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 are due to be released in November 2023. In the meantime, the Office for Health Improvement & Disparities have removed their trend data which relied on resident population estimates from Fingertips (mainly affecting trends in mortality rates), and it will be added back in sometime after November 2023 (no date has been given). 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.

Two GP practices in Hull are due to merge on the 4 December 2023, so local analysis of the disease prevalence information (from the Quality Outcomes Framework) which is presented on this page will be delayed until December so the prevalence of these two practices can be combined.

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.
• In 2021/22, 18,603 (6.5%) patients aged 6+ years registered with Hull GPs were diagnosed with asthma which was similar to England (6.5%), and in 2021/22, 9,182 (3.0%) patients were diagnosed with COPD which was higher than England (1.9%). Practices serving the oldest patients and the patients living in the most deprived areas of Hull had a statistically significantly higher prevalence of diagnosed COPD than those with younger patients and patients living in the least 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). 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. Emergency hospital admissions for asthma were lower in Hull compared to England for both those aged under 19 years and those aged 19+ years particularly so for children and young people. However, in Hull compared to England during 2019/20, emergency hospital admissions were twice as high as England for COPD and 28% higher for pneumonia. Emergency hospital admission rates also fell sharply in 2020/21 for both COPD and pneumonia, but remained substantially higher than England.
• In 2019, there are a higher percentage of deaths due to respiratory disease in Hull (15.9%) compared to England (13.6%) 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 by around one-third (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.
• Mortality rates from respiratory disease occurring under the age of 75 years for 2017-19 are twice as high in Hull compared to England, and the rates have been increasing in Hull over the last 12 years in contrast to an overall reduction in England (slight recent increase). The differences in even starker for premature mortality from respiratory disease considered to be preventable with rates 124% higher in Hull compared to England among those aged under 75 years. Furthermore, for 2001-03 approximately half of premature deaths from respiratory disease were considered to be preventable, but in 2017-19 around two-thirds of premature deaths were considered to be preventable (59% for men and 74% for women). One major reason for the difference in Hull is the very high and increasing mortality rate for COPD.
• Over the three year period 2017-19, there were 408 deaths from respiratory disease which occurred in Hull among people aged under the age of 75 years, and 261 (64%) of them were considered to be preventable. People in Hull admitted to hospital as an emergency for COPD were 30% more likely to die within 30 days of that admissions compared to people admitted as an emergency in England.
• For all ages, there were 666 deaths from COPD in the three year period 2017-19 (327 men and 339 women), and 351 deaths from pneumonia for patients registered with Hull GPs. Between 2001-03 and 2017-19, rates have increased in Hull by 32% for men (compared to decreases of 25% for England) and by 58% for women (compared to increases of 3% for England). There were a further 655 deaths among patients registered with Hull GPs who did not die of COPD but who had COPD noted as a contributory factor in relation to their death (and rates have increased by 81% between 2006-08 and 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 260,000 residents in Hull (local authority), but there are around 300,000 patients registered with Hull GPs (representing Hull’s CCG). Around 40,000 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

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 2020/21 being one-third higher in Hull. The emergency admission rate was twice as high though in 2019/20 with far fewer admissions in 2020/21 due to the COVID-19 pandemic.

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

The emergency admission rates for respiratory disease have been increasing in Hull since 2013/14 although there was a slight decrease in the admission rate between 2018/19 and 2019/20. 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%).

Percentage Of All Deaths That Are Respiratory Disease

In 2019, the percentage of deaths where the underlying cause of death is respiratory disease were all higher in Hull compared to England and Humber, Coast and Vale regardless of age (excluding North East Lincolnshire which has a higher percentage for people aged under 65 years and 85+ years).

However, in 2020, whilst the rates are higher in Hull compared to England for each age group and higher for those aged 65+ years (with the exception of 85+ years where North Lincolnshire had the highest rate), the percentages among those aged under 65 years was the lowest in Hull across Humber, Coast and Vale.

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, although the percentage in 2019 fell back down to a similar percentage to 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 77% higher in Hull compared to England for 2021 for both men and women.

Information was previously displayed for three-year periods on Fingertips with trends displayed and the following was noted: There was a fall in the premature mortality rate in Hull between 2001-03 and 2004-06, but since then the mortality rate has been gradually increasing in Hull with more marked increases in the last 4-5 years. For the latest three year period 2017-19, there were 401 deaths from respiratory disease among Hull residents aged under 75 years which is the highest over the last 15 years. In contrast, under 75 mortality rates for both England and the region have been decreasing over the last 15 years. There is a substantial and increasing inequalities gap between Hull and England in relation to premature mortality from respiratory disease.

For 2021, there were 100 deaths from respiratory disease that occurred prior to the age of 75 years among Hull men and women.

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 since 2013-15 the inequalities gap has been increasing.

For 2021, there were 57 deaths from respiratory disease that occurred prior to the age of 75 years among Hull men.

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.

For 2021, there were 43 deaths from respiratory disease that occurred prior to the age of 75 years among Hull women.

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 are twice has high in Hull for 2021 compared to England. They are also the highest across the region, and higher by some margin, in particular for men. The rate in Hull is 12th highest for persons, 12th highest for males and 19th highest for females across all local authorities across England.

The trends over time for three-year periods were previously given on Fingertips and the following was noted.

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.

Of the 100 deaths from respiratory disease which occurred in Hull during 2021 among people aged under the age of 75 years, 65 (65%) 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.

Of the 57 premature deaths from respiratory disease for men for 2021, 37 (65%) 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. The pattern in the mortality rate among Hull 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.

For 2021, 43 premature deaths from respiratory disease were considered to be preventable for women out of 57 premature respiratory deaths representing three-quarters of all premature respiratory deaths.

For 2021, the directly standardised mortality rate for respiratory disease per 100,000 population among those aged 65+ years in Hull is 35% higher than England (593 versus 441 deaths per 100,000 population). The rate in Hull is among the highest in the region.

The trend data was shown on Fingertips, but is not currently available. When the data was available, the following was noted. In contrast to the mortality rate among those aged under 75 years, the respiratory mortality rate among those aged 65+ years has remained relatively constant at around 1,000 deaths per 100,000 population over the last 15 years, whereas the rate in England and across the region has shown a steady decline over this period. However, in Hull, there has been more variability in the last 3-4 years with the rate increasing in 2018 likely to due to an increase in deaths from flu, and a subsequent fall back to ‘usual’ levels for 2019, followed by a fall between 2019 and 2020 likely due to the COVID-19 pandemic with the most vulnerable who might have been susceptible to respiratory disease mortality, dying from COVID-19 instead (which does not fall under the category respiratory disease as mentioned above) and with reduced social contact within the population which meant that the flu virus could not circulate as much as it does in a usual year.

There were 233 deaths from respiratory disease among Hull residents during 2021.

Asthma

Diagnosed Prevalence

The prevalence of asthma among patients aged 6+ years registered with Hull GPs from the Quality and Outcomes Framework is 6.5% for 2020/21 for Hull (03F) is the same as England, but lowest across the Humber and North Yorkshire Integrated Care Board.

An indicator relating to asthma has been included in the Quality and Outcomes Framework since 2004/05, but related to all ages. In 2020/21, the indicator was changed to be the number of patients aged 6+ years who have asthma so the trends over time are not available over a long period of time as the indicator definition has changed.

For the two years 2020/21 and 2021/22, the prevalence of diagnosed asthma is the same in Hull as England for both years increasing from 6.4% to 6.5%.

From the local analysis of the national Quality and Outcomes Framework datasets, there was no statistically significant association between average age of the practice patients and the prevalence of diagnosed asthma across the 32 practices in Hull for 2021/22. There was also no statistically significant association between the prevalence of diagnosed asthma and the average deprivation score of registered patients (using the Index of Multiple Deprivation 2019). Further analysis including the prevalence of asthma for each practice is available within the file within Local Analysis of Quality and Outcomes Framework Data.

Hospital Admissions

Fingertips also presents information on emergency hospital admissions for asthma although the information is presented for different geographical areas for under 19s and for those aged 19+ years. The information is summarised here for under 19s but more detailed information is available under A&E Attendances and Hospital Admissions under Health Factors under Children and Young People with the information presented for children and young people aged 0-9, 10-18 and 0-18 years separately.

Hull has the lowest emergency admission rates for under 19s over the three year period 2019/20-2021/22 compared to other sub-Integrated Care Boards within Humber and North Yorkshire ICB, as well as a a rate more than half that of England.

Rates are presented as the number of emergency admissions per 100,000 population for under 19s (crude rates).

Among under 19s, emergency admissions for asthma in Hull were lower than England for both the last two periods with a significant reduction between 2018/19-2020/21 and 2019/20-2021/22. However, it is possible that a reduction could have occurred because of the COVID-19 pandemic as the time period covers three years including 2020/21 where all hospital activity was affected by the pandemic.

Among those aged 19+ years, the rate of emergency admissions for asthma in Hull are given as the directly age standardised admission rates per 100,000 population for those aged 19+ years (standardised to the European Standard Population), and the rate is similar in Hull as England for 2020/21.

Among those aged 19+ years, the emergency admission rate for asthma increased between 2013/14 and 2016/17 and remained relatively constant between 2016/17 and 2018/19. Emergency admissions were lower in 2019/20, and then decreased sharply (by half) in 2020/21 likely associated with the COVID-19 pandemic.

Deaths

The directly age standardised mortality rate for asthma per 100,000 population is one-third higher in Hull (03F) compared to England for 2017-19.

However, the number of deaths are small with 18 deaths in the latest three year period 2017-19. As a result of the small numbers, there is considerable year-on-year variability, although it does appear that the rate remained relatively constant between 2006-08 and 2010-12 before increasing to a high in 2013-15. Since 2013-15 the mortality rate from asthma has decreased considerably, and whilst there has been an increase in the last year between 2016-18 and 2017-19, there is currently no statistically significant difference in the mortality rate between England and Hull.

Chronic Obstructive Pulmonary Disease

Diagnosed Prevalence

Given the high prevalence of smoking in Hull both historic and current levels, and the strong association between smoking and COPD, it is not surprising that Hull has a high percentage of patients registered with Hull GPs who have been diagnosed with COPD.

From Quality and Outcomes Framework, for 2021/22, 3.0% of all patients registered with Hull GPs (03F) had a diagnosis of chronic obstructive pulmonary disease (COPD) compared to 1.9% for England.

The diagnosed prevalence of COPD at practice level has also been increasing in Hull, and at a higher rate of increase compared to England.

There are 9,182 patients registered with Hull GPs diagnosed with COPD in 2021/22.

From the local analysis, there was a statistically significant association between average age of the practice patients and the prevalence of diagnosed COPD across the 29 practices in Hull for 2021/22. The prevalence was 1.5% among practices serving the youngest patients compared to 3.5% among practices serving the oldest patients. For every increase in the average age of the patients of 10 years, the prevalence of COPD increased by 1.3 percentage points. Further analysis of diagnosed disease by the average age of practice patients is within the file above and within Local Analysis of Quality and Outcomes Framework Data.

There was also a statistically significant association between average deprivation score of registered patients (based on the Index of Multiple Deprivation 2019) and the prevalence of diagnosed COPD across the 29 practices in Hull for 2021/22. The prevalence was 1.9% among practices serving the patients living in the least deprived areas of Hull compared to 3.5% among practices serving the patients living in the least deprived areas of Hull. For every increase in the deprivation score of 10 units, the prevalence of COPD increased by 0.5 percentage points. Further analysis of diagnosed disease by the average deprivation score of practice patients is given within Local Analysis of Quality and Outcomes Framework Data.

Hospital Admissions

The age standardised emergency hospital admission rate for COPD per 100,000 population in Hull (03F) is almost than twice that of England for 2020/21 (standardised to European Standard Population).

The number of emergency hospital admissions for COPD in Hull steadily increased from 400 admissions per 100,000 population in 2013/14 to a high of 525 admissions per 100,000 population during 2017/18. Whilst the rate decreased between 2017/18 to 2019/20, the rate in Hull is twice as high as England.

The rate fell sharply in 2020/21 with admissions halving due to the COVID-19 pandemic, although given the very high rates in Hull, it is likely that the number of emergency hospital admissions for COPD will increase in 2021/22.

Overall, in 2019/20 there were 1,125 emergency admissions for COPD which decreased to 645 during 2020/21.

Deaths

For 2016-18, the mortality rate within 30 days of a hospital admission for COPD is 30% higher among patients registered with Hull GPs compared to England. The rate is given as the directly age standardised mortality rate per 100,000 emergency COPD hospital admissions standardised to the European Standard Population and are given for Clinical Commissioning Groups.

The rate has remained relatively unchanged over the last three years in Hull, although has decreased in England. There were 233 deaths over the three year period 2016-18 that occurred with in 30 days of an emergency admission to hospital for COPD.

The directly age standardised mortality rate for COPD per 100,000 population is 55% higher in Hull compared to England for men and more than twice as high for Hull women for 2021.

Trends over time were shown on Fingertips for three-year periods 2001-03 to 2017-19, and showed that there had been a sharp increase in the deaths from COPD in Hull for men and women combined increasing by 47% between 2001-03 when there were 440 deaths (76.8 deaths per 100,000 population) and 2017-19 with 666 deaths (113.2 deaths per 100,000 population). In contrast, the mortality rate across England has decreased by 10% and across the Yorkshire and Humber region by 9% over the same period.

During 2021, there were 134 deaths from COPD among Hull men and women.

Among males, there has been a 32% increased in the mortality rate between 2001-03 and 2017-19 in Hull with a total of 327 deaths from COPD over the three years 2017-19. Over the same period, mortality from COPD has decreased by 25% for England and by 26% for the region.

During 2021, there were 68 deaths from COPD among Hull men.

The greatest increase has been for females, with the number of deaths from COPD increasing by 58% from 224 in 2001-03 (65.2 deaths per 100,000 population) to 339 in 2017-19 (102.9 deaths per 100,000 population). In contrast to males, there have been slight increases in the mortality rate between 2001-03 and 2017-19 for females for England (2.8%) and across the Yorkshire and Humber region (5.7%). For women, the mortality rate was half as much again in Hull (54% higher) compared to England in 2001-03 which was substantially higher, however, it was 137% higher in 2017-19.

During 2021, there were 66 deaths from COPD among Hull women.

The mortality rate with COPD as the underlying cause is high in Hull, but the mortality rate where COPD is a contributory factor is also high. The latter relates to deaths that are deaths were COPD is a contributory or secondary factor and does not include deaths (above) where COPD is the main or underlying factor in the death. As stated on The Office for Health Improvement & Disparities’ Fingertips, “focusing on those that die with but not directly from COPD allows us to understand better the role that COPD plays in mortality from other conditions given its association with comorbidities.”

The directly standardised mortality rate from COPD recorded as a contributory factor per 100,000 population was twice as high as England (at Clinical Commissioning Group level).

Given that the mortality rate from COPD has increased quite sharply over the last 15 years, it is not surprising that the number of deaths from other causes where COPD is mentioned as a contributing factor has also increased. The rate has increased by 81% in Hull between 2006-08 to 2017-19, although it is possible that some of the increase could be associated with better recording among deaths of secondary or underlying conditions.

Whilst at a different geographical level (local authority versus Clinical Commissioning Group), there were 695 deaths from COPD recorded among Hull residents in 2017-19 and a further 655 deaths among patients registered with Hull GPs dying of something else but who had COPD as a contributing factor within their death. This equates to around 450 deaths per year from COPD directly or dying with COPD as a contributory factor.