Profiling health equity using routinely gathered data: eye health in the minority ethnic population in Glasgow

1. Profiling health equity using routinely gathered data: eye health in the minority ethnic population in Glasgow Lucy Thompson Senior Researcher, Public Health Resource Unit Paul Burton Information Manager (Public Health), Information Services

2. Background • RNIB five year strategy • 5 geographically-based Community Engagement Projects • specific goal within each CEP to produce an eye health equity profile to inform and serve as a baseline for subsequent community development work

3. “Scotland’s health is improving. But there are big differences between rich and poor. In 2006, men could on average expect 67.9 years of healthy life and women 69 years. In the most deprived 15% of areas in Scotland, though, men could only expect 57.3 years of healthy life and women 59 years” (Scottish Executive, 2008).

4. Policy context Better Health, Better Care (2007) Equally Well (2008) Review of Community Eye Care Services (2004) New GOS contract (2006) Scottish Vision Strategy (2008)

5. Priority Action: Removing barriers to eye health and sight loss services, prioritising groups whose uptake of services is low and who may be at higher risk of sight loss. This includes those from Black and Minority Ethnic groups.

6. Objectives (1) • To profile the eye health needs of adults in the black and minority ethnic (BME) community of Glasgow in terms of: • Prevalence of four main conditions – age-related macular degeneration (AMD), diabetic retinopathy (DR), cataract and glaucoma (normative need); • Uptake of optometry and ophthalmology services (including DR screening) (expressed need). • To describe the availability of optometry and ophthalmology services (including DR screening), and to compare this to assessed need;

7. Objectives (2) • To review the outcomes of local qualitative research studies to ascertain the views of members of the community on their need (felt need) and their perception of services; • To make recommendations for: • further research to augment the above information; • amendments to routine data collection to enhance available information; • local action to be developed as part of the Community Engagement Project; • influencing local commissioning and care pathways.

8. Ethnicity in Glasgow - 2001 • Scotland: just over 5 million people, 2% minority ethnic groups (2001 census data) • Glasgow: • Estimate 5% minority ethnic groups • Mainly resident in: • Pollokshields East (47.8%) • Pollokshields West (30.2%) • Govanhill (19%) • Hillhead and Woodlands (15.1%) • Yorkhill and Anderston (12%)

10. Ethnicity in Glasgow - 2008 • Scotland: just over 5 million people, 2% minority ethnic groups (2001 census data) • Glasgow: • Estimate 8% minority ethnic groups @2008 • Mainly resident in: • Pollokshields East (47.8%) (52%) • Pollokshields West (30.2%) (38%) • Govanhill (19%) (29%) • Hillhead and Woodlands (15.1%) (17%) • Yorkhill and Anderston (12%) (15%)

11. From: Glasgow City Council (2010) Population by ethnicity in Glasgow.

12. New areas of interest: • Pollokshields East (47.8%) (52%) • Pollokshields West (30.2%) (38%) • Govanhill (19%) (29%) • Nitshill and Darnley (9%) (18%) • Ibrox and Kingston (11%) (18%) • Sighthill (11%) (17%) • Hillhead and Woodlands (15.1%) (17%) • Yorkhill and Anderston (12%) (15%) • Arden and Carnwadric (5%) (10%)

13. SIMD 09 • NHSGGC comprises 23% of national population = 1,199,026 (2009) • NHSGGC contains most deprived (Parkhead / Barrowfield) dz in Scotland • 30% of NHSGGC dzs are of 15% most deprived in Scotland (local share) • 46% of 15% most deprived dzs in Scotland lie within NHSGGC (national share) • 349,621 NHSGGC residents live in these datazones

15. QOF 2009/10 Quality & Outcomes Framework (QOF): voluntary; measures achievement against a range of evidence-based indicators.

17. Free Eye Examinations

18. DRS (2009)

19. Interpreting services • NHS GGC figures 2008/9 interpretation services requests • From 11 optometrists: 89 (79 assignments) • Most common languages: • Mandarin • Turkish • Singhalese (although these were from a single practice) • Urdu and Punjabi only one request each

20. Eye epidemiology • There are no good prevalence data for eye health in minority ethnic groups in the UK • Will require a bespoke data gathering exercise • Indicative data from NEHEM:

21. NEHEM National Eye Health Epidemiological Model (NEHEM) Expert systematic review of epidemiological population-based studies of the prevalence of glaucoma, age-related macular degeneration, low vision and cataracts. Prevalence rates from combinations of research studies (most relevant to the UK population) applied to age/sex population estimates in local areas (2001 Census resident populations). Appropriate adjustments were made where prevalence rate estimates were significantly different between sub-groups such as the black or Asian populations. Where age groupings incompatible or not quoted, statistical regression techniques were used to estimate prevalence (also where open-ended age ranges e.g. 80+).

22. NEHEM: NHSGGC

23. Ophthalmology SMR01 (1) • Admission rates (Source: SMR01, 2007-9) have been calculated for three of the four conditions; glaucoma, cataracts or AMD will have been one of potentially six diagnoses for each admitted patient.

24. Ophthalmology SMR01 (2) • Standardising the admission rates for relative distributions of age and sex across the quintiles, reveals a relationship with deprivation for all three conditions. • There would appear to be a greater likelihood of admission for one of these conditions for residents of the more deprived areas.

28. Ophthalmology SMR00 (1) • For patients not attending their (Ophthalmology) outpatient appointment during 2009, there would appear to be a decreasing trend associated with increasing age; and increasing deprivation (Source: SMR00, 2009). • Standardising the non-attendance rates for relative distributions of age and sex across the quintiles, reveals a relationship with deprivation (RR = 2.16 for most deprived; RR = 1 for least deprived).

29. Ophthalmology SMR00 (2) • The majority (91.03%) of patients attending an (Ophthalmology) outpatient appointment during 2009, were seen within three months. • Although not formally analysed, there would appear to be no discernible difference in waiting times for an (Ophthalmology) outpatient appointment (Source: SMR00, 2009) across the quintiles.

30. Lessons • We are not in a position to say we have assessed need • Need for better use of existing data systems • Bespoke data collection as short-term option • Audit of GP practices complete • Talk to service users and stakeholders directly • This is underway as part of Community Engagement Project

31. Acknowledgements • Gozie Joe Adigwe, RNIB • Ken O’Neill and the CEP advisory group • Paula Barton, Information Services – maps • Anna Matthews –literature work • Merav Kliner, NHS Bradford and Airedale – policy and literature input