Sources of Health and Demographic Information Flashcards
Define demography
The study of the size, structure, dispersement and development of human populations
What is the population census?
What type of information does it provide?
The simultaneous recording of data by the government at a particular time, pertaining to all persons living in a particular territory.
Data:
- Describes both households and people
- Cultural characteristics- ethnicity/religion
- Demographic data- age, sex
- Material deprivation - homeownership, overcrowding, car access, lone parents, lone pensioners
- Health- general, long term illness, unpaid care
- Workplace and journey to work
- Date goes to office of national statistics
What is the framework for assessing quality of health information?
CARTA:
- Completeness
- Accuracy
- Representativeness/ relevance
- Timeliness
- Accessibility
How can the CARTA assessment framework be used to assess the census?
Strengths Weaknesses
- *C** 98% complete Low enumeration of some groups
- *A** Coverage and quality Self reported surveys
- *R** Data available for different Low enumeration of levels some groups
- *T** 10 years, takes time for release
- *A** www.ons.com/census Individual returns, confidential for 100 years
What is the census used for in the context of health?
Calculate service needs based on population size and structure (age, ethnic minorities e.t.c)
Calculate incidence rates from base population
Identify and target inequalities by measuring material deprivation
How is fertility measured?
- Live births per 1000 of the population (inaccurate: includes men)
- General fertility rate: live births/1000 women of child bearing age (15-44 years)
- Total fertility rate: number of live babies that would be born to a woman if she were to live to the end of childbearing age and bear children in accordance with current age-specific fertility rates.
What is the total fertility rate affected by?
Delay in childbearing until older ages
Lower completed family size
Population structure (ageing population)
What are birth rates used for?
To determine the requirement for maternity services
How are mortality statistics collected?
By the office of national statistics
Coded using ICD-10
How are deaths registered?
2 ways:
- Medical doctor issues death certificate
- Family registers death with local registrar for births, marriages and deaths
- Coroner reports death, information given straight to registrar for births, marriages and deaths
What 3 pieces of information must be given on death certificate regarding cause of death?
a) Disease or condition leading directly to death
b) Any other disease or condition (if any) leading to:
- Intermediate cause of death
- Underlying cause of death
Define underlying cause of death
How is this information used?
a) The disease or injury which initiated the train of morbid events leading directly to death OR
b) The circumstances of the accident or violence which produced the fatal injury
Used by mortality statistics: prevention of underlying cause will result in the greatest population health gain
For a patient with a primary squamous cell carcinoma of the lungs who died from intercerebral haemorrhage caused by metastases from the primary:
Place this information into the correct headings on a death certificate:
Disease or condition leading directly to death:
- Intracerebral haemorrhage
Other disease or condition (if any) leading to intermediate cause of death:
- Cerebral metastases
Other disease or condition (if any) leading to underlying cause of death:
- Squamous cell carcinoma of the lung
What are the strengths and weaknesses of mortality statistics?
Strengths:
- Complete coverage in the UK (for births as well)
- Important information on the health of the population
Weaknesses:
- Accuracy: underlying cause of death subject to diagnostic uncertainty, coding issues and variable quality
- Ethnicity information not collected
- Derivation of socio-economic status (completed by relative- may not be reliable)- posthumous inflation of status by relatives.
What are population estimates?
What are their strengths and weaknesses?
Estimations of population size and structure between censuses. Used for planning services/resource allocation
Applies information from births, deaths and marriages to present:
- Census baseline + births - deaths + migration
Strengths:
- More up to date than census
- More accurate than projections
Weaknesses:
- Less reliable with time from census
- Poor information on migration
- Says nothing about the future
What are population projections?
What are they used for?
What are their strengths and weaknesses?
Used for forecasting future population size and structure based on assumptions about:
- Mortality
- Fertility
- Migration
Strengths: can be used for longer term planning
Weaknesses:
- Less accurate the further ahead
- Unforseen changes of past trends can invalidate projections
How are births registered?
Information given to the local registrar for births, deaths and marriages by both the:
- Birth attendant to (usually midwife) within 36 hours of the birth.
- Parent(s) within 42 days of the birth
Information is passed from the local registrar for births, deaths and marriages to the office for national statistics
How is morbidity data gathered?
Cancer registration system
NHS data
Notifications of infectious diseases
What is the cancer registration system?
How is data recorded?
What is it used for?
What are its strengths and weaknesses?
National Cancer Registration and Analysis Service (NCRAS): Public Health England
Cancer diagnosis triggers registration and sends core dataset:
- Diagnosis
- Personal details
- Treatment
- Outcomes
Used for:
- Monitoring cancer rates
- Evaluation and improvement of cancer treatment
- Evaluation of screening programmes
- Aiding cancer research
Strengths:
- Detailed information updated over time
- Record linkage to cancer deaths
Weaknesses:
- Expensive
- Access difficult due to confidentiality
What are Hospital Episode Statistics?
What type of information is gathered?
What is it used for?
What are the strengths and weaknesses?
Hospital Episodes Statistics:
- Records all hospital admissions, outpatient visits and A&E visits in England.
- Gathers information on:
- Personal details (age, gender etc)
- Clinical information (diagnoses and treatments)
- Admin data (date of admission and discharge)
- Geographical data (where the pt lives, where treated)
Used by commissioning organisations, researchers and provider organisations for:
- Monitoring trends in hospital activity
- Supports local service planning
- Monitors health trends over time
- To provide fair access to healthcare
Strengths:
- Completeness: covers all hospital activity
- Accuracy: standard codes used
- Representative: routine national data
Weaknesses:
- Accessibility: to individual data is poor
What are Data Coding Systems?
ICD-10:
- Describes conditions treated or investigated
- Used by HES and mortality statistics
- E.g. diabetes mellitus (E10-E14)
OPCS-4:
- Records details of operations
What is the Quality and Outcomes Framework? (QOF)
What are the strengths and weaknesses?
Rewards GPs for improved patient care
Strengths Weaknesses
C Almost 100% GP response Excludes non- participating practices
A May be inaccurate /incomplete recording
R Representative of all pop. Data aggregated for practice, not age, sex
T Updated annually, timely
A Online Aggregated data only
How are infectious diseaeses notified?
What is the information used for?
- Doctor suspects notifiable disease→ notifies local health protection team
- Laboratories –> PHE
Both LHPT and PHE info then collated by PHE and produces national trends each week.
Used for:
- Preventing further infection
- Identifying outbreaks
- Monitoring trends
What are the strengths and weaknesses of notifications of infectious diseases?
Strengths:
- Timeliness: weekly report by Public Health England
- Representative: routine national data
- Linked to other data to improve accuracy
Weaknesses:
- Completeness: poor/variable for some diseases (not all cases of food poisoning notified, many treated at home)
- Accuracy: questionable due to diagnostic uncertainty. Often ‘suspected’ cases.
