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.

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 6.3% for 2023/24 for Hull (03F) and is similar to England, but the 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 three years 2020/21 to 2022/23, the prevalence of diagnosed asthma in Hull has remained relatively constant and has been comparable to England although has fallen slightly in Hull over the last two years. The recorded prevalence for Hull has been consistently below the average across the Humber and North Yorkshire Integrated Care Board.

From the local analysis of the national Quality and Outcomes Framework datasets, there was a statistically significant association between average age of the practice patients and the prevalence of diagnosed asthma across the 28 practices in Hull for 2023/24. If the practices were divided into five approximately equal sized groups based on average age of patients (with each fifth having approximately one-fifth of the total registered patients in Hull) then the prevalence increased from 5.2% for the practices serving the youngest practice patients to 6.5% for the practices serving the oldest practice patients. For every increase in the average age of the patients of 10 years, the prevalence of asthma increased by 1.5 percentage points. Further analysis including the prevalence of asthma for each practice is available within the file within Local Analysis of Quality and Outcomes Framework Data.

There was no statistically significant association between the prevalence of diagnosed CHD and the average deprivation score of registered patients (using the Index of Multiple Deprivation 2019) across the 28 practices.

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 2020/21-2022/23 compared to other sub-Integrated Care Boards within Humber and North Yorkshire ICB, as well as a a rate which is around half that of England.

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

Between 2017/18 and 2022/23, among under 19s, the emergency admissions for asthma in Hull have been consistently lower than England. It is possible that the reduction since 2017/18-2019/20 was influenced by the COVID-19 pandemic when then hospital activity for many non-COVID-19 conditions was reduced.

These decreases in Hull have been mirrored nationally and across the local Humber and North Yorkshire Integrated Care Board areas.

Among those aged 19+ years, the rate of emergency admissions for asthma in Hull (03F) is slightly lower than the rate for England for 2022/23 with 60.8 admissions per 100,000 population in Hull compared to 72.1 admissions per 100,000 population for England.

The rate is given as the directly age standardised admission rates per 100,000 population for those aged 19+ years (standardised to the European Standard Population).

Among those aged 19+ years, the emergency admission rate for asthma in Hull has been quite variable between 2013/14 and 2019/20. There was a generally increasing trend between 2013/14 and 2016/17, with the rate remaining relatively constant between 2016/17 and 2018/19. Emergency admissions were lower in 2019/20, and then decreased sharply (by half) in 2020/21 which is likely associated with the COVID-19 pandemic. The rate have increased for both 2021/22 and 2022/23, but the rates are around one-quarter lower in 2022/23 than they were in 2019/20 prior to the pandemic.

During 2022/23, there were 140 emergency hospital admissions for asthma among Hull residents.

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 2023/24, 3.1% 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 9,826 patients registered with Hull GPs diagnosed with COPD in 2023/24.

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 28 practices in Hull for 2023/24. The prevalence was 2.0% among practices serving the youngest patients compared to 3.7% 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 1.5 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 28 practices in Hull for 2023/24. The prevalence was 2.1% among practices serving the patients living in the least deprived areas of Hull compared to 3.6% 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 is 1.7 times higher in Hull (03F) compared to England (318 versus 191 emergency hospital admissions per 100,000 population) for 2022/23.

The rate is given as a directly age-standardised admission rate per 100,000 population standardised to the 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 increased for 2021/22. The rate remained relatively unchanged for 2022/23. The latest rate is currently significantly below pre-pandemic admission rates, with the change in the rate of admissions for Hull since 2020/21 very similar to those changes observed nationally and for the region.

The inequalities gap between Hull and England decreased between 2019/20 and 2020/21 and has remained at that slightly lower difference for 2022/23. However, despite the inequalities gap narrowing slightly the admission rate in Hull is 1.7 times higher than England for 2022/23.

Overall, in 2022/23 there were 815 emergency admissions for COPD which is much lower than the peak of 1,245 in 2017/18 or 1,125 in 2019/20 prior to the pandemic.

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 78% higher in Hull compared to England for deaths registered during 2020-2022 (66% higher for men and 91% higher for women).

Mortality from COPD in Hull was the highest in the region, and eighth highest across local authorities in England for deaths registered during 2020-2022 (Manchester with 90.2 deaths per 100,000 population had the highest rate).

There were 481 deaths to Hull residents from COPD that were registered during the three year period 2020 to 2022. There has been a steady increase over time in the mortality rate in Hull until 2017-19. Among all deaths from COVID-19 during 2020 and 2021, 16.1% had an underlying cause of COPD. So whilst the total number of people who died directly from COPD during the COVID-19 pandemic was lower as shown by the sharp decrease between 2017-19 and 2020-22, it would appear that the mortality rate among Hull residents with COPD was high; it was just that they were dying of COVID-19 rather than COPD itself. Further information is given within the Causes of Death in Hull under Population.

Whilst the mortality rate did decrease between 2017-19 and 2020-22 in England, the reduction did not appear particularly marked. This suggests that people with chronic obstructive pulmonary disease in Hull were more susceptible to COVID-19 than people in England. There are many reasons why people in Hull might be more likely to catch COVID-19 and die from COVID-19. These could be associated with the age profile of the people with chronic obstructive pulmonary disease in Hull, their working status (employed or not working or retired), likelihood of going out and catching COVID-19 (living alone, less support to collect medicines and food, less ability to shop online, perception of risk, compliance with wearing masks, etc), differences in access to care and hospital treatment, and higher mortality rate (more at risk due to progression or severity of chronic obstructive pulmonary disease or number, severity and complexity of other co-morbidities). It is not known which, if any, of these might be more or less likely among Hull residents, but these are simply examples of potential reasons for the differences in the COVID-19 mortality rate among people with chronic obstructive pulmonary disease.

Among men, there were 234 deaths to Hull residents from COPD that were registered during the three year period 2020 to 2022.

The COPD mortality rate has increased gradually until 2017-19 when the rate decreased due to the COVID-19 pandemic.

Among women, there were 247 deaths to Hull residents from COPD that were registered during the three year period 2020 to 2022.

In Hull, the increase in COPD mortality rate prior to the pandemic was greater for women compared to men. There was also a sharp decrease in the COPD mortality rate in women during the pandemic.

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 in Hull (03F) as England.

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 sub-Integrated Care Board), 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.

Location of Deaths

Over three year period 2017-19, the percentage of deaths from COPD that occurred in care homes, in hospital and at home in Hull (03F) is reasonably similar to England, although slightly fewer deaths occurred at home (21.6% versus 24.7%) and in care homes (11.5% versus 12.4%), and slightly more in hospital (64.0% versus 60.1%).

Pneumonia

Hospital Admissions

Compared to England, the directly age standardised emergency hospital admission rates for pneumonia are 21% higher in Hull (03F) for 2022/23 (rates given as admissions per 100,000 population standardised to the European Standard Population).

The emergency hospital admission rate for pneumonia increased sharply – almost doubling – in Hull between 2013/14 and 2019/20 from 332 to 625 admissions per 100,000 population. There was a large increase between 2013/14 and 2016/17 with a smaller increase from 2016/17 onwards. In 2013/14, the admission rate in Hull had been statistically significantly lower than England, but in the 2019/20, the rate in Hull was statistically significantly higher than England.

However, there was a very sharp decrease – almost halving – in the emergency admissions to hospital for pneumonia between 2019/20 and 2020/21 in Hull due to the COVID-19 pandemic. A common cause of pneumonia is an infection from influenza, and due to increased social isolation (both enforced during period of lockdown and by personal choice particularly among those most at risk of morbidity and mortality from COVID-19), the influenza virus could not circulate as much as it could in a usual year. So one might anticipate fewer admissions from pneumonia, however, there were fewer admissions overall for many diseases and medical conditions during 2020/21. Whilst COVID-19 can cause pneumonia, it is possible that the primary diagnosis of the admission is COVID so these admissions are not included within 855 admissions in 2020/21. A relatively high percentage of people who died of COVID-19 had pneumonia mentioned on their death certificate (see Causes of Death under Population for more information) so it is possible that some people were admitted to hospital in 2020/21 who had pneumonia, but had COVID-19 as their primary cause of the admission.

The number of admissions increased for both 2021/22 and 2022/23, but the admission rate in 2022/23 is 28% lower than it was in 2019/20 prior to the pandemic.

There were 1,135 emergency admissions to hospital for pneumonia during 2022/23.

The median length of hospital stay for emergency hospital admissions for pneumonia is also presented on Fingertips for 2022/23, and the median length of stay is five days in Hull (03F) which is the same as England.

Deaths

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

There were a total of 322 deaths with pneumonia as the underlying cause over the three years 2017-19. The mortality rate from pneumonia decreased in Hull between 2008-10 and 2012-14, but the rate has remained relatively unchanged since 2012-14. A similar pattern occurred for England with the largest decreases between 2006-08 and 2012-14 followed by slower decreases since 2012-14, although in contrast to Hull the mortality rate from pneumonia in England has further decreased between 2012-14 and 2017-19 albeit at a slower rate.

Thus the mortality rate with pneumonia as the underlying cause is high in Hull, but the mortality rate where pneumonia is mentioned on the death certificate is even higher. These are deaths where pneumonia is an underlying cause and where pneumonia is a contributory or secondary factor so it does include deaths (above) where pneumonia is the main or underlying factor in the death. Focusing on those deaths where pneumonia is mentioned on the death certificate (either as an underlying cause or as a contributory or secondary factor) gives a better indication of the overall burden of pneumonia on lives and services.

The directly age standardised mortality rate from deaths with pneumonia mentioned on the death certificate as an underlying or contributory factor per 100,000 population is substantially higher in Hull (03F) than England being 40% higher for 2017-19.

The mortality rate from all deaths where pneumonia was mentioned on the death certificate decreased in Hull between 2006-08 and 2012-14, but has increased since although there was a slight decrease in the last year from 2016-18 and 2017-19. Whilst the latest rate in 2017-19 is 10% lower than the high of 2006-08, it is currently 4% higher than the lowest rate in 2012-14. In contrast, the mortality rate in England has shown a consistent fall over the entire 11 year period.

Projected Numbers With Bronchitis and Emphysema

The Projecting Older People Population Information System (POPPI) gives modelled estimates of the number of people in Hull aged 65+ years predicted to have bronchitis and emphysema.

They use estimates for the estimated prevalence from different surveys and research which have generally been derived at a national level (generally different prevalence estimates for different age groups for men and women separately). They then apply these prevalence figures to Hull’s population. For instance, if the prevalence among males in England in a specific age group is 5% and there are an estimated 500 men living in Hull in that age groups, they would estimate there were 25 men in that age group living in Hull with that condition. For many conditions, there is an increased prevalence in populations with higher levels of deprivation, and in most cases, deprivation is not taken into consideration. Thus in many cases, these estimates for Hull are likely to underestimate the numbers in Hull due to the high levels of deprivation in Hull. In this particular model other factors are also not considered such as the prevalence of smoking.

Further definitions are available from www.poppi.org.uk.

It is estimated that around 670 people in Hull have bronchitis and emphysema in 2020, but that this will increase to around 840 by 2040. The increases are due to the population changes anticipated for Hull between 2020 and 2040 as the estimates are made by applying age-specific prevalence estimates to Hull’s population structure. Given that hospital admissions and mortality rates in Hull are around twice those of England, it is possible that the estimated number of people in Hull with bronchitis and emphysema should be around twice the figures below. Nevertheless, the estimates below will give some indication of the increase in numbers for Hull due to population changes alone.

Gender	Age	2020	2025	2030	2035	2040
Males	65-74	266	266	293	302	283
Males	75+	153	181	197	216	242
Males	65+	419	447	490	518	525
Females	65-74	115	119	131	134	124
Females	75+	136	148	157	172	192
Females	65+	251	267	288	306	316
Persons	65-74	381	385	424	436	407
Persons	75+	289	329	354	389	433
Persons	65+	671	714	778	825	841

Strategic Need and Service Provision

All Respiratory Disease

People should be aware that smoking can cause respiratory conditions such as COPD and make other respiratory conditions such as asthma worse. People should also be aware that stopping smoking has immediate health effects within lung function improving within a year. Not smoking should be seen as the norm, with the aim of creating a smoke free generation.

It is necessary to work together to ensure people understand the benefit of positive life choices and know how to access information and seek early support to change. In order to do this effectively, health care providers need to work together with different communities to use existing assets to realise the benefit of positive life changes, and treating people as individuals.

People should attend their annual reviews (generally within primary care) for asthma and COPD so that they get the best on-going treatment for their condition.

Asthma

Asthma prevalence can be reduced over the long-term by reducing air pollution and cigarette smoking, and by increasing breastfeeding rates. In order to treat effectively, diagnoses need to be made in primary care. Asthma symptoms can be better controlled by having an asthma review once a year. Self-management of symptoms can be improved by the use of asthma action plans and better education, which have been shown to reduce admissions by more than half. The 2012 National Paediatric Asthma Audit demonstrated that only 45% of children admitted were given an action plan at discharge and 43% of children didn’t have their inhaler technique checked before discharge. For the 2012 National Adult Asthma Audit, 20% of newly-diagnosed asthmatics and 30% of known asthmatics were not commenced on inhaled corticosteroid therapy at discharge. Nine percent of patients were non-adherent to their asthma treatment. Just under half (49%) had their inhaler technique reviewed, but 26% of patients were found to have poor technique. A clinic review appointment was scheduled in 67% of patients within four weeks of discharge, and 43% had a written record of advice to see their GP within a week of discharge.

Chronic Obstructive Pulmonary Disease

Although the damage that has already occurred to the lungs cannot be reversed, the progression of COPD can be slowed, and stopping smoking is particularly effective at doing this. Symptoms can be relieved with medication such as using an inhaler to make breathing easier, and pulmonary rehabilitation may also help. As COPD cannot be cured, prevention is very important. Not smoking should be seen as the norm, with the aim of creating a smoke free generation.

As mentioned above, knowledge, changing lifestyle behaviours and attending annual reviews once diagnosed are very important in preventing and reducing the impact of COPD.

Resources

The Office for Health Improvement & Disparities’ Fingertips: https://fingertips.phe.org.uk/

NHS Digital. Quality and Outcomes Framework. https://qof.digital.nhs.uk/

Asthma.  www.nhs.uk. 2014, NHS: London.

NHS Right Care, The NHS Atlas of Variation in Healthcare for Respiratory Disease. https://www.england.nhs.uk/rightcare 2012, NHS Right Care: London.

Chronic obstructive pulmonary disease.  www.nhs.uk. 2014, NHS: London.

Action on Smoking and Health, Factsheet 02: Smoking Statistics: Illness and death.  www.ash.org.uk. 2015, Action on Smoking and Health: London.

Newton, J.N., et al., Changes in health in England, with analysis by English regions and areas of deprivation, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 2015. 386(10010): p. 2257-2274.

American Cancer Society, When smokers quit – what are the benefits over time?  www.cancer.org. 2014, American Cancer Society: Atlanta.

Surgeon General of the US Public Health Service, The health consequences of smoking – nicotine addition: a report of the Surgeon General. US Department of Health and Human Services: Rockville, 1988.

Paton, J., British Thoracic Society Paediatric Asthma Audit 2012.  www.brit-thoracic.org.uk. 2013, British Thoracic Society: London.

Lindsay, J. and L. Heaney, British Thoracic Society Adult Asthma Audit 2012.  www.brit-thoracic.org.uk. 2013, British Thoracic Society: London.

Office for National Statistics. Excess winter mortality in England and Wales: 2017 to 2018 (provisional) and 2016 to 2017 (final). Office for National Statistics, 2018.

Updates

This page was last updated / checked on 8 October 2024.

This page is due to be updated / checked in January 2025.