Respiratory Disease

This topic area covers statistics and information relating to respiratory disease including asthma and chronic obstructive pulmonary disease in Hull including local strategic need and service provision.

This page contains information from the Office for Health Improvement & Disparities’ Fingertips. Information is taken ‘live’ from the site so uses the latest available data from Fingertips and displays it on this page. As a result, some comments on this page may relate to an earlier period of time until this page is next updated (see review dates at the end of this page).

In July 2022, Clinical Commissioning Groups (CCGs) ceased to exist and were replaced by the Integrated Care System. The sub Integrated Care Board areas which include Hull are within the Humber and North Yorkshire Integrated Care Board. In Fingertips, the sub-ICB area referenced by 03F relates to Hull (see Integrated Care Board for the codes relating to the other local sub-ICB areas). For some indicators on Fingertips, the data is still being presented at CCG level (and for Humber, Coast and Vale) and has not yet been updated for sub-ICBs. However, for Hull the geographical area for the CCG and the sub-ICB area (03F) are the same so the information can still be examined and compared to understand the health needs within Hull.

The Office for National Statistics ‘back-date’ their recent estimates of the resident population once more accurate Census data becomes available. Their revised estimates were released for each local authority on the 23 November 2023. Prior to this, the Office for Health Improvement & Disparities removed their trend data which relied on resident population estimates from Fingertips (mainly affecting trends in hospital admission rates or mortality rates). Most indicators have been updated for the back-revised population estimates and the trends over time data has been added back in Fingertips, but there are a small number of indicators where this is not the case. Some of the statements on our website pages have been retained with the comments relating to the trend data when it was shown on Fingertips even though the trend data is not shown, and the actual values will change (in most cases slightly) once the calculations are redone using the new backdated population estimates.

Headlines

• The main respiratory diseases and conditions are respiratory infections, asthma, influenza and pneumonia, pneumonitis (inflammation of the lung tissue which is not a specific disease but a sign of an underlying condition), bronchitis and emphysema, and other chronic obstructive pulmonary diseases (COPD).
• Around 80% of lung cancer and COPD cases are directly attributable to smoking, and other lung conditions such as the common cold, asthma and influenza are made worse by smoking. Due to the high prevalence of current and former smoking in Hull, the rates of respiratory disease particularly COPD are very high in Hull.
• In 2023/24, 18,581 (6.3%) patients aged 6+ years registered with Hull GPs were diagnosed with asthma which was slightly lower than England (6.5%), and 9,826 (3.1%) patients were diagnosed with COPD which was much higher than England (1.9%). Practices serving the oldest patients had a statistically significantly higher prevalence of diagnosed asthma and COPD than those practices serving younger patients. Furthermore, practices serving more patients who lived in the most deprived areas of Hull had a higher prevalence of diagnosed COPD compared to practices serving patients living in less deprived areas of Hull.
• There were 5,570 emergency hospital admissions for respiratory disease in Hull during 2019/20 and this was 30% higher than England (2,063 versus 1,592 per 100,000 population). Prior to this, the rate in Hull had also been increasing at a faster rate than the increase in England thus increasing the inequalities gap. However, the number emergency hospital admissions substantially reduced in 2020/21 to 2,450 (942 per 100,000 population) due to the COVID-19 pandemic. Whilst there has been a sharp increase for both 2021/22 and 2022/23 in the admission rate in Hull, the admission rate at 1,683 admissions per 100,000 population is substantially less than it was in 2019/20 prior to the pandemic. There were 4,685 emergency hospital admissions for respiratory disease in Hull during 2022/23.
• Emergency hospital admissions for asthma among those aged 19+ years almost halved in Hull between 2019/20 and 2020/21 due to the COVID-19 pandemic. Whilst rates have increased for both 2021/22 and 2022/23, the latest rates are around one-quarter lower than they were in 2019/20. For children and young people aged under 19 years, the emergency hospital admission rate for asthma in Hull has been both considerably lower and consistently lower than England. The under 19 admission rate has also decreased over time, although with the data only presented for three-year periods and for only four periods in total so it is not possible to distinguish between long-term trends and the possible impact of the COVID-19 pandemic on admission rates. There were 115 hospital emergency admissions for asthma during the three year period 2020/21 to 2022/23 for those aged under 19 years, and 140 emergency admissions for those aged 19+ years in 2022/23.
• The rate of emergency hospital admission rate for COPD in Hull has been consistently around twice as high as England since 2015/16. The admission rate decreased sharply by 43% between 2019/20 and 2020/21 in Hull although this was similar to the 45% decrease for England. The admission rate increased for 2021/22, but remained relatively unchanged in 2022/23 in Hull. The admission rate in 2022/23 is considerably lower than the rate in 2019/20 prior to the pandemic. In Hull, at its peak in 2017/18, there were 525 admissions per 100,000 population (247 for England) and there were 458 admissions per 100,000 population during 2019/20 prior to the pandemic (247 for England). The latest rate in Hull for 2022/23 is 318 admissions per 100,000 population. During 2022/23, there were 815 emergency hospital admissions for COPD in Hull, but in 2019/20 there had been 1,125 admissions.
• There were 1,135 emergency hospital admissions for pneumonia during 2022/23. The admission rate had almost doubled between 2013/14 and 2019/20 from 332 to 625 admissions per 100,000 population with 1,515 admissions in 2019/20. However, the rate decreased sharply in 2020/21 due to the COVID-19 pandemic. Whilst the rate has increased in Hull for both 2021/22 and 2022/23, the rate at 447 admissions per 100,000 population in 2022/23 is considerably lower than it was in 2019/20 prior to the pandemic.
• In 2020, there was a higher percentage of deaths in Hull due to respiratory disease (11.4%) compared to England (10.2%) with the percentages increasing over time among those aged under 75 years. However, in 2020, the percentage of deaths due to respiratory disease reduced considerably falling from 2019 by around one-third (from 15.9% to 11.4% for all ages). With the COVID-19 pandemic during lockdowns (and in between lockdowns for the elderly and vulnerable) there was less social contact and as a result less influenza in circulation. Furthermore, people who might have been particularly susceptible to respiratory disease may have died from COVID-19 (which does not fall into the category of respiratory disease in terms of the classifications using the International Classification of Diseases) and thus the percentages who died from respiratory disease in 2020 was reduced.
• There were 321 deaths that occurred under the age of 75 years which were registered during the three year period 2020 to 2022 which were from respiratory disease (177 men and 144 women). A total of 212 of these deaths were classified as from causes considered to be preventable equating to 66% of all premature respiratory deaths (63% for men and 69% for women).
• Prior to the COVID-19 pandemic, the premature mortality rates from respiratory disease had decreased for men between 2008-10 and 2013-15, but had increased between 2013-15 and 2017-19. For women, the rates had increased consistently between 2004-06 and 2017-19. The premature mortality rate from respiratory disease from causes considered to be preventable was slightly different for men with the mortality rate in 2008-10 very similar to the mortality rate in 2017-19, although the change in the mortality rate for causes considered to be preventable was reasonable similar to the overall premature respiratory disease mortality rate for women. For both men and women, for both the premature mortality rate and the premature mortality rate from causes considered to be preventable, there was a sharp decrease between 2017-19 and 2020-22 associated with the COVID-19 pandemic, and evident specifically when examining the mortality rate from COPD. Examining the primary and secondary causes of death in more detail, it was clear that people with respiratory disease and specifically COPD were still dying between 2018-20 and 2020-22, but fewer of them died directly from respiratory with some dying from COVID-19 instead (16% of all COVID-19 deaths in 2020 and 2021 had COPD as a secondary cause). Prior to the pandemic, in 2017-19, the mortality from chronic obstructive pulmonary disease in Hull was the highest among all local authorities in England for both men and women, and substantially higher than the next highest local authority (13% higher for men and 9% higher for women) for 2017-19. Whilst mortality rates have decreased, they are still almost double those in England and among the highest in the country. In Hull, smoking is likely to be the major reason for the very high rate mortality rate from COPD and the increasing mortality rate prior to 2017-19. It is likely that the mortality rate in Hull for COPD will increase sharply for the period 2022-24 once deaths registered in 2020 and 2021 (during the pandemic) are no longer included in the three year period of time.
• The number of deaths from asthma is small with a total of 18 registered during the three year period 2017-19. The mortality rate was consistently higher in Hull compared to England between 2006-08 and 2014-16 but has been comparable to England between 2015-17 and 2017-19. There were 332 deaths to Hull residents from pneumonia which were registered during the three-year period 2017-19.

The Population Affected – Why Is It Important?

All Respiratory Disease

The main respiratory diseases and conditions are respiratory infections, asthma, influenza and pneumonia, pneumonitis (inflammation of the lung tissue which is not a specific disease but a sign of an underlying condition), bronchitis and emphysema, and other chronic obstructive pulmonary diseases.

The diagnosed prevalence of asthma and chronic obstructive pulmonary disease can be examined from data collected as part of the Quality and Outcomes Framework within primary care. Quality of care indicators are also included, and it means that high percentage of the patients diagnosed with asthma and chronic obstructive pulmonary disease have annual reviews which gives medical staff the opportunity to provide information and encourage their patients to improve their lifestyle behaviours to improve their health, and lower their risk of morbidity and mortality from their condition. Local analysis of the QOF data has been completed with prevalence calculated for each GP practice and Primary Care Network group.

The Office for Health Improvement & Disparities’ Fingertips also provides information on respiratory disease with some of the information at Clinical Commissioning Group (CCG) level and some at local authority level. Whilst there will be differences in the actual figures the pattern and trends will be very similar as the CCG and local authority geographical boundaries are the same. The only difference is the population, there are around 269,000 residents in Hull (local authority), but there are around 310,000 patients registered with Hull GPs (representing Hull’s patient population). Just over 25,000 residents of East Riding of Yorkshire local authority are registered with Hull GPs.

Asthma

Asthma is a common long-term condition that can cause coughing, wheezing, chest tightness and breathlessness. The severity of these symptoms varies from person to person. Whilst there is no cure, asthma can be controlled well in most people most of the time to lead a normal active life, although some people may have more persistent problems. Control can be achieved through the tailored use of medication (usually inhalers) and to some extent by avoiding things that the individual knows will make their symptoms worse (triggers). One potential trigger is cigarette smoke. Occasionally, asthma symptoms can get gradually or suddenly worse (“asthma attack” or “exacerbation”). Severe attacks may require hospital treatment and can be life threatening, although this is unusual. In the UK, 5.4 million people have asthma (1 in 12 adults and 1 in 11 children). The majority of asthma deaths are considered to be preventable. There are wide variations in outcomes for people living with asthma. Nationally a five-fold difference has been demonstrated between some areas in hospital admissions for adults with acute exacerbation of their asthma and as much as a six-fold difference for children.

Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease. People with COPD have difficulties breathing, and often have a persistent cough with phlegm and frequent chest infections.

Some cases of COPD are caused by fumes, dust, air pollution and genetic disorders, but these are rarer. The most common cause is smoking, and it is estimated that 78% of all COPD deaths are directly attributable to smoking.

COPD is one of the most common respiratory diseases in the UK. It usually only starts to affect people over the age of 35, although most people are not diagnosed until they are in their 50s. It is thought there are more than 3 million people living with the disease in the UK, of which only about 900,000 have been diagnosed. There are around 25,000 deaths each year in the UK from COPD. Nationally, COPD has the fourth highest disability adjusted life years and thus has a substantial impact on the quality of people’s lives.

Health benefits are immediate after quitting smoking. Within 12 hours, carbon monoxide levels in the blood drop to normal levels. Within 2-13 weeks, circulation improves and lung function increases. After 1-9 months, coughing and shortness of breath decreases, and people start to retain lung function.

The Hull Picture

All Respiratory Disease

Some information is available on respiratory disease as a whole, but information is also included below on asthma, chronic obstructive pulmonary disease and pneumonia.

Hospital Admissions

The Office for Health Improvement & Disparities’ Fingertips presents information on emergency hospital admissions for all respiratory diseases, and the rate in Hull (03F) is considerably higher than England for 2022/23 being 26% higher in Hull.

Rates are presented as the number of admissions per 100,000 population standardised to the European Standard Population (directly age standardised admission rates).

Prior to the COVID-19 pandemic, the emergency admission rates for respiratory disease have been increasing quite sharply in Hull since 2013/14 although there was a slight decrease in the admission rate between 2018/19 and 2019/20. Over this time, the rate of increase in Hull has been marginally higher than that for England, increasing the inequalities gap over time.

The emergency admission rates for respiratory disease fell sharply between 2019/20 and 2020/21 to a new low (40% lower than the lowest rate previously in 2013/14). This decrease will be associated with the COVID-19 pandemic. The decrease in Hull (-54%) was similar to the decrease for England (-55%).

Whilst there have been sharp increases for both 2021/22 and 2022/23, the latest admission rate in 2022/23 is 18% lower than it was prior to the pandemic in Hull, and similar to the admission rate for 2014/15.

There were 4,685 emergency hospital admissions for respiratory disease during 2022/23 in Hull.

Percentage Of All Deaths That Are Respiratory Disease

In 2020, the percentage of deaths where the underlying cause of death is respiratory disease were all higher in Hull compared to England and the regional average, and among the highest of the local authorities in the region.

There is year-on-year variability, but there has been a slight reduction over time in the percentage of deaths with an underlying cause of respiratory disease in Hull over all ages although the trend differs by age.

The percentage of deaths from respiratory disease has shown a slight decrease between 2009 and 2019, although there was a sharp increase in 2018 but the percentage in 2019 fell back down to a similar percentage to that in 2017.

Nationally, there was an excess of winter deaths during the winter of 2017/18 which is December 2017 to March 2018 (compared to non-winter deaths prior to 2017 and after 2018 which is August to November 2017 and April to July 2018) and this was noted to be the highest since the winters of 1975 and 1976 with one-third of these excess deaths caused by respiratory disease. There were 85% more respiratory deaths in the winter months compared to the non-winter months for 2017/18. It was speculated that this was due to the predominant strain of flu, the effectiveness of the influenza vaccine, and below-average winter temperatures. There was moderate to high levels of influenza activity with co-circulation of influenza A (H3N2) and influenza B observed, impacting predominantly older adults with increased care home outbreaks. Furthermore, even though flu vaccination uptake was higher in 2017/18 compared to 2016/17, the vaccine was less effective among the older people (27% effective among 2-17s, 12% effective among 18-64s and 10% effective among those aged 65+ years).

Of note more recently, is the fall between 2019 and 2020. Deaths with an underlying cause of respiratory deaths include all deaths within chapter J of the International Classification of Diseases whereas COVID-19 is coded within chapter U so will not be included within the definition of respiratory disease as used by this indicator. However, it is possible that COVID-19 is influential in these percentages. It is possible that the fall in the number of deaths between 2019 and 2020 could be due to COVID-19 in that some of the people that were particularly vulnerable to respiratory disease (including flu) may have died from COVID-19. Furthermore, during the lockdowns for the COVID-19 pandemic, and even in the periods when the county was not in lockdown (particularly for the elderly and vulnerable), there was less social contact. This had a considerable impact on flu as the virus was not able to circulate as much as it would normally over a usual winter period. Thus reducing the number of deaths from flu which falls into the category of respiratory disease.

In recent years, there has been around 400 deaths per year among Hull residents which has an underlying cause of respiratory disease, but this decreased to 325 for 2020 (a fall of 28%).

The percentages of respiratory disease deaths among those aged under 65 years has been increasing slightly in the last decade although overall numbers are relatively small at around 40-50 per year, and there has been substantial decrease of 30% between 2019 and 2020 again likely due to the COVID-19 pandemic.

The percentage of respiratory deaths among those aged 65-74 years is quite variable but has been steadily increasing over time in Hull, and there was also an increase in 2018 although the rate in 2019 was relatively high in relation to the overall trends between 2009 and 2019. In recent years, around 80-90 deaths have been due to respiratory disease among those aged 65-74 years.

There has been a sharp fall between 2019 and 2020 (falling by a third) likely associated with the COVID-19 pandemic.

The percentage of respiratory disease deaths among those aged 75-84 years has, in general, been decreasing in the last decade, but there was a sharp increase in the percentage of deaths with an underlying cause of respiratory disease in 2018 which was discussed above.

There have been around 120-130 deaths due to respiratory disease in this age group in recent years, but this increased to 164 in 2018. In 2020, there were 119 deaths from respiratory disease among those aged 75-84 years in Hull. This represents a fall in the percentage of deaths from respiratory disease of 16% between 2019 and 2020, but this is smaller than the decreases observed for those aged under 65 years (-30%) and 65-74 years (-33%).

The percentage of deaths due to respiratory disease among those aged 85+ years in Hull has been decreasing in Hull to 17.2% for 2019, although there was a sharp increase in the percentage to 20.6% in 2018. In recent years, there have been around 135-145 deaths among Hull residents aged 85+ years where the underlying cause was respiratory disease (although this was 180 in 2018).

There has also been a substantial fall in the number and percentage in 2020 with the percentage reducing by 35%. This is also likely to be a result of the COVID-19 pandemic.

Deaths

The directly age standardised mortality rate for respiratory disease per 100,000 population (standardised to the European Standard Population) among those aged under 75 years is 75% higher in Hull compared to England for deaths registered during the three year period 2020-22 (67% higher for men and 83% higher for women).

The premature mortality rate from respiratory disease gradually increased between 2004-06 and 2017-19. The rate decreased sharply between 2017-19 and 2020-22 due to the COVID-19 pandemic as fewer people died from an underlying cause of respiratory disease; a high mortality rate was still observed but a significant number of people with pre-existing respiratory disease specifically chronic obstructive pulmonary disease died of COVID-19 instead. Further information is given within the Causes of Death in Hull under Population, and further information specifically in relation to impact on the chronic obstructive pulmonary disease mortality rate is given below.

There were 321 premature deaths with an underlying cause of respiratory disease that were registered during the three year period 2020 to 2022.

Among men, there has been some year-on-year variability in the mortality rate over time, but for 2017-19 the rate is among the highest over the 17 year period from 2001-03 with a mortality rate of 74.0 deaths per 100,000 population in 2017-19 (only three years had slightly higher rates: 2008-10, 2009-11 and 2016-18). Since 2012-14 and 2013-15 when the mortality rate was the lowest in England and the Yorkshire and Humber respectively, the mortality rate has been increasing nationally and across the region. However, the increase in the premature mortality rate for Hull has been greater than the increase for England and across the region, and as a consequence between 2013-15 and 2017-19 the inequalities gap has been increasing.

A decrease in the premature mortality rate from respiratory disease occurred among men between 2017-19 and 2020-22 likely associated with the COVID-19 pandemic.

Among men, there were 177 deaths from respiratory disease that occurred prior to the age of 75 years among Hull residents.

For women, since 2004-06 the premature mortality rate from respiratory disease has been gradually increasing and the mortality rate in Hull for 2017-19 is the highest it has been since 2001-03. Between 2001-03 and 2017-19, the under 75 mortality rate for respiratory disease has been gradually decreasing for England and across the Yorkshire and Humber region, and with Hull’s increase over time, this means that the inequalities gap between Hull and England has increased over time. The premature mortality rate from respiratory disease among women was 115% higher in Hull compared to England for 2017-19 which represents a large increase from 2001-03 when Hull’s rate was 60% higher than England. Even 60% higher represents a substantial inequalities gap, but the rate in Hull was double the rate in England for 2017-19.

A decrease in the premature mortality rate from respiratory disease occurred among women between 2017-19 and 2020-22 likely associated with the COVID-19 pandemic.

Among women, there were 144 deaths from respiratory disease that occurred prior to the age of 75 years among Hull residents.

Fingertips also presents the directly age standardised mortality rate for respiratory disease that is considered preventable among those aged under 75 years (given as a rate per 100,000 population standardised to the European Standard Population).

The premature mortality rates for respiratory disease that is considered to be preventable in Hull is around twice that of England for deaths registered during 2020-22. The rate in Hull is eighth highest among the lower-tier local authorities in England.

Between 2001-03 and 2017-19, in Hull, the under 75 mortality rate from respiratory disease considered to be preventable has increased by 43% from 31.7 to 45.4 deaths per 100,000 population. Over the same period, there has been a fall in England and across the region between 2001-03 and around 2008-09 / 2009-11 before the rate increasing although for both England and the Yorkshire and Humber region the latest rate in 2017-19 is marginally less than the rate it was in 2001-03.

Given that the overall mortality rate for respiratory disease has been increasing in Hull, and there is an even more marked difference between Hull and England in relation to preventable respiratory mortality, it is perhaps not surprising that the mortality rate for respiratory disease considered to be preventable among under 75s has been increasing over time in Hull.

However, between 2017-19 and 2020-22, the premature mortality rate from respiratory disease from causes considered to be preventable has decreased, although as mentioned above this is likely due to increased mortality due to COVID-19 rather than a reduction in the number of people dying.

Of the 321 deaths from respiratory disease that were registered during 2020-22 in Hull among people aged under the age of 75 years, 212 (66%) of them were considered to be preventable.

The mortality rate reduced for men between 2001-03 and 2004-06, but has increased particularly between 2004-06 and 2008-09. The rate of increase levelled but has increased further between 2015-17 and 2017-19.

In contrast, the mortality rate fell for England and across the region between 2001-03 and 2012-14 / 2013-15, but has since increased slightly although for both England and the Yorkshire and Humber region, the latest rates in 2017-19 are lower than they were in 2001-03.

The mortality rate among men decreased between 2017-19 and 2020-22 likely associated with the COVID-19 pandemic.

Among men, of the 177 deaths from respiratory disease that were registered during 2020-22 in Hull among people aged under the age of 75 years, 112 (63%) of them were considered to be preventable.

For women, a similar pattern occurred for England and across the region as for men, in that the rates decreased between 2001-03 and 2012-14 / 2013-15, but has since increased slightly. However, in Hull, the pattern in the mortality rate among women was different to that observed nationally or regionally, and also differed in relation to Hull men. For women in Hull, there has been a more consistent increase over the entire period, and the greatest increase has occurred more recently between 2012-14 and 2017-19.

There was also a decrease in the mortality rate among women during 2017-19 and 2020-22 associated the with COVID-19 pandemic.

Among women, of the 144 deaths from respiratory disease that were registered during 2020-22 in Hull among people aged under the age of 75 years, 100 (69%) of them were considered to be preventable.