Health Profile for Jersey 2014.

STATES OF JERSEY

HEALTH PROFILE FOR JERSEY 2014

Presented to the States on 16th April 2014 by the Minister for Health and Social Services

STATES GREFFE

2014   Price code: F  R.49

Health Profile for Jersey 2014

Data for 2010 to 2012 (or most recent) with comparisons to Guernsey, English regions and Europe

Health Intelligence Unit Public Health Directorate

Health and Social Services Department

_______________________

Published: April 2014

HIU INFORMATION READER

Acknowledgements and Contributions

The main contributors to this report are the Jersey Public Health Intelligence Unit, led by Dr Susan Turnbull, Jersey Medical Officer of Health and Jill Birbeck, Head of Health Intelligence.

Our thanks to Jenny Cataroche (Guernsey Public Health Analyst) and Dr Steven Bridgeman (Guernsey Medical Officer of Health) for working with us to agree on the comparable indicators used. Special thanks go to the Jersey Health Intelligence team for ensuring accurate and comparable statistical analysis, as well as data and reference checking, especially to Marion Walton, for starting off this piece of work and to Marguerite Clarke, for her hard work finishing it off. Thanks are also due to the Health & Social Services Department, States of Jersey Statistics Unit, Jersey Meteorological Office and Child Health Administration team for the use of their data within this report, and to Public Health managers and officers, for their input and comment.

Page

Introduction  1 Foreword by the Medical Officer of Health  2 Overall Findings  3 Key Findings by Chapter  4

Table of Contents

Main Causes of Death  27 Specific Causes of Death  30 Cancers  30 Circulatory Disease  31 Suicide  32 Preventable Deaths  33 Smoking-Related Deaths  34 Alcohol-Related Deaths  36 Premature Deaths – Years of Life Lost under 75  37 Premature Deaths – Years of Working Life Lost  39 Premature Mortality (Longer Lives)  41 Place of Death  42 Excess Winter Mortality  44

Disease Incidence and Prevalence

Cancer Incidence  46 Disability Prevalence  49 Long-standing illness, disability or infirmity  49 Future Disease Incidence and Disease Prevalence Data  50

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Introduction

Introduction

This Health Profile for Jersey provides a set of key indicators for the health status of adults and young people in Jersey in 2010 to 2012. There has been close collaboration between the Jersey and Guernsey Public Health Directorates to develop the indicators used and ensure both reports cover similar areas. It provides Channel Island comparisons, where possible, as well as comparisons with the UK and Europe where appropriate.

The report covers data for the period 2010-2012 (or the most recent year available). The indicators have been selected from health indicators used nationally and internationally focusing on population health status or modifiable lifestyles and behaviours. Together they provide a snapshot of the overall health of our population and how we compare with other areas. The indicators presented in this publication have been selected on the basis of their policy relevance, data availability and comparability with other areas.

Statistics on deaths are one of the most widely available, robust and comparable sources of information on health and as such form the bulk of this report.

The profile provides facts about how Jersey compares with other areas. It does not seek to analyse why the figures are as they are or what may need to be done about them, though these will be important questions to consider.

Within the report our local rates are compared with other areas, but where they are significantly higher or lower it is also important to take account of the actual numbers involved. We need to consider which of the indicators have the most impact on the population as a whole and warrant further investigation and focused effort to try to improve them and in turn achieve maximum population health gain.

The comparative data come from official national statistics including:

• Department of Health Public Health Outcomes Framework;
• Health & Social Care Information Centre (HSCIC), formerly the National Compendium of Health Outcome Data (NCHOD);
• Health Profiles produced for England by the Association of Public Health Observatories;
• Organisation for Economic Co-operation and Development (OECD) Health Database;
• World Health Organisation (WHO).

Jill Birbeck

Head of Health Intelligence

Public Health Directorate, Health & Social Services Department, Jersey

Foreword

Foreword from the Medical Officer of Health

I am pleased to present this, the third comprehensive Health Profile for Jersey which includes comparisons with our sister island Guernsey, as well as with England and beyond. This has been an interesting and valuable piece of collaborative work between the Islands in 2013/14, the latest of a series of joint endeavours.

The goal of public health is to improve the health status of the population. Many factors influence the health status of the population, including a number that fall outside health care systems, such as the social, economic and physical environment in which people live, and individual lifestyle and behavioural factors.

Large variations are observed between countries in life expectancy, mortality, disease incidence and other measures of population health status. Good health is consistently ranked as one of the most valued aspects in people's lives. Good health status also has instrumental value through enhancing opportunities to participate in education, training, and the labour market. Many lifestyle factors and individual behaviours affect population health status, including tobacco smoking, alcohol drinking, and being overweight or obese.

For a large number of cancers, the risk of contracting or dying with the disease increases with age, so we are likely to see an increase in both cancer incidence and deaths in the future. The better news is that modifiable risk factors such as smoking, obesity, exercising, excess sun exposure and environmental exposures are thought to explain more than 90% of all cancers. Prevention, early detection and treatment remain at the forefront of the ongoing battle to decrease the burden of cancer.

This report summarises our current knowledge of comparative health indicators and, as before, will provide the basis for further analysis and targeted action where needed. Where there is variation there is always scope for improvement.

Good Public Health Intelligence is fundamental to good Public Health. My thanks to my excellent Health Intelligence Team and our Guernsey counterparts for all the hard work that has resulted in the completion of this, our latest Jersey Health Profile

Dr Susan Turnbull

Jersey Medical Officer of Health

Public Health Directorate, Health & Social Services Department, Jersey

Overall Findings

Overall Findings

Overall, Jersey's statistics are positive in many of the comparisons. Our stillbirth and infant mortality rates have fallen over time and remain low; we have few low birth weight babies, very low teenage conception rates, high coverage for childhood immunisations, high self-reported health status, high life expectancy and decreasing numbers of deaths from heart disease.

However, we should not be complacent as within these positive population level statistics will be sub-populations who may experience poorer health outcomes. Jersey has: comparatively low breast feeding rates; 1 in 6 babies living in homes where they are at risk from passive smoking; suicide rates resulting in many valuable years of working life lost; a high level of liver disease, cancers of the lung, head and neck as well as skin cancers.

Cancers and heart disease remain the major causes of death locally as well as world-wide. The report shows that there are still premature deaths that are preventable, for example much liver and heart disease, many cancers, accidents and suicides.

Our high level of alcohol consumption is reflected in the worst premature death rates from liver disease compared with England, and a high proportion of potential working life lost (YWLL) from chronic liver disease. Smoking causes 1 in 6 of all deaths amongst those aged 35 and over, and lung cancer also accounts for a high proportion of working life lost. The impact of alcohol and smoking related ill-health on our economy is shown by the new YWLL indicator.

Many of the factors known to cause ill health, such as smoking, are decreasing while others, like obesity, are increasing. While our obesity levels are still lower than other countries, obesity continues to increase. Although we compare favourably in terms of physical exercise and eating 5-a-day' we still have a proportion of the population who do nothing active and eat very few fruit & vegetables.

As in many countries world-wide, our gains in longevity at older ages combined with the reduction in fertility rates are contributing to a steady rise in the proportion of older persons in our population. Whether longer life expectancy is accompanied by good health and functional status among the ageing population has important implications for health & social care systems.

Both Channel Islands have produced similar health outcomes for most of the indicators reported on. Differences include the fact that Jersey has a higher incidence of breast and prostate cancer, but lower teenage conception rates and higher reported levels of physical activity and healthy eating than Guernsey.

Key Findings

Key findings by chapter

Demography

Projected rise in the proportion of older people in our population contributed to by gains in

longevity at older ages combined with a reduction in population fertility rates.

Fertility

Fertility rates in Jersey are significantly lower than England.

Infant mortality has decreased from 28 per 1,000 population in 1950-1952 to 3.4 per 1,000

in 2010-2012.

Breast feeding rates are low but 1 in 3 mothers are breastfeeding exclusively at 6-8 weeks.

Self perceived health & life expectancy

Life expectancy at age 65 is 19 years for men and 21 years for women.

• 85% of the population rate their health as good or better.

Burden of Disease

The top 3 main causes of death are ischaemic heart disease, stroke and lung cancer.

Cancers are the main cause of death locally. Cancers and circulatory disease account for

>60% of all deaths.

Most working years of life lost are due to accidents, suicide, lung cancer, liver disease and

ischaemic heart disease.

Deaths from liver disease rank us among the worst compared to regions in England.

Most commonly diagnosed cancers are: breast, prostate, colorectal, lung and malignant

melanoma.

One in ten (10%) of the population have a long term illness or condition that affects their

day-to-day activity.

Mental Health

Overall population mental wellbeing in Jersey is moderate' (rather than high or low). 21% of the population reported a low mental wellbeing score.

• 20% of men and 24% of women report moderate or extreme anxiety and depression.

Key Findings

Sexual Health

Teenage pregnancy rates remain very low compared to other areas.

Termination rates are significantly lower than in England.

The Genitourinary Medicine (GUM) clinic has seen activity increase over the last few years,

with total numbers seen in 2013 being 59% higher than those seen in 2009.

Disease Prevention

Jersey has a high coverage for all childhood immunisations.

HPV vaccine uptake is higher locally than in the UK.

Breast and cervical screening coverage remain below the NHS target of 80%.

Lifestyle

1 in 6 babies born in 2012 are living in households where they are at risk from second hand

smoke exposure (passive smoking).

1 in 7 Islanders are drinking alcohol at levels that are likely to be causing them health

problems or harm now or in the future (higher risk drinkers).

Obesity levels, at 16%, are still lower than other areas but are increasing.

54% of our population are active at the recommended level of 150 minutes of moderate

activity a week.

1/3 of adults eat 5 or more portions of fruit and vegetables a day.

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1. DEMOGRAPHY

Population

The total population of Jersey at the end of 2012 was estimated to be 99,000, comprising 50,200 females and 48,800 males (Table 1.1).

The resident population estimate for Guernsey in 2012 is 63,100, whilst that of Alderney is 2,100.

Table 1.1: 2012 Jersey end of year population by age and gender

Source: States of Jersey Statistics Unit

Numbers independently rounded to the nearest 100.

The structure of the Jersey population is shown in Figure 1.1. Population pyramids provide a visual representation of how a population is distributed across different age groups. The main population bulge in Jersey is currently between 40-49 years. There are a greater proportion of females in the older age groups (65+), which reflects the increased survivorship of women over men at these ages. The Guernsey population shows a similar pattern.

Around 27% of the population are under 25 and 16% of the population are aged 65 and over. Figure 1.1: Population Structure of Jersey 2012

95+ 90-94 85-89 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4

-6000  -4000  -2000  0  2000  4000  6000 Data source: States of Jersey Statistics Unit for year-end 2012

The States of Jersey Statistics Unit estimate that the proportion aged 65 and over in our population will increase over the coming years which will increase demand on local health services. Guernsey predicts a similar increase.

Population Density

Jersey has an area of 119.5 km2 at high tide. This translates to a population density of

828 people per square kilometre in 2012 in Jersey. This is lower than that for Guernsey, and over double that of England (Figure 1.2), which was around 411 people per km[2] in 2012[3], but lower than Islands like Malta (approximately 1,300 per km2) and Bermuda (approximately 1,290 per km2)2.

Figure 1.2: Population Density (per square km)

The population density of Guernsey was 1,001 people per km2 whilst that for Alderney was around 261 per km2.

Guer Je Engl W N. Irel Scotl

Source: ONS Compendium of UK Statistics, States of Jersey Statistics Unit, Guernsey Public Health and Strategy Directorate

Dependency Ratio

The dependency ratio is a measure of the number of people in a population who are dependent (children and people of pensionable age) compared with the number of people of working age. This ratio is used to monitor the burden on the working population.

The Jersey dependency ratio for year-end 2012 was 48% meaning there are 48 dependent children and adults for every 100 of working age. Essentially for every 1 child or person of pensionable age, there are 2 people of working age.

Under a population projection scenario which maintains the current registered population, this ratio will increase to 66% in the medium term (2035). So, in future, Jersey is likely to have a higher proportion of dependent children and adults in our population (66 for every 100 of working age by 2035).

Figure 1.3: Dependency Ratio and Projected Dependency Ratio

Year-end 2012  Year-end 2020  Year-end 2035

Assuming the 2012 registered population is maintained. For other projection scenarios please see 2013 Population Projection Report. Data source: States of Jersey Statistics Unit, Population Projections 2013

2. FERTILITY

Birth Rate

Crude Birth Rate - the number of resident live births in Jersey for the calendar year per 1,000 total population.

In 2012 there were 1,124 births to resident mothers, giving a crude birth rate of 11.4 live births per 1,000 population. This is similar to the rate of 10 per 1,000 in Guernsey & Alderney, where there were around 625 to 675 births a year between 2010 to 2012, and slightly lower than the birth rate of 12.9 per 1,000 in England and Wales[2] in 2012.

Table 2.1: Jersey birth rates, 2010-2012

*Year-end population estimates

Source: Jersey Health Intelligence Unit, States of Jersey Statistics Unit

The birth rate in Jersey has remained stable, ranging  

between 10.7 and 11.7 per 1,000, over the last ten years,  

although the actual number of births has been increasing  

31

since the middle of the decade.

The average age of resident mothers (at the time of birth)

was 31 years in 2011 and 2012. The highest number of  Average age (at births over the last twenty years have been to mothers  birth) of resident

aged 30-34, with the lowest number of births to the under

20's and over 40's.  mothers in

2012

While the number of births to mothers aged 25 to 29 has decreased since 1997 there has been an increase in births to older mothers aged 35 to 39 over the same period. Since 2000, there have been more births to women aged over 40 years than to women under 20 years of age.

General Fertility Rate

General fertility rate (GFR) is defined as the number of live births for every 1,000 females of childbearing age (15-44) in the local population.

Over the period 2010 to 2012, the average general fertility rate for Jersey was 54.9 per 1,000 female population. The rate for Jersey was similar to the fertility rate in Guernsey and both were significantly lower than the England average, as well as the rate for all English regions (Table 2.2).

Table 2.2: General Fertility Rates, Channel Islands 2010-12, England, London and South West 2012

Source: Jersey Health Intelligence Unit, Guernsey Public Health and Strategy Directorate, HSCIC Indicator P00427

Total Fertility Rate

Total Fertility Rate (TFR) is defined as the average number of children that would be born to a woman who experienced the current age-specific fertility rates throughout her childbearing years (15-49 years). TFR is used as an estimate of whether a population is replacing itself or not.

In Western countries a TFR of about 2.1 is required to maintain long term population levels assuming no migration.

The average total fertility rate between 2010 and 2012 for Jersey was 1.61; this is similar to Guernsey but significantly lower than the England average and the English regions (Table 2.3). The Channel Island rates remain below the level required for population replacement (see definition box above).

Both Channel Island rates are lower than the average rate of 1.8 recorded among high and upper middle income countries globally (Table 2.4).

Table 2.3: Total Fertility Rates, Channel Islands 2010-12 and England, London and South West 2012

Source: Jersey Health Intelligence Unit, Guernsey Public Health and Strategy Directorate, HSCIC Indicator P00428

Table 2.4: WHO Global Average Total Fertility Rate, 2011

Income bracket  Mean TFR

Source: World Health Statistics

Stillbirth Rate

The stillbirth rate is defined as the number of stillbirths per 1,000 live and stillbirths. A stillbirth is the birth after the 24th week of gestation of a baby that has died in utero (in the womb, or uterus, before

delivery). Still birth (Definition) Act 1992.

The stillbirth rate for Jersey was 2.1 per 1,000 (2010-12), a decrease from 2.6 per 1,000 in 2008- 2010, and is similar to that for Guernsey for the same period. Both Channel Island rates are lower than the most recent comparison data for England, but the wide confidence intervals around the local estimates (because of low numbers) mean the differences are not statistically significant (Table 2.5).

The small number of stillbirths in Jersey & Guernsey means that these figures can be distorted by small fluctuations from year to year.

Table 2.5: Stillbirth Rates, 2010-2012

Source: Jersey Health Intelligence Unit, Guernsey Public Health and Strategy Directorate, HSCIC Indicator P00468

The stillbirth rate in Jersey has decreased over time (Figure 2.1), a similar decrease has been reported for Guernsey and England and Wales[3]. Locally, rates have decreased from around 15 per 1,000 births in the 1960's to less than 5 per 1,000 in recent years.

Figure 2.1: Stillbirth Rates, 3-year averages, 1950-2012

20 15 10 5

Still Births per 1,000 births

0

Source: Jersey Health Intelligence Unit

Infant Mortality Rate

Infant mortality rate is defined as the number of deaths under the age of one per 1,000 live births. The calculation excludes still births.

This indicator reflects the effect of economic and social conditions on the health of mothers and newborns, as well as the effectiveness of health services.

The number of children under 1 year of age that die on the Island is low, between 1 and 6 in any one year (since 2000). Infant mortality in Jersey was 3.4 per 1,000 (in the period 2010-12). This compares with 1 per 1,000 in Guernsey (Table 2.6) but is not significantly different. Both Channel Island rates are lower than the average rate for England (4.3 per 1,000) and the EU 2010 average (4.2 per 1,000[4]). The Jersey rate is not significantly different from these averages, because of the large confidence intervals which are due to our small populations and relatively low numbers of births and infant deaths.

Infant mortality rates vary greatly between countries; as seen in the latest Organisation for Economic Co-operation and Development (OECD)[5] data which reveals the range was from 1.6 in

Iceland to 47.2 in India.

Table 2.6: Infant Mortality rates, 2010-2012

95% CI  95% CI Infant Mortality

Lower limit  Upper limit rate

(LL)  (UL)

Guernsey  1.0  0.1  3.7 Jersey  3.4  1.9  6.1 South West  3.6  3.4  3.9 London  4.2  4.0  4.4 England  4.3  4.2  4.4

Source: Jersey Health Intelligence Unit, Guernsey Public Health and Strategy Directorate, HSCIC Indicator P00723

The infant mortality rate in Jersey has decreased significantly in the last 60 years (Figure 2.2) from 28 per 1,000 in 1950-1952 to 3.4 per 1,000 in 2010-2012. The OECD reports a similar fall in infant

mortality across all OECD countries[6] since the 1970's. Figure 2.2: Infant Mortality Rates, 3-year averages, 1950-2012

30 25 20 15 10

5

3 year average 0IM R per 1,000

Source: Jersey Health Intelligence Unit

Low Birth Weight[7]

Babies weighing less than 2,500g at birth are considered to have a low birth weight.

Low birth weight is used as a general health indicator for newborns because it is a key determinant of infant survival, health and development

One in fourteen (7%) live births in Jersey over the period 2010-2012 were low birth weight babies. While not directly comparable with UK data this indicates that Jersey has a similar proportion of low birth weight babies.

The low birth weight rate in Guernsey, which is comparable to figures produced for England[8], was lower than the rate in England (6% compared to 7%). In the UK the proportion of low birth weight babies ranges from 8% in the West Midlands to 6% in the South West. In the EU the average was 6.9% low birth weight babies in 2010[9], ranging from 11.7% in Cyprus to 4.2% in Sweden.

Breastfeeding Rates

Breastfeeding has a major role to play in promoting health in both the short and long term for baby and mother. It provides ideal food for the healthy growth, development and protection of infants, and is an integral part of the reproductive process with important health implications for mothers as well as babies.

The global public health recommendation is that infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health, before starting mixed feeding alongside ongoing breastfeeding, where possible.[10]

Breastfeeding Initiation

Breastfeeding initiation: proportion of babies born in Jersey recorded as being breastfed within the first 48 hours of birth

Jersey breastfeeding initiation rates are around 75% and  

are in line with the English average and Guernsey (Table  

75% 2.7). As the UK has one of the lowest rates of

breastfeeding worldwide, Jersey and Guernsey rates are

also considered low.

The proportion of births where breastfeeding was

Table 2.7: Breastfeeding initiation comparisons,  initiated within the

 2010-2012  first 48 hours

2010-2012

Source: Jersey Health Intelligence Unit, Guernsey Public Health and Strategy Directorate, Department of Health, breastfeeding statistics www.gov.uk

Prevalence of Breastfeeding at 6 to 8 weeks

Breastfeeding prevalence: the proportion of babies born in Jersey recorded as breastfed at the 6 to 8 week check.

Breastfeeding prevalence in Jersey is calculated on all births with a known breastfeeding status (93% of all births in 2012).

Around one in three (36%) mothers were exclusively breastfeeding at 6-8 weeks in 2012 in Jersey[2]. More than half (53%) were either partially or totally breastfeeding, higher than the England proportion of 49% partially or totally breastfed (Table 2.8).

Table 2.8: Infants partially or totally breastfed at 6-8 weeks, 2012 (percentage of known status)

Area  Percentage

London  71%

Jersey  53%

South West  50%

England  49%

*Jersey data is for cohort born in calendar year 2012. England data is those babies due a 6 week check in 2012 Source: Jersey Health Intelligence Unit, Department of Health, breastfeeding statistics www.gov.uk

No comparable data is available for Guernsey as breastfeeding data is collected retrospectively at the eight month check.

3. SELF-PERCEIVED HEALTH AND LIFE EXPECTANCY

Self-perceived health

Asking individuals to rate their health is considered a good indication of current and future morbidity in a population. A question is included in the annual social survey in Jersey.

In 2012, around half (52%) of respondents to the Jersey Annual Social Survey (JASS) rated their health to be excellent' or very good'. Fewer than one in twenty adults (3%) reported being in poor' general health. These proportions have remained similar since 2007[2].

Figure 3.1: Self-perceived health rating, 2012

3%

13%

12%

Excellent Very good Good

33%  39%  Fair

Poor

Source: States of Jersey Statistics Unit, Jersey Annual Social Survey 2012

The latest Eurostat[3] data on self reported health status indicates that two-thirds (68%) of Europeans rate their health as good or very good (Table 3.1).

Table 3.1: Proportion of population rating their health as good or very good in 2012

Source: Eurostat indictor hlth_silc_01 2012 data

NOTE: cannot compare to Jersey as Eurostat data is based on a 4-scale question whereas Jersey data is based on a 5-scale question

Jersey Annual Social Surveys in 2012 and 2013 included a question which asked respondents to rate their health on a scale of one to ten (ten being the best imaginable health and one being the worst). On average, adults in Jersey rated their health (on a scale of one to ten) at 7.6 in 2012[4] and 7.4 in 2013[5].

A similar question was asked in Guernsey in 2008, where respondents were asked to rate their health on a scale of 0 (representing the worst imaginable health) to 100 (best imaginable). The average (mean) score was 78. This is similar to the score (if divided by 10 to give the same scale) as that recorded for Jersey respondents.

Life Expectancy[6] at birth

Life expectancy at birth measures how long on average a baby born today would expect to live, if current death rates did not change. Similarly, life expectancy at 65 is a measure of how much longer a person of that age today could expect to live if they were to experience the current local age-specific mortality rates.  

Life expectancy at birth has continued to increase in European[7] countries, reflecting sharp reductions in mortality rates at all ages. These gains in longevity have been attributed to a number of factors including rising living standards, improved lifestyle and better education, and greater access to quality health services.

Figure 3.2: Life expectancy at birth

Life Expectancy at birth  In Jersey the life expectancy at birth for

females is around 4 years longer than for men.

Life expectancy and gender differences are similar in Jersey and Guernsey and in line with the highest English regions.

The average gender gap in life expectancy across EU countries was 5.8 years in 2010-2012[8].

In England and Wales, there is a well- documented socio-economic divide in life expectancy, with individuals living in poorer neighbourhoods or having manual/routine

Source: Jersey Health Intelligence Unit; ONS Life Expectancy at Birth and at age 65 for local areas in England and Wales, 2010-2012, Guernsey Public Health and Strategy Directorate.

Three-year rolling averages, based on deaths in calendar years and proxy mid-year population estimates

occupations having, on average, a shorter life expectancy than individuals living in more affluent neighbourhoods or with managerial/professional occupations[9]. Comparative data for Jersey is currently unavailable as our deaths data is not linked to any employment data.

Globally[10], male life expectancy in 2011 varied from 46 to 83 years (median = 70) and female life expectancy was 47 to 86 years (median = 76). Both Channel Islands have life expectancies well above the average for the European region of 77 years for men and similar to the European average of 83 years for women in 2010-2012.

Life Expectancy at 65

Life expectancy at 65 has increased among both men and women over the past decades. These gains in longevity at older age combined with the reduction in fertility rates are contributing to a steady rise in the proportion of older persons in our population, as across Europe.

Currently, women in Jersey can expect to live, on average, an additional 21 years once they have reached 65, while men can expect to live for an additional 19 years (Figure 3.3). This is the same as Guernsey and England and the EU average (2010-2012)[11] for women of 21.2 years and above the EU average for men of 17.7 years.

Figure 3.3: Life expectancy at 65 for Jersey residents 2010-2012, years

Gender gap

2.6 years

2.9 years

5. years
6. years

Source: Jersey Health Intelligence Unit; ONS Life Expectancy at Birth and at age 65 for local areas in England and Wales, 2010-2012, Guernsey Public Health and Strategy Directorate.

Three-year rolling averages, based on deaths in calendar years and proxy mid-year population estimates

The gender gap in life expectancy at 65 for both Jersey and Guernsey (Figure 3.3) are lower than that reported for the EU at 3.5 years in 2010-2012.

Changes in life Expectancy

Since 2000 there has been a small incremental increase in life expectancy for both men and women over time (Figure 3.4). This trend is in line with many other European countries.

The increase for males was larger than that seen for females causing the gender difference in life expectancy to narrow over time. The narrowing of the gender gap has also been seen in Guernsey and England and Wales, as well as in EU countries.

Figure 3.4: Change in Life Expectancy over time  2010-2012

79yea.2 rs 83yea.7 rs

2005-2007

77yea.6rs   83yea.2rs  Life Expectancy has 2000-2002 increased by 2.4

76.1  81.3  years for females years years

and 3.1 for males over the last decade.

Source: Jersey Health Intelligence Unit

Three-year rolling averages, based on deaths in calendar years and proxy mid-year population estimates

Life Expectancy comparisons

The World Health Organization[12] reported that in 2011, the average life expectancy of birth for the global population is 70, ranging from 60 in low income countries to 80 in high income countries.

The overall life expectancies of 81.6 and 82.3 in Jersey and Guernsey respectively are in line with those in high income countries, as reported in the Central Intelligence Agency (CIA) World Factbook[13].

Both Jersey and Guernsey would rank in the top 10% of countries reported by the CIA (Table 3.2). For 2013, Monaco was ranked top for life expectancy, with residents expected to live 89.63 years, whilst Chad was ranked last with a life expectancy of 49.07. Jersey appears 14th out of 223 countries, whilst Guernsey appears 7th.

Table 3.2 shows the top and bottom 3 countries ranked by the CIA, where Jersey, Guernsey and near-neighbours lie, as well as Poland and Portugal who represent the two largest migrant populations in Jersey.

Table 3.2: CIA World Factbook Life Expectancy rankings, 2013 estimates

Source: CIA World Factbook

Top  Jersey ranks in the top 10% worldwide for 10%  overall life expectancy

4. BURDEN OF DISEASE

4.A.  MORTALITY Population Mortality

In Jersey there were 386 male and 388 female deaths recorded for Jersey residents in 2012, giving a total of 774 deaths. This equates to a crude death rate of 785 per 100,000 population and an age standardised rate (ASR[2]) of 506 per 100,000 in calendar year 2012.

For the period 2010-12 the age standardised rate of 516 per 100,000 was higher than the mortality rate in Guernsey for the same period (Table 4.1).

Table 4.1: Population Mortality 2010-2012

Jersey 2010-2012  Guernsey 2010-2012 Male  Female  Persons  Male  Female  Persons

Deaths  1,146  1,156  2,302  823  878  1,701 Average Age at Death  73  80  77  75  82  79

Age-standardised rate (per 100,000)*  624  424  516  595  404  490

* Mid-year population for Jersey, End of March population Guernsey Source: Jersey Health Intelligence Unit, Guernsey Public Health and Strategy Directorate

When compared to England, Jersey mortality rates are similar to the England average and regions in the south but significantly lower than regions in the North of England (Table 4.2). Guernsey rates are significantly lower than the England average.

The average EU all cause mortality rate was reported as 663 per 100,000 in 2010, ranging from 500 per 100,000 in Spain and Italy to over 900 per 100,000 in the Baltic and central European countries.[2]

Average (mean) age at death in the period

2010-2012

Table 4.2: Ranked comparison of England, Wales and English Regions Mortality 2010-2012 ASR per 100,000  95% CI LL[2]  95% CI UL[3]

North East  598.3  593.9  602.7

North West

Yorkshire & the Humber

West Midlands

East Midlands

England & Wales

England

Jersey

London

East of England

South West

Guernsey

South East

Source: Jersey Health Intelligence Unit, Guernsey Public Health and Strategy Directorate, HSCIC Indicator P00339

The ASR for Jersey has reduced slightly in recent years, from 548 per 100,000 in 2008-2010, to 531 per 100,000 in 2009-2011 to 516 in 2010-2012.

Main Causes of Death

Causes of death are categorised and coded according to the International Statistical Classification of Diseases and Related Health Problems, a publication now in its 10th revision and commonly known as ICD-10. Comparing the number of deaths across subcategories of the ICD-10 allows the leading causes of death to be analysed.

The top three main causes of death in 2010-2012 were cancers (neoplasms), accounting for 32% of all deaths, circulatory diseases (28%) and respiratory diseases (13%). Mental and behavioural disorders (mostly dementia) made up 6% of all deaths while diseases of the digestive system resulted in 5% (see Figure 4.1). In recent years cancers have overtaken circulatory diseases as the main cause of death locally. In the EU and OECD countries mortality from circulatory diseases are still the main cause of death, accounting for 30% and 33% of all deaths respectively, followed

by cancers (28% and 26% of all deaths respectively). Figure 4.1: Main causes of death 2010-2012

Circulatory, incl  External causes - Heart, 28%  Accidents, Suicide etc, 4%

Nervous system, 4%

Digestive, 5%

Neoplasms

(cancer), 32%

Mental & Behavioural, 6%

Respiratory, 13%

All other causes, 9%

Source: Jersey Health Intelligence Unit

Guernsey shows a similar pattern to Jersey with a similar proportion of deaths from cancers and circulatory diseases, causing 30% and 31% of all deaths and respiratory diseases causing 10% of all deaths.

Deaths from cancers (neoplasms) and circulatory disease account around 60% of all annual deaths in both Channel Islands (Table 4.3) and for 64% of deaths in the EU[4] (2010).

Table 4.3: Top causes of death 2010-2012

*Age standardised using the 1976 European Standard Population

Table 4.4: Specific causes of death 2010-2012, all ages

Jersey 2010-2012

*Age standardised using the 1976 European Standard Population

Sources: Jersey Health Intelligence Unit, Guernsey Public Health and Strategy Directorate

Specific Causes of Death

Top five specific causes of death

The greatest numbers of deaths in Jersey are caused specifically by ischaemic heart disease, followed by stroke, lung cancer, bronchitis, emphysema & COPD and pneumonia (Table 4.4). These top five causes of deaths also cause the most deaths in Guernsey.

Cancers

Cancers are the main cause of death in Jersey accounting for just under a third of all deaths in 2012 (250 deaths). Cancer is not one disease; there are more than 100 different types of cancer each with different risk factors and treatment outcomes.

While lung cancer alone accounts for more than 20% of all cancer deaths (around 55 deaths a year), the most common cancer site was the digestive organs, accounting for 75 deaths (30% of all cancer deaths). In 2012, cancers of the digestive system comprised pancreatic cancer (32%), cancer of the oesophagus (21%), colorectal cancer (19%) and liver cancer (11%), with cancers of the stomach, gall bladder and other digestive organs' making up the remainder.

Table 4.5: Top 5 cancers for men and women, 2012

Male  Female

Percentage  Percentage ICD  ICD

Cancer Site  of Cancer  Cancer Site  of Cancer

Code  Code

Deaths  Deaths Digestive organs  Digestive organs

(mainly colorectal, pancreas  C15-C26  30%  (mainly colorectal, pancreas  C15-C26  31% and oesophagus)  and oesophagus)

Respiratory &  Respiratory &

Intrathoracic  C30-C39  22%  Intrathoracic  C30-C39  18% (mainly lung cancer)  (mainly lung cancer)

Urinary tract  C64-C68  10%  Breast  C50  17%

Malignant neoplasm of ill-

Male genital organs  C60-C63  7%  defined, secondary and  C76-C80  7%

unspecified sites

Lip, oral cavity and

C00-C14  6%  Female genital organs  C51-C58  6% pharynx

Source: Jersey Health Intelligence Unit

Cancer death rates are higher for men than women (in 2010-2012 the ASR for men was 222 per 100,000 compared to 140 per 100,000 for women) and this is reflected in EU data[7] (for 2010).

When individual cancers are considered; lung cancer accounted for the greatest number of cancer deaths among men in Jersey over the period 2010-2012, followed by prostate, colorectal and cancer of the oesophagus. Among women, lung cancer accounted for the most deaths in 2010- 2012, followed by breast cancer, pancreatic and ovarian cancer.

Circulatory Disease (also referred to as Cardiovascular Disease)

Circulatory diseases accounted for over a quarter (28%) of all local deaths, 213 deaths in 2012, and are the second leading cause of mortality locally. This is less than the latest reported EU average of 36% of all deaths caused by Circulatory Disease in 2010. The crude death rate for circulatory diseases was 216 deaths per 100,000 population in 2012, maintaining the level seen in 2010 and 2011 (around 220 per 100,000).

Deaths due to diseases of the circulatory system are mostly accounted for by ischaemic heart disease (also referred to as coronary heart disease or heart attack) and stroke (or cerebrovascular disease). Locally, ischaemic heart disease (IHD) accounted for 40% of all deaths from circulatory disease, 11% of all deaths of Jersey residents in 2012. Stroke accounted for 30% of all circulatory deaths, 9% of all deaths. These proportions reflect the latest EU findings: IHD is responsible for 13% of all deaths in the EU; stroke is responsible for 9% of all EU deaths; and 60% of all deaths from circulatory disease are caused by IHD or stroke.

The number of male deaths from ischaemic heart disease exceeds the number of female deaths, while a greater numbers of females than males died from a stroke.

Suicide

In 2010 to 2012, deaths from suicidein Jersey returned to more expected levels after a peak in 2008 and 2009 (Table 4.6).

The suicide rate was 10.4 per 100,000 in 2010-12 for persons aged 15 and over. This is lower than in previous years when rates ranged between 15 to 17 per 100,000, due to the influence of the particularly high suicide rate observed in 2009.

Table 4.6: Annual number of resident deaths from suicide[8] and events of undetermined intent

Source: Jersey Health Intelligence Unit, ICD-10 codes X60-X84 and Y10-Y34

Suicide rates in Guernsey were not significantly different to Jersey in 2010-2012, with a reported rate of 13.2 per 100,000 for suicide and events of undetermined intent.

Suicides rates in Jersey were not significantly different to England and Wales or the South West region of England (Table 4.7) in 2010-2012. Our current suicide rate is also lower than the latest reported EU average of 12.3 per 100,000 in 2010 where rates range from a low of 8 or less per 100,000 in southern European countries to over 17 per 100,000 in the Baltic States and Central Europe[9].

Table 4.7: Suicide ASR compared with England, London and the South West, 2010-2012, persons 15 years and over

Source: Jersey Health Intelligence Unit, HSCIC indicator P00535 for Suicide only, does not include events of undetermined intent due to availability of comparative data

However, suicide rates remain high in men. They are around 3 times higher than the female death rate; with the highest rate among young men aged 30-49. In 2010-12 there was an average of 7 male suicides annually compared with 3 female suicides. Reported suicide death rates across the EU are four to five times greater for men than women.

Figure 4.2: Male and female suicide rates for Jersey compared to England and the Southwest, aged 15 years and over.

15.9  Males  Females

14.2

12.2

5.0

4.2 3.2

Jersey  England  South West

Source: Jersey Health Intelligence Unit, HSCIC indicator P00535 for Suicide only, does not include events of undetermined intent due to availability of comparative data

Preventable Deaths

The ONS definition of Preventable deaths: a death is preventable if, in the light of understanding of the determinants of health at the time of death, all or most deaths from that cause (subject to age limits if appropriate) could be avoided by public health interventions in the broadest sense.

The quantification of preventable premature mortality is a key focus of the Department of Health Outcomes Framework (2010-2016)[10] which looks at the importance of prevention as well as treatment in reducing avoidable deaths. Preventable deaths include causes that are believed could have been avoided through individual behaviour or public health measures to limit an individual's exposure to harmful substances or conditions.

On average, around 160 deaths each year (around 20% of all deaths) in Jersey are to causes considered preventable. Our rate is not significantly different to the rate in England and Wales (Table 4.8).

Table 4.8: Preventable deaths 2010-2012

Jersey  England & Wales

Nudmbeather os f  Rate  LL  UL  Nudmbeather os f  Rate  LL  UL 2010  177  161.1  138.1  186.8  96,786  150.4  149.5  151.4

All Pdreeatventabhs le  2011  158  142.3  120.8  166.6  94,584  145.0  144.1  146.0

2012  153  135.0  114.3  158.4  -  -  -  -

Rate is ASR per 100,000 population, standardised to the 1976 European Standard Population LL & UL: lower and upper 95% confidence Intervals

Source: Jersey Health Intelligence Unit and ONS

The average rate for Jersey over the period 2010-2012 is 146.0 per 100,000 (confidence interval 133.3, 159.7). The comparative Guernsey rate for the same period being 120.1 per 100,000 (confidence interval 106.5, 135.0) is lower than Jersey, but not significantly different.

Many of these preventable deaths are smoking and alcohol related.

Smoking-related deaths

Smoking is the primary cause of preventable illness and premature death in the UK[11] and tobacco kills around half of its users[12]. In Jersey, around one in six (17%) deaths of adults aged 35 and over in 2012 are estimated to be caused by smoking[13] and is similar to the estimated 16% in Guernsey. This amounts to around 130 individuals dying annually from smoking attributable causes in Jersey.

In recent years the development of Smoking Attributable Fractions[14] (SAFs) for several diseases and causes of death has allowed a better estimate of the impact of smoking on health.

Most smoking-related deaths are from one of three types of disease: lung cancer, chronic obstructive pulmonary disease (COPD, which incorporates emphysema and chronic bronchitis) and ischaemic heart disease (CHD).

Of these, smoking caused: 37% of all respiratory deaths, around 35 deaths a year; 30% of all cancer deaths, around 70 deaths a year; 11% of all circulatory disease deaths, around 23 deaths a year. These are similar to the proportions seen for England[15] and Guernsey (Table 4.9).

Table 4.9: Estimated proportion of Smoking Related Deaths (>35 years) in each cause of death category

Sources: Jersey Health Intelligence Unit, Guernsey Public Health and Strategy Directorate, HSCIC 2013, Statistics on Smoking 2013

Smoking attributable deaths are more common in males than females (Figure 4.3) in both Jersey and Guernsey.

• 1 in 6 of all deaths of those over 35 is attributable to smoking
• 130 people die each year from smoking-related causes
• Smoking attributable deaths are more common in men

Figure 4.3: Estimated deaths attributable to smoking, as a percentage of all deaths from that disease*, by gender, 2012

Male  Female

40%

36%  

34%

22%

15%

7%  6%

0%

All Cancers  All Circulatory  All Respiratory  All Digestive

(C00-C99)  Diseases  Diseases  Diseases

*Among adults aged 35 and over Source: Jersey Health Intelligence Unit

An estimated 78% of deaths from trachea, lung and bronchus cancer were attributable to smoking; four-fifths (78%) of larynx cancers and four-fifths (82%) of bronchitis and emphysema deaths were also smoking-related. One in ten (11%) of ischaemic heart disease deaths and two-thirds (66%) of head and neck cancers deaths were attributable to smoking over the period 2010-2012.

Alcohol-related deaths

Around 2% of all deaths (around 14 a year) in Jersey are from alcohol-related causes[16], such as alcoholic liver disease and cirrhosis. These deaths account for around 300 years of life lost each year (total years of life lost under the age of 75. See page 37 for further explanation). In Guernsey there are around 6 deaths per year related to alcohol, accounting for 103 years of life lost.

Deaths caused specifically by alcohol have remained stable over the past 5 years (2008 to 2012). Over the period 2010-2012, the age-standardised death rate in Jersey was 13 per 100,000 population. The majority of these deaths were due to alcoholic liver disease, accounting for around three-quarters (77%) of all alcohol-related deaths over the period 2010-2012. Males accounted for

approximately 72% of all alcohol-related deaths; a similar proportion to that seen in the UK in 2012[17].

Figure 4.4: Alcohol-related death rates, by region, 2012

25

Male  Female 20  

15  10  

Age standardised rate per 100,000

5  0  

North  North  Yorkshire  East  West  East of  London  South  South  Jersey

East  West  and The Midlands Midlands England  East  West

Humber

Source: Jersey Health Intelligence Unit, ONS

Premature Deaths – Years of Life Lost under 75

The concept of years of life lost (YOLL) is used to estimate the potential length of time a person would have lived had they not died prematurely. It is based on the assumption that every individual could be expected to live until the age of 75 and premature death before that age may be preventable.

Years of life lost (YOLL) data can help health planners to identify areas of concern and prioritise resources to try to avert preventable early deaths. The age of 75 is most commonly used as the cut off point in premature death statistics. Causes accounting for the most YOLL do not necessarily cause the most deaths but may be causing deaths at a younger age.

In Jersey more than 250 people a year die before they reach 75, accounting for over 3,700 YOLL annually from all causes of death. Our rate of 380 YOLL per 10,000 is comparable to the England average but higher than Guernsey and the South West (Table 4.10).

Table 4.10: Years of Life Lost (all causes) 2010-2012

Jersey  Guernsey

Total  Total

YOLL  Rate per 10,000  YOLL  Rate per 10,000  E&W  South West

population (95% CI)*  population (95% CI)*

(2010-12)  (2010-12)

* Rate calculated using the 1976 European Standard Population

Source: Jersey Health Intelligence Unit, Guernsey Public Health and Strategy Directorate, HSCIC Indicator P00332

Cancers accounted for the majority of years of life lost due to deaths under 75 in Jersey followed by circulatory disease and external causes, such as suicide and accidents (Figure 4.5). Guernsey has a slightly different picture with external causes (suicide & accidents) responsible for slightly more YOLL than cancer, followed by circulatory disease.

In particular, deaths from lung, colorectal and breast were responsible for the majority of premature deaths due to cancers in both Islands.

  835 potential years of life were lost due to intentional

self-harm between 2010 and 2012

• 1,030 potential years were lost due to accidents over the same time period

For males, the predominant causes of premature death are cancers of the digestive organs (mostly colorectal and pancreatic cancers), lung cancer (cancer of respiratory organs), suicide and ischaemic heart disease. For females, premature deaths are caused mainly by lung cancer, breast cancer, liver disease and cancers of the digestive organs (mainly pancreatic cancers).

Figure 4.5: Potential Years of Life Lost, annual average 2010-2012

4,000  3,747

Male  Female  All

3,500

3,000

2,500

2,355 2,000

1,514

1,500

1,392 1,000  745

932  520

372

500  583  233

398    501  244  

0  123    103  163  

Neoplasms  Diseases of the  Diseases of the  Diseases of the  External causes  Total

circulatory  respiratory  digestive system  of morbidity and

system  system  mortality

Source: Jersey Health Intelligence Unit

Premature Deaths – Years of Working Life Lost

The concept of years of working life lost (YWLL) is used to estimate the potential length of time a person would have worked had they not died prematurely. It is based on the assumption that every individual could be expected to live and therefore work until the pension age (65). YWLL provides a measure of the impact of avoidable mortality in a population and the potential effect premature death has on the economy.

In Jersey, 46% of all Years of Life Lost were due to deaths among people of working age (16-64 years) or younger; this is similar to the proportion in Guernsey (43%).

Table 4.11: Potential Years of Working Life Lost 2010-2012

Source: Jersey Health Intelligence Unit

As for total YOLL, deaths from accidents, suicides & injuries of undetermined intent and lung cancer contributed the most to potential years of working life (YWLL) lost between 2010 and 2012 (Table 4.11).

Conditions with the highest average YWLL are those where death occurs, on average, at younger ages. Thus accidents, suicide and undetermined injury account for more years of life lost per individual death than lung cancer, although it causes more deaths, because these deaths happen in a much younger age group.

A similar picture is seen in Guernsey, with suicides & undetermined injury, accidents and chronic liver diseases including cirrhosis accounting for the greatest potential years of working life lost per death.

Premature Mortality (Longer Lives)

Public Health England published their Longer Lives Tool in 2013 which allows comparison of premature mortality rates across English regions and is designed to be a powerful enabler for change and to facilitate debate on improving health and living longer lives.

Using the same methodology, it is possible to map where Jersey is in the longer lives' rankings. A recent revision and update of the tool was published in February 2014 for premature mortality between 2010 and 2012. For more information see www.longerlives.phe.org.uk.

More than 250 people a year die in Jersey before their 75th birthday, accounting for more than a third (34%-36%) of all deaths each year. Like England, a child born in Jersey today can expect to live a longer, healthier life than ever before, yet, they still have a one in three chance of dying before they reach 75.

Figure 4.6: Premature Mortality rankings, 2010-2012

• Premature mortality was 332 per 100,000 in 2010- 2012, this was better than the English average  
• Jersey ranks 53rd out of 151 regions, behind York
• For premature deaths due to cancer, Jersey would be 91st out of 151 regions
• The ASR of 154 per 100,000 for premature cancer deaths is worse than the overall average for England
• For heart disease and stroke deaths, Jersey ranks 11th out of 151 regions, behind Somerset
• The ASR of 61 per 100,000 for these conditions is amongst the best of the English regions

• For lung disease, Jersey has a premature mortality rate of 36 per 100,000
• The rate in Jersey is worse than the England average, ranking 81st out of 150 regions
• For Liver disease* in 2010-2012 Jersey had a rate of 21 per 100,000, meaning Jersey is worse than the overall average for England
• Jersey ranks 88th, behind Ealing

*Includes deaths from liver cancer

Source: Jersey Health Intelligence Unit, Public Health England Longer Lives Tool

Place of Death

Around half of all Jersey deaths occur in hospital; this is the same in Guernsey (49%). A further one in six deaths occurs in private homes, whilst one in four occurs in nursing or residential homes.

Figure 4.7: Place of on-Island deaths 2012

Other, 1%

Residential Home, 7%

Source: Jersey Health Intelligence Unit