Long-term Monitoring of Health Inequalities - Headline Indicators - October 2010

Annex 2: Indicator Definitions & Sources

• Healthy Life Expectancy

Source: Scot PHO (using raw deaths data from the General Register Office for Scotland; Scottish Household Survey data on self-assessed health for adults aged 16+ years [data for 2003/04 not available]; Census 2001 data for self-assessed health for those aged <16 years).
Definition: Healthy life expectancy ( HLE) is defined as the number of years people can expect to live in good health. The discrepancy between healthy and total life expectancy ( LE), therefore, indicates the length of time people can expect to spend in poor health. HLE is calculated through a combination of life expectancy and survey data on people's own assessments of their health. The method used to calculated the Life Expectancy estimates is based on Chiang ( II) methodology; the HLE calculation is based on the Sullivan method. The uncertainty around estimates of HLE are larger than those around life expectancy because relatively small samples are involved in the age and sex specific breakdowns of survey data required to calculate HLE (for example: In the calculations to produce these estimates of HLE, there were 900 age/sex/decile breakdowns for self-assessed health data from the Scottish Household Survey; 53% of which had fewer than 100 respondents and 13% of which had fewer than 50 respondents).

• Premature Mortality (from all causes, aged under 75 years)

Source: General Register Office for Scotland.
Definition: European age-standardised rates of deaths from any cause amongst those aged under 75 years.

• Mental Wellbeing (adults aged 16 years and over)

Source: Scottish Health Survey.
Definition: Warwick-Edinburgh Mental Wellbeing Scale ( WEMWBS). This has been developed as a tool for measuring positive mental wellbeing at a population level. The scale comprises fourteen separate statements describing feelings related to mental wellbeing; respondents are asked to indicate how often they have felt such feelings over the last two weeks. Results are presented as average WEMWBS score for the population concerned. The minimum possible score is 14 and the maximum 70.

• Low birthweight

Source: NHS Information Services Division ( ISD) ; SMR02 maternity dataset.
Definition: The figures are presented as a percentage of all live, singleton births (not including home births or births in non- NHS hospitals). Figures are for financial year (i.e. '2005' is for '2004/05'). Low birth birthweight is defined as < 2,500g - the standard World Health Organisation definition.

• Coronary Heart Disease - first ever hospital admission for heart attack aged under 75 years

Source: NHS Information Services Division ( ISD) ; SMR1/01 records (all inpatient and daycase discharges) - all records were extracted from the SMR01 linked database.
Definition: European age-standardised rates of first ever hospital admission for acute myocardial infarction (heart attack) amongst those aged under 75 years. The following World Health Organisation International Classification of Disease coding was used: ICD10 'I21-I22'; ICD9 '410'.

• Coronary Heart Disease - deaths aged 45-74 years

Source: NHS Information Services Division ( ISD); using deaths data from General Register Office for Scotland.
Definition: European age-standardised rates death from coronary heart disease amongst those aged 45-74 years. The following World Health Organisation International Classification of Disease coding was used: ICD10 'I20-I25'; ICD9 '410-414'.

• Cancer - incidence rate aged under 75 years

Source: NHS Information Services Division ( ISD); Scottish Cancer Registry.
Definition: European age-standardised rates of new cases of cancer amongst those aged under 75 years. Cancer defined as all malignant neoplasms excluding non-melanoma skin cancer. The following World Health Organisation International Classification of Disease coding was used: ICD10 'C00-C96' excluding 'C44' (the Scottish Cancer Registry does not use code 'C97').

• Cancer - deaths aged 45-74 years

Source: NHS Information Services Division ( ISD); Scottish Cancer Registry.
Definition: European age-standardised rates of deaths from cancer amongst those aged under 45-74 years. Cancer defined as all malignant neoplasms excluding non-melanoma skin cancer. The following World Health Organisation International Classification of Disease coding was used: ICD10 (2000 onwards) 'C00-C97' excluding 'C44'.

• Alcohol - first ever hospital admission aged under 75 years

Source: NHS Information Services Division ( ISD).
Definition: European age-standardised rates of first ever hospital admission for alcohol related conditions amongst those aged under 75 years. These rates include hospitals discharges where alcohol-related problems are recorded as either primary or secondary reasons for admission to hospital and will cover first ever admission since 1981 (a patient may have had admissions prior to 1981 which would not be recorded in this database). Caution is necessary when interpreting these figures. The recording of alcohol misuse may vary from hospital to hospital. Where alcohol misuse is suspected but unconfirmed it may not be recorded by the hospital. The following revised World Health Organisation International Classification of Disease coding was used: ICD10: F10, K70, X45, X65, Y15, Y90, Y91, E244, E512, G312, G621, G721, I426, K292, K860, O354, P043, Q860, T510, T511, T519, Y573, R780, Z502, Z714, Z721. ICD9: V57, 2550, 2651, 2910, 2911, 2912, 2913, 2915, 2918, 2919, 3039, 3050, 3483, 3575, 3594, 4255, 5353, 5709, 5710, 5711, 5712, 5713, 5771, 6554, E8600, E8601, E8609, E9473, E9509, D3039 & A3317, D3039 & A3344. See: http://www.alcoholinformation.isdscotland.org/alcohol_misuse/3986.html

• Alcohol - deaths aged 45-74 years

Source: General Register Office for Scotland.
Definition: European age-standardised rates of death from alcohol related conditions amongst those aged 45-74 years. The definition of alcohol related deaths includes deaths where there was any mention of alcohol related conditions on the death certificate, rather than just as the main cause of death. The following World Health Organisation International Classification of Disease coding was used: ICD10 F10, G31.2, G62.1, I42.6, K29.2, K70, K73, K74.0, K74.1, K74.2, K74.6, K86.0, X45, X65, Y15; ICD9 291, 303, 305.0, 425.5, 571.0, 571.1, 571.2, 571.3, 571.4, 571.5, 571.8, 571.9, E860.

• All-cause mortality aged 15-44 years

Source: General Register Office for Scotland.
Definition: European age-standardised rates of deaths from any cause amongst those aged 15-44 years. Specific breakdowns for deaths from assault, drug related deaths and suicide are also provided, as the major causes of death for which there are large inequalities amongst young people. There may be some double counting in these breakdowns. The following World Health Organisation International Classification of Disease coding was used: Assault ICD10 'X85-Y09', 'Y87.1' ICD9 'E960-969'; Drug related ICD10 'F11-16', 'F19', 'X40-44', 'X60-64', 'X85', 'Y10-Y14'; Suicide (intentional self harm + undetermined intent) ICD10 'X60-84', 'Y87.0' ICD9 'E950-959', 'E980-989'.