Invisible Lives Key Findings: A Summary

1. The starting point for this project was epidemiological evidence suggesting that there are an estimated 3.7 million people in the UK with a progressive lung disease called Chronic Obstructive Pulmonary Disease (COPD). With only 900,000 people currently diagnosed and receiving treatment and care, the remaining estimated 2.8 million people are unaware they have a disease which, if left untreated, could severely restrict their lives and eventually kill them.

2. COPD is a general term that is used to describe a number of conditions, including chronic bronchitis and emphysema. COPD is an incurable, but largely preventable disease, which leads to damaged airways in the lungs, causing them to become narrower and making it harder for air to get in and out. With early diagnosis and the right care, the progression of the disease can be slowed down allowing people to live healthy and active lives for longer.

3. The most important risk factor for COPD is smoking, followed by other aspects of social deprivation, diet and occupational exposure to dust, indoor pollution such as smoke from wood and coal fires, and, in a small number of cases, inherited faulty genes. Recent research also indicates that poor airway function after birth should be recognised as a risk factor for COPD.

4. COPD is a widespread but largely invisible disease. Most people in the UK have not heard of the disease or its symptoms; it has been neglected by health care services, with misdiagnosis a common theme; and those affected become isolated by the physical and emotional side effects of the disease as its severity increases. Most will eventually find themselves unable to work, will struggle to do everyday activities, and, without proper treatment and care, will be rushed into hospital fighting for breath time and time again – a terrifying event. Because of this, and because of the stigma attached to having a smoking-related lung disease, people with COPD feel invisible and seldom have the energy or the confidence to challenge those in authority or to campaign for improvements in care.

5. Despite its invisibility, COPD is the UK’s fifth biggest killer disease, claiming more lives than breast, bowel or prostate cancer; it is the second most common cause of emergency admission to hospital and one of the most costly inpatient conditions treated by the NHS; it is estimated that the direct cost of providing care in the NHS for people with COPD is almost £500 million a year – more than half of which relates to hospital care. The estimated annual cost of treating people with mild COPD is £149; it is £1,307 for a person with severe COPD.

6. At present, most people are diagnosed with COPD when the disease has reached a late stage. If people with COPD can be reached whilst the disease is still in its early stages, its progression can be slowed with appropriate management and care.

7. As the NHS begins to tackle how it organises COPD services through a new National Service Framework due in 2009 in England, the establishment of clinical standards in Scotland and similar strategies tackling respiratory disease in the other UK nations, one of its biggest challenges is to identify and reach the estimated 2.8 million people with undiagnosed COPD. The British Lung Foundation (BLF) approached Dr Foster Intelligence to help identify where the ‘missing millions’ at risk of future hospital admission with COPD are living and how best to target them, including the best communication channels to reach and engage this audience.

8. To identify those at risk, Dr Foster Intelligence used various data sources including hospital admissions data and COPD GP surgery registrations data from the Department of Health, Experian’s Mosaic™ lifestyle segmentation and TGI (Target Group Index) Analysis. Mosaic™ lifestyle segmentation is a population classification tool which breaks the population of Great Britain into 61 ‘lifestyle types’ based on more than 400 data variables. By overlaying this information on the postcodes of people admitted to hospital with COPD, it was possible to predict which Mosaic™ lifestyle types are most at risk of future hospital admission with COPD.

9. Using this data it was possible to identify which areas of the UK (defined by 192 Primary Care Organisation (PCO) boundaries) contain populations which have the highest proportion of predicted COPD hospital admissions. It was then possible to identify which areas of the UK face the greatest overall challenge from COPD taking into account the proportion of predicted COPD hospital admissions and the population size compared to the rest of the UK.

10. In Scotland these COPD ’hotspots’ include Greater Glasgow and Lanarkshire. In England they include ex-industrial and inner city areas in the North East, North West and Yorkshire and Humberside; pockets of deprivation in otherwise affluent areas such as Barking & Dagenham in London; and areas with disproportionately high populations of older people including the South Coast of England and East Anglia. In Wales they include Blaenau Gwent and ex-mining towns along the Welsh valleys. In Northern Ireland they include Belfast and Londonderry. Many of these areas have high and enduring levels of deprivation and associated unemployment.

11. The tables below (see report for full list) show the relative risk of COPD admissions according to Primary Care Organisation (PCO) compared to the UK average. South Tyneside tops the list with a huge 62% higher risk of future hospital admission with COPD. In descending order, Hull, Barking & Dagenham, Blaenau Gwent, Knowsley, Gateshead, Greater Glasgow & Clyde and Sunderland also have high relative risk of between 55% and 51%.

12. They also show Z-scores that indicate the PCO areas facing the greatest challenge from COPD, based on the proportion of people at risk of future hospital admission with COPD and population size.

13. In Scotland, Greater Glasgow & Clyde and Lanarkshire face the greatest and second greatest challenges from COPD of all PCOs in the UK.

14. In the North of England, Liverpool faces the 3rd greatest challenge in the UK, followed by Hull (4th), Sunderland (5th) Manchester (6th), County Durham (7th), South Tyneside (9th), Gateshead (10th), Sheffield (14th), Knowsley (15th), Wakefield (16th), Salford (17th) and Barnsley (20th).

15. In the Midlands, Sandwell faces the 8th greatest challenge in the UK, followed by Nottingham (13th).

16. In the South of England, Barking & Dagenham in London faces the 12th greatest challenge from COPD in the UK. Six of the twenty PCOs facing the least challenge from COPD are in the South West of England; seven are in the South Central and South East Coast areas.

17. In Wales, the ex-mining area of Blaenau Gwent faces the greatest challenge from COPD. In Northern Ireland, Belfast faces the greatest challenge from the disease.

18. Those at risk of future hospital admission with COPD live mostly in social housing and have, or have had, industrial or semi-skilled jobs, uncertain employment, low levels of disposable income and considerable health problems.

19. From the above analysis the BLF selected a list of COPD ‘hotspot’ areas by PCO including the top ten ‘hotspot’ PCOs in the UK and the top ‘hotspot’ PCOs in each nation and English Strategic Health Authority. Dr Foster Intelligence then identified specific communities most at risk of future hospital admission with COPD within these PCOs. Postcode areas associated with the top four ‘lifestyle’ types at risk of hospital admission with COPD within each PCO area were selected. By extenuation, these are the areas likely to face the greatest challenge from COPD, both undiagnosed and established.

20. The total population of the COPD ‘hotspot’ PCOs selected by the BLF is 6.5 million people. Within these ‘hotspots’, 1.9 million people live in postcode areas at high risk of future hospital admission with COPD. It is important to note that not every individual living in these postal areas is at risk, and that other lifestyle types within each PCO area may also be at risk. This is a way of focusing effort on areas at greatest risk in terms of targeted health campaigns. The top 10 ‘hotspot’ PCOs and their target population size are included in Table 1 below, with the target population expressed as a percentage of the total population of the PCO area.

Tables

Top ten COPD hotspots in the UK

PCOs across the UK with the highest proportion of people at risk of future hospital admission with COPD.† © Experian Ltd

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