Local Tobacco Control Profiles The webinar will start at 1pm May 2017 update www.tobaccoprofiles.info

Webinar guidance Please mute your microphone Use the Instant Messenger function to ask questions or to comment There will be some Q&A time at the end of the webinar Local Tobacco Control Profiles – May 2017 update

Indicators updated in May 2017 SMOKING RELATED MORTALITY Smoking attributable mortality Smoking attributable deaths from heart disease Smoking attributable deaths from stroke SMOKING RELATED ILL HEALTH Smoking attributable hospital admissions Emergency admissions for COPD Premature births (<37 weeks gestation) Lung cancer registrations Oral cancer registrations UPDATED IN MARCH Low birth weight of term babies Hospital admissions for asthma (under 19 years) Local Tobacco Control Profiles – May 2017 update

Smoking related mortality With this domain we aim to look at deaths from illness that are proven to be related to smoking as smoking is considered to be the most important cause of preventable ill health and premature mortality in the UK and is responsible for 1 in 6 of all deaths in England. NB: This year there has been a change in the methodology used to calculate these indicators (highlighted). Smoking attributable fractions are used in the calculation which require smoking prevalence at local authority level for different age groups. Previously these have been estimated using regional smoking prevalence from the Integrated Household Survey due to small numbers. We now use the Annual population survey for the latest smoking prevalence estimates, which has enabled us to calculate the smoking attributable fractions for each local authority using a combined 3 year dataset. Also the Regional values are now the sum of the relevant local authorities and the England is the sum of the regional values, where previously they were calculated separately. Local Tobacco Control Profiles – May 2017 update

Smoking attributable mortality Starting with all smoking attributable mortality, which includes deaths from various cancers, cardiovascular and respiratory diseases, and diseases of the digestive system. Here you can see in the trend that there has been significant improvement since the period 2007-09. The increase in the latest data point could be a factor of the new methodology, as the increase is seen across the majority of areas. Local Tobacco Control Profiles – May 2017 update

Smoking attributable mortality Mapping the data for England, with the red areas being significantly worse than the England rate, green significantly better and yellow similar to England, you can see there are quite clear differences between the north and the south of the country. Local Tobacco Control Profiles – May 2017 update

Smoking attributable mortality Investigating this further by looking at the values by region shows that the differences are highly significant, and if we look at the smoking prevalence rates against these there is a similar trend with the highest and lowest regions being the same. Smoking prevalence 18.7% 18.6% 18.6% 18.0% 15.7% 16.3% 16.6% 15.9% 15.5% Local Tobacco Control Profiles – May 2017 update

Smoking attributable deaths In the profiles we also look at smoking attributable deaths from heart disease and stroke, as these are the two illnesses with the highest smoking attributable deaths. This chart shows the trend in both indicators, which is levelling off. Local Tobacco Control Profiles – May 2017 update

Smoking attributable deaths by deprivation Interestingly, there is also a clear deprivation gradient for both of these, with the most deprived having around twice as many smoking attributable deaths as the least deprived group. For those of you who don’t know can be found in the inequalities tab. Local Tobacco Control Profiles – May 2017 update

Smoking related ill health Moving on to the smoking attributable ill health domain, again here are the latest England values now showing on the tool. We know that smoking is a modifiable risk factor and our aim with this domain is to highlight the health issues that can be related to smoking, comparing data for local authorities to assess geographical variation and also comparing inequalities where possible in order to see whether there is a need for targeted interventions. Again I have highlighted the updated indicators from today. Local Tobacco Control Profiles – May 2017 update

Premature births Over the past year or so we have added some new indicators related to health issues caused by smoking and premature births is one of these as there is substantial evidence that smoking during pregnancy and exposure to second-hand-smoke can lead to premature birth. Looking at the data you can see there has been an increase in the last few years, which may look like small year-on-year increases but are actually significant which you can see from the confidence intervals here. This is perhaps surprising given the reduction in smoking prevalence and smoking in pregnancy in recent years. Local Tobacco Control Profiles – May 2017 update

Smoking attributable hospital admissions The Smoking attributable hospital admissions indicator aims to highlight the size of preventable smoking-related conditions on inpatient hospital services. Admissions to hospital due to smoking related conditions represent a large demand on NHS resources, accounting for around 5.5% of the total NHS budget. The data shows an increase in the last few time points, and although the latest of these may also be a factor of the change in methodology we discussed earlier, as smoking attributable fractions are also used to calculate this indicator, there is some cause for concern as smoking related ill health can continue after quitting and therefore smoking related hospital admissions may not follow the current downward trend of smoking prevalence. Local Tobacco Control Profiles – May 2017 update

Smoking attributable hospital admissions by deprivation Again there is a clear deprivation gradient seen here, with the most deprived having almost twice as many smoking attributable hospital admissions as the least deprived, which we should perhaps expect given that the most deprived have smoking prevalence 6% higher than the least deprived (20.4%, 14.3%). Local Tobacco Control Profiles – May 2017 update

Inequalities breakdown by sex Chronic Obstructive Pulmonary Disease (or COPD) is the umbrella term for serious lung conditions that include chronic bronchitis and emphysema and smoking is considered it’s biggest preventable risk factor. COPD is a condition that can be effectively managed in a primary care setting, if diagnosed early, and therefore by looking at emergency admissions areas with lower rates of diagnosis and/or poor management of this condition can be identified. In addition to a new time point being added the Emergency hospital admissions for COPD, we have also had inequalities breakdowns added showing the differences between men and women, with men having significantly higher admissions than women. Local Tobacco Control Profiles – May 2017 update

Inequalities breakdown by sex hospital admissions for asthma in young people aged 18 and under had a sex breakdown added showing males with significantly higher admissions than females. This indicator was recently added from the ChiMat tool as there is evidence that tobacco smoke is a strong risk factor for developing asthma and exposure to second hand smoke can be particularly harmful to the lungs of asthma sufferers. Local Tobacco Control Profiles – May 2017 update

Cancer registrations Data for lung and oral cancer registrations was updated for the period 2013-15. The link between smoking and lung and oral cancers has long been established with 80% of lung cancer hospital admissions and 65% of those for oral cancer directly related to smoking. As with the smoking attributable hospital admissions, a smokers risk of developing one of these cancers is still prevalent even after quitting, and therefore it is important to monitor trends in registrations, which you can see have remained stable in recent years. Local Tobacco Control Profiles – May 2017 update

Cancer registrations (2013-15) Lung cancer registrations Oral cancer registrations Mapping the rates again with the same RAG coding, firstly for lung cancer, you can see clear differences between cancer rates in the north of England and the south, although there are some red areas throughout the country particularly a few in London. Oral cancer registrations do also show a distinct north/south difference, but with relatively small numbers of registrations providing large confidence intervals there are only 28 local authorities with worse and 19 better. Local Tobacco Control Profiles – May 2017 update

Questions? Local Tobacco Control Profiles – May 2017 update

Feedback on the webinar Do a poll evaluation here tobacco.profiles@phe.gov.uk Local Tobacco Control Profiles – May 2017 update