizures. The seizures are caused by sudden intense and abnormal neural activity in the brain. The national prevalence of epilepsy was 0.8% in 2020/21, however no local prevalence data is available.

Kidney disease

Chronic Kidney Disease (CKD) include conditions which damage the kidneys and reduce their ability to filter waste from the blood. As the condition gets worse waste builds up in the blood and causes symptoms such as: high blood pressure, low red blood cell count, weak bones, poor nutritional health and nerve damage. Over the long term CKD also increases the risk of cardiovascular disease. CKD, along with diabetes, is the second biggest cause of disability across Hampshire (GBD 2019). The prevalence of CKD in Hampshire in 2020/21 was 4.0%, the same rate as shown nationally. Prevalence varies between the districts with Fareham, Gosport and Havant showing the highest rates. Overall in Hampshire 45,250 people were registered with CKD.

Liver disease

Liver disease is one of the top causes of death in England and people are dying from it at younger ages and is the third biggest cause of premature death amongst the working age population. Most liver disease is preventable and much is influenced by alcohol consumption, obesity prevalence, and also the prevalence of Hepatitis B and Hepatitis C infections. Data on risk factor prevalence suggest that alcohol and obesity may be the major factors influencing outcomes. It’s estimated that 1 in 3 people who are obese or overweight have early-stage non-alcohol related fatty liver disease (NAFLD). Applying this to the population of Hampshire estimated to be overweight or obese would mean approximately 23,700 people have early-stage NAFLD.

Musculoskeletal conditions

Musculoskeletal disorders (MSD) are a group of conditions affecting joints, bones, muscles and soft tissue and is the biggest cause of disability across Hampshire (GBD 2019). Pain is the most prominent symptom in most people with musculoskeletal problems. It leads to limitation in function and can result in long-term work disability with economic consequences. It can also lead to significant health and social care expense. In Hampshire in 2021, 17.1% of people reported having a long-term musculoskeletal (MSK) problem, comparable to England (17.0%). The New Forest (19.7%), Gosport (21.1%) and Havant (20.5%) are the areas within Hampshire with the highest prevalence.

Oral Health

Oral health is an important aspect of general health and wellbeing. Good oral health is important in order to prevent dental decay, tooth loss, gum disease and mouth cancer. It also enables people to eat and enjoy a variety of foods, communicate, and socialise in the community all of which contribute to a healthier lifestyle. Poor oral health can result in pain, sleepless nights and time off school and work, and tends to be more common in deprived, compared with affluent, communities. Dental caries (tooth decay) and periodontal (gum) disease are the most common dental pathologies in the UK. Tooth decay has become less common over the past two decades but is still a significant health and social problem, widening oral health inequalities.

Oral health behaviours such as high sugar, obesity, smoking, substance misuse, alcohol consumption and poor oral hygiene increase the risk of oral disease.

National Dental Epidemiology Programme (NDEP) survey of five-year-old children showed that 14% of 5-year-olds in Hampshire had visually obvious dental decay, lower than the England average (23.4%). Adult oral health data from the latest decennial Adult Dental Health Survey (ADHS) in 2009 showed a continued improvement in adults’ dental health nationally over the past 40 years. Data reported at the former English Strategic Health Authority (SHA) level shows that the South-Central SHA, which Hampshire would be a part of, at 98% had the highest proportion of adults who were dentate, that is had at least one natural tooth, higher the England average of 94%. At 2% a much lower proportion were edentate (toothless) and used full dentures. Poorer oral health disproportionately affected those at the older end of the age spectrum and those from more deprived areas.

Access to primary dental care is key to preventing poor oral health and maintaining and improving good oral health. There was a steep decline in access to NHS dental services in 2020/21, up until which Hampshire had a stable trend since 2015/16. In 2019/20, 93.9% of Hampshire respondents were able to obtain an NHS dental appointment in the previous 2 years which was in line with the national picture. In 2020/21, this percentage was lower in Hampshire (75.3%) than England (77%) and the South East average (77.3%).

Findings from the Hampshire School Health and Wellbeing survey (November – January 2019/20) indicated that 76% of primary and 87% of secondary school pupils in Years 5, 7 and 10 said they had been to the dentist in the last 12 months.

 

Long term conditions full report
Needs assessments and reports

JSNA Cancer Report

This report aims to examine cancer incidence and mortality trends in the population across Hampshire and Isle of Wight Integrated Care Board (HIOW ICB). It focuses on the four predominant cancer types; breast, colorectal, lung and prostate. The data highlights the importance of prevention and the early diagnosis of cancer in people who live in the Hampshire and Isle of Wight area. By exploring the prevalence of risk factors, which may increase the risk of someone developing cancer, incidence and mortality trends and local variation across the ICB, it can inform which cancer types, populations and areas the ICB, and partners should focus on. Most of the data presented in this report can be explored in more detail in the JSNA Cancer PowerBI data resource. The data can be used to;

  • explore cancer risk factors by small area in the context of cancer incidence to inform preventative work
  • present incidence and mortality rates and trends across the ICB compared to England
  • better understand the person demographics of those who have died by cancer by type, age, sex, occupation, deprivation to identify inequalities in population groups and characteristics of people diagnosed with cancer
  • identify place inequalities of where people live within the population at a small geographical areas middle super output area (MSOA), by GP and Primary Care Networks (PCNs) of cancer incidence across Hampshire and Isle of Wight.
  • understand early diagnosis data and variance by cancer type

The data have been presented at the available geographies, these may be ICB or Sub ICB, PCN, GP, local authority or MSOA. Some data are presented for Portsmouth however mortality and hospital admissions do not include Portsmouth.

Oral health needs assessment 2016/17

This needs assessment presents the oral health needs of Hampshire’s residents to inform the commissioning of oral health services. The report identifies evidence based interventions and provides evidence of unmet need so that we can best target resources to improve oral health.

Health needs assessment of adults with learning disabilities in Hampshire 2017

Adults with learning disabilities are one of the most vulnerable groups in society and inequalities in care can lead to increased premature deaths and improving the lives of adults with learning disabilities has become a national priority. This health needs assessment brings together a range of intelligence on the health of people with a learning disability and the particular risk factors that they experience.

Recommendations are provided to continue improvements and direct focus to the areas of health and care that are needed most for people with learning disabilities. A useful presentation is also included.

Children with special educational needs and disability (SEND) 2016/17

These reports address the needs of Hampshire children and young people aged 0-25 years who have special educational needs or a disability (SEND):

JSNA - Children with Special Educational Needs and Disabilities Assessment

Children and Young People’s Emotional Wellbeing and Mental Health Needs Assessment 2018  

This report builds on the previous 2014 report.  It includes information on the prevalence and incidence of mental health conditions for children and young people aged 0-19 and provides an update on risk and protective factors affecting their emotional and mental health.  This document will be used to support work to meet the mental health needs of children and young people in Hampshire.

Children and Young People’s Emotional Wellbeing and Mental Health Needs Assessment 2018

Looked After Children, Statement of Need 2018

This 2018 statement of need provides information on Looked After Children in Hampshire, which was a priority theme identified in the 2017/18 Hampshire JSNA.

Statement of Need - Looked After Children 2018