7.1 Introduction

The West Midlands Public Health Observatory produces Primary Care Trust (PCT) Profiles around key indicators of demography, mortality and morbidity. The data for these can be accessed at http://www.wmpho.org.uk/links/pctpages/profilelist.asp. These profiles present contemporary data but only a static picture of health across the region. It is important to examine trend data to get a clearer picture of the variation in health experienced across the region. This chapter therefore presents trend data on a number of key PCT Profile indicators. Of the 12 indicators presented in this chapter, 5 were selected because they are 'Our Healthier Nation' (OHN) targets. The other trend data presented in this chapter are for infant mortality and live birth rates.

OHN (The White Paper, 1999) is an action plan to tackle poor health and includes targets to reduce premature death from the main killer diseases. The trend data in this chapter relate to the following targets: By the year 2010 to reduce the cancer death rate in people under 75 by at least a fifth; to reduce the coronary heart disease and stroke death rate in people under 75 by at least two fifths; and to reduce the accidents death rate by at least a fifth and serious injury by at least a tenth.

In order to highlight health inequalities across the region, this chapter presents trend data for those PCTs with DSRs which fall into the highest and lowest 10 per cent of all West Midlands PCTs in the baseline year of 1996 i.e. the top 3 and bottom 3 PCTs for that indicator in 1996. The CD-ROM enclosed with this publication contains 1996-2002 trend data for all PCTs across the West Midlands Region.

All the charts show directly standardised mortality rates (DSR) for a specific disease except for All Causes. Deaths were extracted from the ONS annual death extracts from 1996 to 2002 using the year of occurrence and standardised to the European Standard Population. PCT codes were allocated using the 'gridallFeb04 NHS Organisation Code' table supplied by the Organisation Codes Service division of the NHS Information Authority. PCT populations were derived using the UKACR (United Kingdom Association of Cancer Registries) PCO (Primary Care Organisations) Populations for the appropriate year.

From January 2001, following recommendation from the World Health Organisation (WHO), mortality data cause of death has been coded in accordance with the Tenth Revision of the International Classification of Diseases (ICD-10). This means that for trend analysis, the number of deaths coded to the equivalent ICD-9 code is multiplied by the comparability ratio supplied by ONS. This produces an 'expected' number of deaths which would have been coded to that specific cause under ICD-10. Further information on comparability ratios can be found at http://www.statistics.gov.uk/about/classifications/icd10/comparability_ratios.asp

o	Directly Standardised Rate or crude rate (males, females or all persons)
	Males (95% Confidence Interval)
	Females (95% Confidence Interval)
	All persons (95% Confidence Interval)
	West Midlands Male
	West Midlands Female
	West Midlands All persons
	England and Wales Male
	England and Wales Female
	England and Wales All persons

7.2 Premature Mortality within the West Midlands in 2002

Figure 07.02.01 Mortality for West Midlands PCTs for the under 75s by specific causes during 2002.

7.3 Mortality from All Causes Aged Under 75

	Figure 07.03.01 PCTs with DSRs that fall into the highest 10 per cent of all West Midlands PCTs (1996 baseline).
	Figure 07.03.02 PCTs with DSRs that fall into the lowest 10 percent of all West Midlands PCTs (1996 baseline).

7.4 Mortality from All Causes Aged 75 and over

	Figure 07.04.01 PCTs with DSRs that fall into the highest 10 per cent of all West Midlands PCTs (1996 baseline).
	Figure 07.04.02 PCTs with DSRs that fall into the lowest 10 per cent of all West Midlands PCTs (1996 baseline).

7.5 Mortality from Coronary Heart Disease Aged under 75

	Figure 07.05.01 PCTs with DSRs that fall into the highest 10 per cent of all West Midlands PCTs (1996 baseline).
	Figure 07.05.02 PCTs with DSRs that fall into the lowest 10 per cent of all West Midlands PCTs (1996 baseline).

7.6 Mortality from Coronary Heart Disease Aged 75 and over

	Figure 07.06.01 PCTs with DSRs that fall into the highest 10 per cent of all West Midlands PCTs (1996 baseline).
	Figure 07.06.02 PCTs with DSRs that fall into the lowest 10 per cent of all West Midlands PCTs (1996 baseline).

7.7 Mortality from All Circulatory Disease Aged Under 75

	Figure 07.07.01 PCTs with DSRs that fall into the highest 10 per cent of all West Midlands PCTs (1996 baseline).
	Figure 07.07.02 PCTs with DSRs that fall into the lowest 10 per cent of all West Midlands PCTs (1996 baseline).

7.8 Mortality from All Circulatory Disease Aged 75 and over

	Figure 07.08.01 PCTs with DSRs that fall into the highest 10 per cent of all West Midlands PCTs (1996 baseline).
	Figure 07.08.02 PCTs with DSRs that fall into the lowest 10 per cent of all West Midlands PCTs (1996 baseline).

7.9 Mortality from All Cancers Aged Under 75

	Figure 07.09.01 PCTs with DSRs that fall into the highest 10 per cent of all West Midlands PCTs (1996 baseline).
	Figure 07.09.02 PCTs with DSRs that fall into the lowest 10 per cent of all West Midlands PCTs (1996 baseline).

7.10 Mortality from All Cancers Aged 75 and over

	Figure 07.10.01 PCTs with DSRs that fall into the highest 10 per cent of all West Midlands PCTs (1996 baseline).
	Figure 07.10.02 PCTs with DSRs that fall into the lowest 10 per cent of all West Midlands PCTs (1996 baseline).

7.11 Mortality from Accidents Aged Under 15

	Figure 07.11.01 PCTs with DSRs that fall into the highest 10 per cent of all West Midlands PCTs (1996 baseline).
	Figure 07.11.02 PCTs with DSRs that fall into the lowest 10 per cent of all West Midlands PCTs (1996 baseline).

7.12 Mortality from Accidental Falls Aged 75 and over

	Figure 07.12.01 PCTs with DSRs that fall into the highest 10 per cent of all West Midlands PCTs (1996 baseline).
	Figure 07.12.02 PCTs with DSRs that fall into the lowest 10 per cent of all West Midlands PCTs (1996 baseline).

7.13. Infant Mortality

	Figure 07.13.01 PCTs with infant mortality rates that fall into the highest 10 per cent of all West Midlands PCTs (1996 baseline).
	Figure 07.13.02 PCTs with infant mortality rates that fall into the lowest 10 per cent of all West Midlands PCTs (1996 baseline).

7.14 Live birth rates

	Figure 07.14.01 PCTs with live birth rates that fall into the highest 10 per cent of all West Midlands PCTs (1996 baseline).
	Figure 07.14.02 PCTs with live birth rates that fall into the lowest 10 per cent of all West Midlands PCTs (1996 baseline).

Reference

Saving Lives: Our Healthier Nation, DoH, July 1999 crown copyright