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. Data will still be available at CCG level for some time after July 2022 so this page continues to refer to CCGs and Hull CCG, and continues to present data at the CCG geographical level. Six local CCGs were also combined to form the Humber, Coast and Vale geographical area, which has also ceased to exist. It has been replaced by the Humber and North Yorkshire ICS. However, data will still be available at Humber, Coast and Vale geographical level, and will be presented within our JSNA.

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 2019/20, 19,302 (6.4%) patients registered with Hull GPs were diagnosed with asthma which was similar to England (6.5%), and in 2020/21, 8,650 (2.9%) patients were diagnosed with COPD which was higher than England (1.9%).
• Emergency hospital admissions for respiratory disease were almost 40% higher in Hull compared to England, and had been increasing in Hull at a faster rate than the increase in England thus increasing the inequalities gap. The pattern is similar but more pronounced for COPD with admission rates double the admission rates in Hull compared to England. There were 5,570 emergency hospital admissions for respiratory disease in Hull during 2019/20 for Hull Clinical Commissioning Group (patients registered with Hull GPs). In 2019/20, there were 1,070 emergency hospital admissions for COPD in Hull among those aged 35+ years, and 185 admissions for asthma among those aged 19+ years. There were 1,515 emergency admissions to hospital for pneumonia during 2019/20 in Hull, and the rate has been increasing dramatically over time in Hull (by 88% between 2013/14 and 2019/20). The number of admissions fell sharply for 2020/21 due to the COVID-19 pandemic to 2,450 admissions for all respiratory disease.
• 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 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 at Clinical Commissioning Group level. Hull has a high emergency admission rate for respiratory disease compared to England being 32% higher for 2020/21. 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 in Hull is around twice that of England (103% higher than England) for 2017-19 for men and women combined.

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.

Among men, there were 216 deaths prior to the age of 75 years from respiratory disease in Hull over the three year period 2017-19. 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 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. There were 185 deaths from respiratory disease among Hull women that occurred prior to the age of 75 years over the three year period 2017-19.

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 is now more twice as high as England (115% higher) whereas it was 60% higher in 2001-03 (which in itself represented a substantial difference between Hull and England).

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).

For 2017-19, the difference in this mortality rate per 100,000 population is even more marked (125% higher than England). The rate in Hull is higher than any of the other local authorities across the Yorkshire and Humber by some margin with the second highest rate in the region in Rotherham with a rate of 30.3 deaths per 100,000 population (and the rate in Hull is 50% higher than this rate at 45.4 deaths per 100,000 population).

So the premature mortality rate from respiratory disease is very high in Hull, but also in Hull a higher percentage of those deaths are preventable.

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.

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.

Of the 401 deaths from respiratory disease which occurred in Hull during 2017-19 among people aged under the age of 75 years, 264 (66%) of them were considered to be preventable. In 2001-03, around half of the premature respiratory deaths were considered to be preventable (164 out of 317; 52%).

Of the 216 premature deaths from respiratory disease for men for 2017-19, 127 (59%) were considered to be preventable. In contrast, 85 of the 169 (50%) were considered to be preventable over the three year period 2001-03.

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.

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.

Over the three year period 2017-19, three-quarters (137 out of 185; 74%) premature deaths from respiratory disease were considered to be preventable for women, and this percentage was much lower in 2001-03 (79 out of 148; 53%).

During 2017-19, a much higher percentage of premature respiratory deaths in Hull were preventable among women (74%) compared to men (59%).

For 2020, the directly standardised mortality rate for respiratory disease per 100,000 population among those aged 65+ years in Hull is 56% higher than England (771 versus 495 deaths per 100,000 population). It is also highest in the region with the next highest rate being Rotherham with 743 deaths per 100,000 population.

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.