Coronary heartdisease statistics:
morbiditysupplement
1
Coronaryheart diseasestatistics:morbiditysupplement
2001 edition
Mike Rayner1, Sophie Petersen1, Michael Moher 2, Lucy Wright2 and Fiona Lampe3
1 British Heart Foundation Health Promotion Research Group, Department of
Public Health, University of Oxford
2 Department of Primary Health Care, University of Oxford
3 Cardiovascular Research Unit, Department of Primary Care and Population
Sciences, Royal Free and University College Medical School, London
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ContentsPage
Foreword 5Summary 6Introduction 71. Myocardial infarction (heart attack) 9
Table 1.1 Incidence of myocardial infarction, adults aged between30 and 69, latest available year, UK studies compared 12
Table 1.1a Incidence of myocardial infarction, adults aged less than 80,by sex and age, 1994/95, Oxfordshire 12
Table 1.1b Coronary event rates, coronary case fatality, annual change incoronary event rates and annual change in coronary casefatality, adults aged 35-64, by sex, latest available data,MONICA Project populations 13
Fig 1.1b (1) Age-standardised coronary event rates, men aged 35-64,latest available data, MONICA Project populations 14
Fig 1.1b (2) Age-standardised coronary event rates, women aged 35-64,latest available data, MONICA Project populations 14
Table 1.1c Change in incidence of myocardial infarction, adults agedbetween 30 and 75, between 1966 and 1996, UK studies compared 15
Table 1.2 Prevalence of myocardial infarction, adults aged between55 and 74, latest available year, UK studies compared 16
Table 1.2a Percentage who report experience of myocardial infarction(ever and recently), by sex and age, 1998, England 17
Table 1.2b Prevalence of myocardial infarction by sex and age,1981/82 and 1991/92, England and Wales 17
Table 1.2c Prevalence of self-reported longstanding heart attack, adults aged16 years and above by sex and age, 1988-1998, Great Britain 18
Fig 1.2c Prevalence of self-reported longstanding heart attack by sex,for all ages and for under 75 years, 1988-1998, Great Britain 18
Table 1.3 28-day case fatality for myocardial infarction, adults,latest available year, UK studies compared 19
Table 1.3a Survival after a mycardial infraction, adults aged less than 80,1994/95, Oxfordshire 19
Table 1.3b 28-day case fatality for myocardial infarction,adults aged 35-79, by sex and age, 1994/95, Oxfordshire 19
Fig 1.3c Change in 28-day case fatality for myocardial infarction,adults aged between 30 and 69, between 1966 and 1995,UK studies compared 20
2. Angina 21Table 2.1 Incidence of angina in adults, latest available year,
UK studies compared 23
Table 2.2 Prevalence of angina, adults aged between 55 and 74,latest available year, UK studies compared 24
Table 2.2a Percentage who report experience of angina (ever and recently),by sex and age, 1998, England 25
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Table 2.2b Prevalence of angina by sex and age, 1981/82 and 1991/92,England and Wales 25
Table 2.2c Change in prevalence of angina, men aged 40-75,between 1978 and 1996, Great Britain 25
3. All coronary heart disease 26Table 3 Prevalence of all CHD, adults aged between 55 and 74,
latest available year, UK studies compared 28
Table 3a Prevalence of treated CHD by sex,age and deprivation category, 1994/98, England and Wales 29
Fig 3a Prevalence of treated CHD by sex anddeprivation category, 1994/98, England and Wales 29
Table 3b Prevalence of chest pain and diagnosed heart disease inadults aged 40 and above, by sex and ethnic group, 1993/94,England and Wales 30
Table 3c Prevalence of treated coronary heart disease by sex,age and region, 1994/98, England and Wales 30
Fig 3c(1) Age-standardised prevalence of treated CHD for men,by region, 1994/98, England and Wales 31
Fig 3c(2) Age-standardised prevalence of treated CHD for women,by region, 1994/98, England and Wales 32
Table 3d Change in prevalence of diagnosed CHD, men aged between40 and 64, between 1978 and 1996, Great Britain 33
Table 3e Percentage reporting longstanding illness by age, sex andcondition group, 1998, Great Britain 33
Fig 3e Percentage of all longstanding illness by condition group,adults, 1998, Great Britain 34
4. Heart failure 35Table 4.1 Incidence of heart failure, by sex and age, 1995/96, Hillingdon 37
Table 4.2 Prevalence of heart failure, adults aged between 45 and 84,latest available year, UK studies compared 38
Table 4.2a Prevalence of treated heart failure, by sex and age, 1998,England and Wales 39
Table 4.2b Prevalence of left ventricular dysfunction, adults,latest available year, UK studies compared 40
Table 4.3 Survival after initial diagnosis of heart failure, adults,1995/96, Hillingdon 40
Appendix 1. 41Appendix 2. 42Appendix 3. 44
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ForewordThere is a common belief that a heart attack is a "good way to go". However, this is often far
from the truth. Coronary heart disease (CHD) is not only the single most common cause of
death in the UK but also one of the most important causes of suffering and disability.
This supplement to our main compendium Coronary heart disease statistics brings together all of
the evidence describing how many people develop, or have to live with the consequences of,
coronary heart disease. It also looks at how long people survive after a heart attack or diagnosis
of angina or heart failure. This comprehensive set of estimates shows, for the first time in our
statistical publications, that the amount of prolonged and serious illness caused by CHD is
enormous.
While our main statistics show that mortality from CHD is falling in the UK, the information on
morbidity trends is not so clear. However, morbidity does seem to be increasing substantially in
those over 75 years old. This may be related to the introduction of more effective forms of
treatment for CHD. Consequently, there are many more people who are surviving but suffering
from the disease.
Morbidity data are much less comprehensive and reliable than mortality data so patterns and
trends (and the reasons for those patterns and trends) are much harder to discern. We need
further research into the problem of morbidity from CHD in the UK.
In the meantime we do know from the data reproduced here that morbidity, like mortality, is
higher in Scotland, Northern Ireland and the North of England than in the South of England.
Also, like mortality, it is higher in lower socio-economic groups and in the South Asian
communities. We also know a considerable amount about what forms of prevention, treatment
and rehabilitation would be most likely to reduce the burden of morbidity from CHD and the
unequal distribution of that burden. While awaiting the results of further research we need to
put what we do know into more effective action.
Dr. Vivienne Press
Assistant Medical Director
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SummaryHeart attack■ In the UK1 there are about 274,000 heart attacks each year, of which around 149,000 are in
men and 125,000 are in women.
● In those aged under 65, there are about 86,000 heart attacks each year (around 66,000 in
men and 20,000 in women).
● In those aged under 75, there are about 104,000 heart attacks each year (around 73,000
in men and 31,000 in women).
■ Currently in the UK1 there are about 1.3 million people who have had a heart attack, of
which around 850,000 are men and 450,000 are women.
● In those aged under 65, there are about 106,000 people who have had a heart attack
(around 79,000 men and 27,000 women).
● In those aged under 75, there are about 400,000 people who have had a heart attack
(around 300,000 men and around 100,000 women).
Angina■ In the UK1 there are about 330,000 new cases of angina each year, of which around 174,000
are in men and 158,000 are in women.
● In those aged under 75, there are about 180,000 new cases of angina each year (around
93,000 in men and 85,000 in women).
■ Currently in the UK1 there are about 2.1 million people who have or have had angina, of
which around 1.1 million are men and 1 million are women.
● In those aged under 75, there are about 700,000 people who have or have had angina
(around 450,000 men and 250,000 women).
Heart failure■ In the UK1 there are about 63,000 new cases of heart failure each year, of which around
33,000 are in men and 30,000 are in women.
■ Currently in the UK1 there are about 760,000 people who have heart failure, of which around
350,000 are men and 410,000 are women.
1 These estimates are derived from applying age-specific rates from selected studies to the UK population estimates for 1999. Forselection criteria see Introduction. See Appendix 3 for UK population estimates.
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IntroductionAimsThe aim of this supplement is to provide more detailed information on morbidity from coronary
heart disease (CHD) and associated conditions than can be provided in the main compendium -
Coronary heart disease statistics. It is divided into three main sections: myocardial infarction
(heart attack), angina and heart failure. It has one further section called ‘All coronary heart
disease’ because some sources of data on morbidity from CHD do not provide separate data on
myocardial infarction and angina.1
In each main section we have aimed to report upon incidence and prevalence of each disease or
condition by sex, age, socio-economic group and ethnic origin in the UK. We have also aimed to
report upon geographical variations within the UK, international differences and changes over
time. In some few instances we have been able to make comparisons in incidence and prevalence
with other diseases and health-related conditions.
Morbidity has various effects on the individual: in particular it leads to an increased risk of
mortality. Each section provides some data on this direct effect of morbidity.
Morbidity also leads to an increased risk of further diseases and ill health and also to a reduced
quality of life – both physical and mental. We had intended to provide data on these direct effects
of morbidity but have not found enough data from which we could draw general conclusions.
Morbidity also has a variety of indirect effects e.g. in relation to subsequent consultations with a
doctor, admissions to hospital, treatment and rehabilitation. These - particularly hospital
admissions and doctor consultations - are often taken as indicators of incidence and prevalence.
We have included some data on doctor consultations, but only where more direct measures of
incidence and prevalence are not available.
Finally the supplement gives a list of currently agreed performance indicators for morbidity from
CHD and associated conditions (see Appendix 1). The Department of Health is presently consulting
on how such performance indicators might be monitored.
SourcesVarious sources of information relating to morbidity from CHD and associated conditions have
been used in compiling this supplement. The sources used are listed in Appendix 2.
The sources of morbidity data can be divided into: routinely collected national data, national
studies and local studies. Each source has pros and cons. Most sources only provide data on one
or two aspects of morbidity from CHD and related conditions. Not all sources supply data for all
1 National Health Service Information Authority (2000) The Healthcare Frameworks Implementation Pack: Healthcare Frameworkfor Coronary Heart Disease. NHS Information Authority: Winchester, lists the following cardiovascular conditions related to CHD:angina, (controlled, symptomatic and unstable), myocardial infarction (simple and complex), heart block, supraventricular arrhythmia,ventricular arrythmia, acute cardiac breathlessness/pulmonary oedema, heart failure and post-angioplasty/surgical complications.
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ages or even both sexes. Data are collected in different ways with different degrees of validity
and reliability. Sample sizes of studies vary considerably as do sampling methods.
In compiling this supplement we have aimed to investigate and cite all possible sources of recent
data relating to morbidity from CHD and heart failure in the UK but have presented data, and
calculated UK estimates, only from studies which give the widest coverage in terms of age, sex,
geographical location, etc. and which used valid and reliable methods of data collection.
We have not included data from studies carried out outside of the UK (except when making
international comparisons). There are however various non-UK sources of data which might
provide useful indicators to the likely situation in the UK, for example studies in Framingham
(US), Gothenburg (Sweden), Reyjkavik (Iceland), etc. We have not included data from studies
carried out prior to 1985 (except for time-trend data).
Data from trials of drugs or surgery, have not been included either, because the subjects of such
trials are generally only a selected proportion of the population. We have included baseline data
from one trial of different implementation strategies for promoting secondary prevention of
CHD in general practice - the ASSIST trial – because this study did not involve selection of
particular patients.
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1. Myocardialinfarction(heart attack)
1.1 IncidenceTable 1.1 shows the results of four surveys of the incidence of myocardial infarction (MI) or
heart attack. It shows that the incidence of heart attack varies around the UK, but that on average
the incidence rate for men aged between 30 and 69 is about 600 per 100,000 and for women it
is about 200 per 100,000.
From these incidence rates we estimate that there are about 66,000 heart attacks per year in men
aged under 65 living in the UK and 20,000 in women giving a total of 86,000.
Table 1.1 also shows that the incidence rate is between 2 and 2.5 times the mortality rate. This
provides a rough way of calculating the number of heart attacks for people aged under 75 and
for people of all ages living in the UK.
Given that about 36,500 men and 15,500 women under the age of 75 die each year from a heart
attack1 we estimate that there are about 73,000 heart attacks in men aged under 75 and 31,000
in women giving a total of 104,000. Given that in total about 74,500 men and 62,500 women of
all ages die each year from a heart attack we estimate that there are about 149,000 heart attacks
in men of all ages and about 125,000 in women giving a total of about 274,000.2
Table 1.1a, with further data from the OXMIS Study, shows that the incidence rate of heart
attack is higher in men than in women and that incidence increases with age.
It is highly likely that incidence rates – like mortality rates - are higher in Scotland, Northern
Ireland and the North of England than in the South of England. Table 1.1 suggests such a trend.
Table 1.1b with the latest data from the MONICA Project suggests that international differences
in the incidence of heart attack parallel international differences in mortality rates. Incidence of
heart attack is higher in MONICA populations in Northern, Central and Eastern Europe than it
is in populations in Southern and Western Europe. The two MONICA populations in the UK –
Belfast and Glasgow - have the two highest incidence rates for women and the second and fourth
highest incidence rates for men (out of a total of 35 MONICA populations). (See also Fig 1.1b(1)
and 1.1b(2).)
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Table 1.1c shows that most studies indicate that the incidence of heart attack is falling in the UK
– on average by about 2% per year in men and women under the age of 70. Table 1.1c also
shows that the decline in incidence accounts for about half of the decline in mortality.
1.2 PrevalenceTable 1.2 shows that different studies give different estimates for the prevalence of a previous
heart attack. The Health Survey for England and the British Regional Heart Study give higher
prevalence rates than the ASSIST trial or Morbidity Statistics from General Practice. This is
likely to be because of different ways of collecting the data - the Health Survey for England and
the British Regional Heart Study involved asking people whether they recalled having a heart
attack as diagnosed by a doctor whilst the ASSIST trial and Morbidity Statistics from General
Practice data were drawn from GP notes.3 Morbidity Statistics from General Practice gives much
lower estimates of prevalence than all the other studies probably because this study only counts
a case as prevalent if the person attended their GP during the survey year.
The ASSIST trial involved searching through individual patient notes in 18 general practices in
Warwickshire. Assuming the ASSIST trial practice populations were representative of the UK the
ASSIST trial suggests that about 5% men and 1% of women aged 55-65 have had a heart attack.
From these prevalence rates we estimate that there are about 79,000 men aged under 65 living in the
UK who have had a heart attack and about 27,000 women giving a total of about 106,000.
The ASSIST trial also suggests that about 7% men and 2% of women aged 55-75 have had a
heart attack. From these prevalence rates we estimate that there are about 300,000 men aged
under 75 living in the UK who have had a heart attack and about 100,000 women giving a total
of about 400,000.
Table 1.2a, with further data from the Health Survey for England, suggests that about 4% of all
men and 2% of women have had a heart attack. From these prevalence rates we estimate that
there are about 850,000 men living in the UK who have had a heart attack and about 450,000
women giving a total of about 1.3 million.4
Table 1.2a also indicates that prevalence is higher in men than in women and increases with age.
There are only a few studies that have examined the change in the prevalence of heart attack over
time and these studies do not present a clear or complete picture.
It is often stated that prevalence of a previous heart attack must be increasing because case
fatality is falling (see Section 1.3), i.e. with declining case fatality there must be an increasing
number of people who have had a heart attack in the past. However since incidence of heart
attack is also falling, it remains possible that the effect of the decline in incidence outweighs the
effect of the decline in case fatality and that prevalence is falling too.
Table 1.2b, with data from Morbidity Statistics from General Practice, suggests that prevalence
of heart attack – as recorded by GPs - is falling and the decline is greatest in younger age groups.
But as noted above Morbidity Statistics from General Practice only counts a case as prevalent if
the person attended their GP during the survey year.
Table 1.2c, with data from the General Household Survey, suggest that there has been no marked
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change in rates of self-reported prevalence of ‘longstanding’ heart attack in adults under 75 but
that in adults aged 75 and over this has increased by 35% in men and 30% in women over the
last 10 years. (See also Fig 1.2c.) The difference between the findings of Morbidity Statistics
from General Practice and the General Household Survey is probably because of different ways
of collecting the data.
1.3 PrognosisTable 1.3 shows that all studies indicate that less than half of people who have a heart attack die
within 28 days.
Table 1.3a, with further data from the OXMIS Study, shows that of those who die within 28
days of having a heart attack, three quarters die within the first 24 hours.
British Regional Heart Study data indicate that after 28 days, chances of survival improve but
are still not as good as men who have not had a heart attack. The study found that of 198 men
aged 42-64 who had a heart attack between 1978 and 1985, and who survived for 28 days, 77%
were alive 5 years after their heart attack, and 63% were alive at 10 years. Of men of the same
age without any evidence of CHD, 96% and 91% survived for 5 and 10 years respectively.5,6
Table 1.3b and Table 1.3 show that 28-day case fatality does not routinely vary with sex in the
UK. Table 1.3b, with further data from the OXMIS Study, also shows that 28-day case fatality
increases with age.
Table 1.3 shows that 28-day case fatality varies around the UK but this variation is small.7 In
general it is found that differences between populations in case-fatality are much smaller than
differences in incidence and mortality.8
Table 1.1b, with the latest data from the MONICA Project, shows that case fatality from heart
attack is higher in many populations in Central and Eastern Europe than in most populations in
Northern, Southern and Western Europe. The two UK MONICA populations – Belfast and
Glasgow – have lower case fatality rates than average for MONICA populations.
Table 1.3c shows that 28-day case fatality for heart attack is falling on average by about 1.5%
per year in men and women under about the age of 70 in the UK.
1 Petersen S, Rayner M, Press V (2000) Coronary heart disease statistics. British Heart Foundation: London.
2 Given that case-fatality rises with age (see Section 1.3) it is likely that the incidence: mortality rate ratio is nearer 2 than 2.5. Similarestimates of the numbers of heart attacks can also be calculated from the case-fatality: mortality rate ratio.
3 The British Regional Heart Study team has carried out a study comparing GP notes with patient self-reports and has shown thatabout 33% of patients who recall a doctor-diagnosis of a heart attack will not have a heart attack recorded in their notes. Only 6%of patients will not recall having had a heart attack if a heart attack is recorded in their notes. (Walker MK, Whincup PH, ShaperAG, Lennon LT, Thompson AG (1998) Validation of patient recall of doctor-diagnosed heart attack and stroke: a postal questionnaireand record review comparison. American Journal of Epidemiology 148; 355-361.)
4 We have derived these estimates from the Health Survey for England rather than the ASSIST trial because the former, unlike thelatter, includes people of all ages.
5 Lampe FC, Whincup PH, Wannamathee SG, Shaper AG, Walker M, Ebrahim S (2000) The natural history of prevalent ischaemicheart disease in middle-aged men. European Heart Journal 21; 1052-1062.
6 Lampe FC, on behalf of the British Regional Heart Study team, personal communication.
7 This is also shown by the United Kingdom Heart Attack Study (Norris RM (1998) Fatality outside hospital from acute coronaryevents in three British health districts, 1994-5. British Medical Journal 316; 1065-70).
8 Volmink JA, Newton JN, Hicks NR, Sleight P, Fowler GH, Neil HAW (1998) Coronary event and case fatality rates in an Englishpopulation: results of the Oxford myocardial infarction incidence study. Heart 80; 40-44.
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Table 1.1 Incidence of myocardial infarction, adults agedbetween 30 and 69, latest available year, UK studiescompared
Source Study Year Place Sex Age group Incidence/ Mortality/ Incidence/100,000 100,000 mortality
Volmink et al, 1998 OXMIS 1994/95 Oxfordshire Men 35-64 273Women 35-64 66
Volmink et al, 1998 OXMIS 1994/95 Oxfordshire Men 30-69 292 120 2.43Women 30-69 94 44 2.14
Tunstall-Pedoe et al, 1999 MONICA 1985/94 Glasgow Men 35-64 777 365 2.13Women 35-64 265 123 2.15
Tunstall-Pedoe et al, 1999 MONICA 1983/93 Belfast Men 35-64 695 279 2.49Women 35-64 188 79 2.38
Lampe et al, 2000 BRHS 1983/95 Great Britain Men 45-59* 950 426 2.23
* at start of follow up (1983/85)
Some rates were age-standardised. See sources for methods of age-standardisation and definitions of MI.
Sources: Volmink JA, Newton JN, Hicks NR, Sleight P, Fowler GH, Neil HAW, on behalf of the Oxford Myocardial Infarction Incidence StudyGroup (1998) Coronary event and case fatality rates in an English population: results of the Oxford myocardial infarction incidencestudy. Heart 80; 40-44;
Tunstall-Pedoe H, Kuulasmaa K, Mahonen M, Tolonen H, Ruokokoski E, Amouyel P, for the WHO MONICA Project (1999).Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10 year results from 37WHO MONICA Project populations. Lancet 353; 1547-1557;
Lame FC, Whincup PH, Wannamathee SG, Shaper AG, Walker M, Ebrahim S (2000) Tha natural history of prevalent ischaemic heartdisease in middle-aged men. European Heart Journal 21; 1052-1062.
Table 1.1a Incidence of myocardial infarction, adults aged lessthan 80, by sex and age, 1994/95, Oxfordshire
Age group Population Number of Incidence /events 100,000
MEN
<35 155283 5 3.235-49 62321 58 93.150-64 43378 226 521.065-79 27230 388 1424.9
WOMEN
<35 143283 0 0.035-49 60339 8 13.350-64 43599 61 140.065-79 33218 249 749.6
Non-fatal and fatal definite MI, fatal possible MI and unclassifiable coronary deaths (MONICA definition 1).
Source: Volmink JA, Newton JN, Hicks NR, Sleight P, Fowler GH, Neil HAW, on behalf of the Oxford Myocardial Infarction Incidence StudyGroup (1998) Coronary event and case fatality rates in an English population: results of the Oxford myocardial infarction incidencestudy. Heart 80; 40-44.
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Tabl
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1bC
oron
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t ra
tes,
cor
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annu
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popu
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de
Aus
tral
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AU
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347
940
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340
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alia
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thA
US-
PER
1984
/93
389
36.8
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9241
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harl
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248
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83/9
234
647
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58.0
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ifax
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nty
CA
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1984
/93
523
37.5
-4.7
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139
33.6
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1984
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8158
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th K
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1983
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835
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145
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Turk
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L19
83/9
254
948
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298
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323
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363
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778
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and
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1981
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ianz
aIT
A-B
RI
1985
/94
279
40.7
-2.3
-0.8
4252
.5-3
.5-4
.8It
aly-
Friu
liIT
A-F
RI
1984
/93
253
45.1
-0.9
-2.0
4749
.9-0
.8-2
.0Li
thua
nia-
Kau
nas
LTU
-KA
U19
83/9
249
854
.81.
21.
080
53.7
2.7
-1.2
New
Zea
land
-Auc
klan
dN
EZ-A
UC
1983
/91
434
49.5
-5.1
-0.6
115
51.4
-3.5
0.6
Pola
nd-T
arno
brze
g Vo
void
ship
POL-
TAR
1984
/93
461
82.7
1.1
1.2
110
88.4
-0.1
-0.7
Pola
nd-W
arsa
wPO
L-W
AR
1984
/94
586
59.9
-0.8
-0.4
153
59.2
1.0
-2.1
Rus
sia-
Mos
cow
(con
trol
)R
US-
MO
C19
85/9
347
760
.7-1
.03.
092
60.2
-6.7
1.5
Rus
sia-
Nov
osib
irsk
(con
trol
)R
US-
NO
C19
84/9
246
459
.90.
9-0
.111
166
.52.
30.
3Sp
ain-
Cat
alon
iaSP
A-C
AT19
85/9
421
036
.71.
8-1
.735
45.5
2.0
1.5
Swed
en-G
othe
nbur
gSW
E-G
OT
1984
/94
363
43.6
-4.2
0.3
8445
.4-3
.71.
2Sw
eden
-Nor
ther
n Sw
eden
SWE-
NSW
1985
/95
509
36.1
-5.1
-2.9
119
34.4
-2.4
0.4
Switz
erla
nd-T
icin
oSW
I-T
IC19
85/9
329
033
.5-2
.6-4
.2Sw
itzer
land
-Vau
d/Fr
ibou
rgSW
I-VA
F19
85/9
323
138
.4-3
.6-3
.0U
nite
d K
ingd
om-B
elfa
stU
NK
-BEL
1983
/93
695
41.0
-4.6
-1.5
188
41.5
-2.4
-1.7
Uni
ted
Kin
gdom
-Gla
sgow
UN
K-G
LA19
85/9
477
748
.2-1
.4-1
.326
546
.40.
2-2
.1U
nite
d St
ates
-Sta
nfor
dU
SA-S
TA19
80/9
243
147
.9-4
.2-1
.613
453
.7-2
.4-0
.4Yu
gosl
avia
-Nov
i Sad
YU
G-N
OS
1984
/95
422
51.9
0.4
-0.4
101
49.9
2.8
0.5
Rat
es a
re fo
r M
ON
ICA
eve
nt d
efin
ition
1 w
hich
incl
udes
fata
l def
inite
MI,
fata
l pos
sibl
e M
I, u
ncla
ssifi
able
dea
th a
nd n
onfa
tal d
efin
ite M
I. A
ge-s
tand
ardi
sed
rate
s: s
ee s
ourc
e fo
r de
tails
and
how
tren
ds w
ere
calc
ulat
ed.
Sour
ce:
Tuns
tall-
Pedo
e H
, Kuu
lasm
aa K
, Mah
onen
M, T
olon
en H
, Ruo
koko
ski E
, Am
ouye
l P, f
or th
e W
HO
MO
NIC
A P
r oje
ct (1
999)
. Con
trib
utio
n of
tren
ds in
sur
viva
l and
cor
onar
y-ev
ent r
ates
to c
hang
es in
cor
onar
y he
art d
isea
se m
orta
lity:
10
year
res
ults
from
37
WH
O M
ON
ICA
Pro
ject
pop
ulat
ions
. Lan
cet 3
53; 1
547-
1557
.
Coronary heartdisease statistics:
morbiditysupplement
14
Fig 1.1b (2) Age-standardised coronary event rates, womenaged 34-65, latest available data, MONICAProject populations
Fig 1.1b(1) Age-standardised coronary event rates, menaged 35-64, latest available data, MONICAProject populations
0
100
200
300
400
500
600
700
800
900
Fin
lan
d-N
ort
h K
arel
ia
Un
ited
Kin
gd
om
-Gla
sgo
w
Fin
lan
d-K
uo
pio
Pro
vin
ce
Un
ited
Kin
gd
om
-Bel
fast
Pola
nd
-War
saw
Fin
lan
d-T
urk
u/L
oim
aa
Can
ada
Den
mar
k-G
lost
rup
Cze
ch R
epu
blic
Swed
en-N
ort
her
n S
wed
en
Lith
uan
ia-K
aun
as
Bel
giu
m-C
har
lero
i
Icel
and
Au
stra
lia-N
ewca
stle
Russ
ia-M
osc
ow
(co
ntr
ol)
Russ
ia-N
ovo
sib
irsk
(co
ntr
ol)
Pola
nd
-Tar
no
brz
eg V
ovo
idsh
ip
New
Zea
lan
d-A
uck
lan
d
Un
ited
Sta
tes-
Stan
ford
Yu
go
slav
ia-N
ovi
Sad
Au
stra
lia-P
erth
Ger
man
y-Ea
st G
erm
any
Swed
en-G
oth
enb
urg
Ger
man
y-B
rem
en
Bel
giu
m-G
hen
t
Fran
ce-L
ille
Fran
ce-S
tras
bo
urg
Swit
zerl
and
-Tic
ino
Ger
man
y-A
ug
sbu
rg
Ital
y-A
rea
Bri
anza
Ital
y-Fr
iuli
Fran
ce-T
ou
lou
se
Swit
zerl
and
-Vau
d/F
rib
ou
rg
Spai
n-C
atal
on
ia
Ch
ina-
Bei
jing
MONICA population
Co
ron
ary
even
t ra
te p
er 1
00
,00
0 p
op
ula
tio
n
0
50
100
150
200
250
300
Un
ited
Kin
gd
om
-Gla
sgo
w
Un
ited
Kin
gd
om
-Bel
fast
Au
stra
lia-N
ewca
stle
Pola
nd
-War
saw
Fin
lan
d-N
ort
h K
arel
ia
Den
mar
k-G
lost
rup
Can
ada
Un
ited
Sta
tes-
Stan
ford
Fin
lan
d-K
uo
pio
Pro
vin
ce
Swed
en-N
ort
her
n S
wed
en
Bel
giu
m-C
har
lero
i
New
Zea
lan
d-A
uck
lan
d
Russ
ia-N
ovo
sib
irsk
(co
ntr
ol)
Pola
nd
-Tar
no
brz
eg V
ovo
idsh
ip
Cze
ch R
epu
blic
Yu
go
slav
ia-N
ovi
Sad
Icel
and
Fin
lan
d-T
urk
u/L
oim
aa
Au
stra
lia-P
erth
Russ
ia-M
osc
ow
(co
ntr
ol)
Swed
en-G
oth
enb
urg
Ger
man
y-B
rem
en
Lith
uan
ia-K
aun
as
Ger
man
y-Ea
st G
erm
any
Bel
giu
m-G
hen
t
Fran
ce-L
ille
Fran
ce-S
tras
bo
urg
Ger
man
y-A
ug
sbu
rg
Ital
y-Fr
iuli
Ital
y-A
rea
Bri
anza
Fran
ce-T
ou
lou
se
Ch
ina-
Bei
jing
Spai
n-C
atal
on
ia
Co
ron
ary
even
t ra
te p
er 1
00
,00
0 p
op
ula
tio
n
MONICA population
Coronary heartdisease statistics:
morbiditysupplement
15
Tabl
e 1.
1cC
hang
e in
inc
iden
ce o
f m
yoca
rdia
l in
farc
tion,
adu
lts a
ged
betw
een
30 a
nd 7
5,be
twee
n 19
66 a
nd 1
996,
UK
stu
dies
com
pare
d
Sour
ceSt
udy
Year
sPl
ace
Sex
Age
gro
up%
cha
nge
in in
cide
nt%
cha
nge
in m
orta
lity
% c
hang
e in
inci
dent
rat
e/ra
te p
er y
ear
rat
e pe
r ye
ar%
cha
nge
in m
orta
lity
rate
Volm
ink
et a
l, 19
98O
XM
IS19
66/6
7 - 1
994/
95O
xfor
dshi
reM
en30
-69
-1.2
-1.8
0.66
Wom
en30
-69
-0.3
-1.3
0.22
Tuns
tall-
Pedo
e et
al,
1999
MO
NIC
A19
85 -
1994
Gla
sgow
Men
35-6
4-1
.4-2
.60.
54W
omen
35-6
40.
2-2
.0-0
.10
Tuns
tall-
Pedo
e et
al,
1999
MO
NIC
A19
83 -
1993
Belfa
stM
en35
-64
-4.6
-6.0
0.77
Wom
en35
-64
-2.4
-3.9
0.62
Lam
pe e
t al,
2000
BRH
S19
78 -
1996
Gre
at B
rita
inM
en40
-75
-2.5
-4.2
0.60
Sour
ces:
Vol
min
k JA
, New
ton
JN, H
icks
NR
, Sle
ight
P, F
owle
r G
H, N
eil H
AW, o
n be
half
of th
e O
xfor
d M
yoca
rdia
l Inf
arct
ion
Inci
denc
e St
udy
Gro
up (1
998)
Cor
onar
y ev
ent a
nd c
ase
fata
lity
rate
s in
an
Eng
lish
popu
latio
n: r
esul
ts o
f the
Oxf
ord
myo
card
ial i
nfar
ctio
n in
cide
nce
stud
y. H
eart
80;
40-
44;
Tuns
tall-
Pedo
e H
, Kuu
lasm
aa K
, Mah
onen
M, T
olon
en H
, Ruo
koko
ski E
, Am
ouye
l P, f
or th
e W
HO
MO
NIC
A P
roje
ct (1
999)
. Con
trib
utio
n of
tren
ds in
sur
viva
l and
cor
onar
y-ev
ent r
ates
to c
hang
es in
coro
nary
hea
rt d
isea
se m
orta
lity:
10
year
res
ults
from
37
WH
O M
ON
ICA
Pro
ject
pop
ulat
ions
. Lan
cet 3
53; 1
547-
1557
;
Lam
pe F
C, M
orri
s RW
, Whi
ncup
PH
, Wal
ker
M, E
brah
im S
, Sha
per
AG
(200
0) I
s th
e pr
eval
ence
of c
oron
ary
hear
t dis
ease
falli
ng in
Bri
tish
men
? T
he B
ritis
h R
egio
nal H
eart
Stu
dy, 1
978
to 1
996.
Pos
ter
at C
ardi
ovas
cula
r D
isea
se P
reve
ntio
n V
con
fere
nce,
4th
-7th
Apr
il, K
ensi
ngto
n T o
wn
Hal
l, L
ondo
n.
Coronary heartdisease statistics:
morbiditysupplement
16
Tabl
e 1.
2Pr
eval
ence
of
myo
card
ial
infa
rctio
n, a
dults
age
d be
twee
n 55
and
74*
, la
test
avai
labl
e ye
ar, U
K s
tudi
es c
ompa
red
MEN
WO
MEN
Sour
ceSt
udy
Year
Plac
e55
-64
65-7
455
-64
65-7
4%
%%
%
Join
t Hea
lth S
urve
ys U
nit,
1999
HSE
1998
Engl
and
8.4
11.6
2.4
5.5
Pers
onal
com
mun
icat
ion
ASS
IST
1997
/98
War
wic
kshi
re4.
77.
80.
92.
7
Roy
al C
olle
ge o
f Gen
eral
Pra
ctiti
oner
s et
al,
1995
Mor
bidi
ty S
tatis
tics
from
Gen
eral
Pra
ctic
e19
91/9
2En
glan
d an
d W
ales
0.7*
*1.
60.
2**
0.7
Pers
onal
com
mun
icat
ion
BRH
S19
92G
reat
Bri
tain
8.0
13.1
*D
ata
from
the
4th
Nat
iona
l Stu
dy o
f Mor
bidi
ty S
tatis
tics
from
Gen
eral
Pra
ctic
e is
for
adul
ts a
ged
betw
een
45 a
nd 7
4.**
for
thos
e ag
ed 4
5-64
.
Sour
ces:
Join
t Hea
lth S
urve
ys U
nit (
1999
) Hea
lth S
urve
y fo
r E
ngla
nd 1
998.
The
Sta
tione
ry O
ffic
e: L
ondo
n;
M M
oher
on
beha
lf of
the
ASS
IST
tria
l tea
m, D
epar
tmen
t of P
rim
ary
Hea
lth C
are,
Uni
vers
ity o
f Oxf
ord,
per
sona
l com
mun
icat
ion;
Roy
al C
olle
ge o
f G
ener
al P
ract
ition
ers,
the
Off
ice
of P
opul
atio
n C
ensu
ses
and
Surv
eys
and
the
Dep
artm
ent
of H
ealth
(19
95)
Mor
bidi
ty S
tatis
tics
from
Gen
eral
Pra
ctic
e,Fo
urth
Nat
iona
l Stu
dy 1
991-
1992
. HM
SO: L
ondo
n;
F L
ampe
on
beha
lf of
the B
RH
S te
am, D
epar
tmen
t of P
rim
ary
Car
e and
Pop
ulat
ion
Scie
nces
, Roy
al F
ree a
nd U
nive
rsity
Col
lege
Med
ical
Sch
ool,
Lon
don,
per
sona
l com
mun
icat
ion.
Oth
er s
ourc
e of
pre
vale
nce
data
:Sm
ith W
C, K
enic
er M
B, T
unst
all-P
edoe
H, C
lark
EC
, Cro
mbi
e IK
(199
0) P
reva
lenc
e of
cor
onar
y he
art d
isea
se in
Sco
tland
: Sco
ttis
h H
eart
Hea
lth S
tudy
. Bri
tish
Hea
rt Jo
urna
l64
; 295
-298
.
Coronary heartdisease statistics:
morbiditysupplement
17
Table 1.2a Percentage who report experience of myocardialinfarction (ever and recently), by sex and age, 1998,England
All ages 16-24 25-34 35-44 45-54 55-64 65-74 75 & over% % % % % % % %
MEN
Ever experienced 4.2 0.1 0.2 0.5 2.7 8.4 11.6 13.5Recently experienced 0.6 0.1 0.0 0.2 0.5 0.8 1.8 1.2(in last 12 months)
Base 7193 875 1338 1305 1289 987 837 562
WOMEN
Ever experienced 1.8 0.0 0.1 0.3 0.8 2.4 5.5 6.5Recently experienced 0.3 0.0 0.0 0.0 0.1 0.7 1.0 0.8(in last 12 months)
Base 8715 1006 1630 1573 1484 1148 967 907
Source: Joint Health Surveys Unit (1999) Health Survey for England 1998. The Stationery Office: London.
Table 1.2b Prevalence of myocardial infarction by sex and age,1981/82 and 1991/92, England and Wales
All ages 15-24 25-44 45-64 65-74 75 & over% % % % % %
MEN 1981 / 82 0.55 0.00 0.16 1.17 1.99 2.241991 / 92 0.38 0.00 0.06 0.73 1.58 1.86
Change -31% - -63% -38% -21% -17%
WOMEN 1981 / 82 0.29 0.00 0.03 0.38 1.11 1.281991 / 92 0.20 0.00 0.01 0.20 0.71 1.18
Change -31% - -67% -47% -34% -8%
ICD (9th Revision) code 410.
Source: Royal College of General Practitioners, the Office of Population Censuses and Surveys, and the Department of Health (1995) Morbidity Statisticsfrom General Practice, Fourth National Study, 1991-1992. HMSO: London.
Coronary heartdisease statistics:
morbiditysupplement
18
Table 1.2c Prevalence of self-reported longstanding heartattack, adults aged 16 years and above by sexand age, 1988-1998, Great Britain
All ages 16-44 45-64 65-74 75 & over% % % % %
MEN 1988 2.2 0.2 4.7 7.5 8.21989 2.3 0.2 4.6 10.0 7.91994 2.3 0.1 3.1 6.6 8.11995 2.5 0.1 3.4 9.2 5.41996 2.3 0.1 3.0 6.6 7.51998 3.2 0.3 4.0 8.9 11.1
WOMEN 1988 1.7 0.1 2.0 6.7 6.61989 1.7 0.1 2.4 6.4 6.51994 2.1 0.1 2.0 5.9 7.31995 1.8 0.1 1.7 4.5 7.31996 2.4 0.1 2.8 6.5 8.31998 2.2 0.0 1.8 6.5 8.6
Source: Office for National Statistics (2000) Living in Britain. Results from the 1998 General Household Survey. The StationeryOffice: London and previous editions.
Fig 1.2c Prevalence of self-reported longstanding heartattack by sex, for all ages and for under 75 years,1988-1998, Great Britian
0
2
4
6
8
10
12
1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998Year
%
Men: all ages
Men: 75 & over
Women: all ages
Women: 75 & over
Coronary heartdisease statistics:
morbiditysupplement
19
Table 1.3 28-day case fatality for myocardial infarction, adults,latest available year, UK studies compared
Source Study Year Place Sex Age group % of fatalities within 28 days
Volmink et al, 1998 OXMIS 1994/95 Oxfordshire Men 30-69 41Women 30-69 44
Norris, 1998* UKHAS 1994/95 UK Men <75 44Women <75 47
Tunstall-Pedoe et al, 1999 MONICA 1985/94 Glasgow Men 35-64 48Women 35-64 46
Tunstall Pedoe et al, 1999 MONICA 1983/93 Belfast Men 35-64 41Women 35-64 42
Lampe et al, 2000 BRHS 1978/95 Great Britain Men 40-59** 41
* 30 days rather than 28 days;** in 1978-80.
Sources: Volmink JA, Newton JN, Hicks NR, Sleight P, Fowler GH, Neil HAW, on behalf of the Oxford Myocardial Infarction Incidence Study Group (1998)Coronary event and case fatality rates in an English population: results of the Oxford myocardial infarction incidence study. Heart 80; 40-44;
Norris RM on behalf of the United Kingdom Heart Attack Study Collaborative Group (1998) Fatality outside hospital from acute coronary eventsin three British health districts, 1994-5. British Medical Journal 31; 1065-1070;
Tunstall-Pedoe H, Kuulasmaa K, Mahonen M, Tolonen H, Ruokokoski E, Amouyel P, for the WHO MONICA Project (1999). Contribution oftrends in survival and coronary-event rates to changes in coronary heart diseasemortality: 10 year results from 37 WHO MONICA Projectpopulations. Lancet 353; 1547-1557;
Lampe FC, Morris RW, Whincup PH, Walker M, Ebrahim S, Shaper AG (2000) Is the prevalence of coronary heart disease falling in British men?The British Regional Heart Study, 1978 to 1996. Poster at Cardiovascular Disease Prevention V conference, 4th-7th April, Kensington TownHall, London.
Table 1.3a Survival after a myocardial infarction, adults aged lessthan 80, 1994/95, Oxfordshire
Number Percentage
All with initial heart attack 995 100%
Survive for longer than 24 hours 603 61%
Survive for longer than 28 days 476 48%
Source: Volmink JA (1996) The Oxford Myocardial Infarction Incidence Study. DPhil Thesis. University of Oxford.
Table 1.3b 28-day case fatality for myocardial infraction, adults aged35-79, by sex and age, 1994/95, Oxfordshire
Age group Population Number of events % of fatalities within 28 days
MEN
35-49 62321 20 34.550-64 43378 90 39.865-79 27230 225 58.0
35-79 132929 335 49.5
WOMEN
35-49 60339 2 25.050-64 43599 23 37.765-79 33218 159 63.9
35-79 137156 184 57.9
Non-fatal and fatal definite MI, fatal possible MI and unclassifiable coronary deaths (MONICA definition 1).
Source: Volmink JA (1996) The Oxford Myocardial Infarction Incidence Study. DPhil Thesis. University of Oxford.
Coronary heartdisease statistics:
morbiditysupplement
20
Tabl
e 1.
3cC
hang
e in
28-
day
case
fat
ality
for
myo
card
ial i
nfar
ctio
n, a
dults
age
d be
twee
n30
and
69,
bet
wee
n 19
66 a
nd 1
995,
UK
stu
dies
com
pare
d
Sour
ceSt
udy
Year
sPl
ace
Sex
Age
gro
up%
cha
nge
in 2
8-da
y ca
sefa
talit
y ra
te p
er y
ear
Volm
ink
et a
l, 19
98O
XM
IS19
66/6
7 - 1
994/
95O
xfor
dshi
reM
en30
-69
-1.0
Wom
en30
-69
-1.1
Tuns
tall-
Pedo
e et
al,
1999
MO
NIC
A19
85 -1
994
Gla
sgow
Men
35-6
4-1
.3W
omen
35-6
4-2
.1
Tuns
tall-
Pedo
e et
al,
1999
MO
NIC
A19
78 -1
9996
Belfa
stM
en35
-64
-1.5
Wom
en35
-64
-1.7
Sour
ces:
Vol
min
k JA
, New
ton
JN, H
icks
NR
, Sle
ight
P, F
owle
r G
H, N
eil H
AW o
n be
half
of t
he O
xfor
d M
yoca
rdia
l Inf
arct
ion
Inci
denc
e St
udy
Gro
up (
1998
) C
oron
ary
even
t an
d ca
se f
atal
ity r
ates
in a
nE
nglis
h po
pula
tion:
res
ults
of t
he O
xfor
d m
yoca
rdia
l inf
arct
ion
inci
denc
e st
udy.
Hea
rt 8
0; 4
0-44
;
Tuns
tall-
Pedo
e H
, Kuu
lasm
aa K
, Mah
onen
M, T
olon
en H
, Ruo
koko
ski E
, Am
ouye
l P, f
or th
e W
HO
MO
NIC
A P
roje
ct (1
999)
Con
trib
utio
n of
tren
ds in
surv
ival
and
cor
onar
y-ev
ent r
ates
to c
hang
esin
cor
onar
y he
art d
isea
se m
orta
lity:
10-
year
res
ults
from
37
MO
NIC
A P
roje
ct p
opul
atio
ns. L
ance
t 353
; 154
7-15
57.
Coronary heartdisease statistics:
morbiditysupplement
21
2. AnginaThis section, unless otherwise specified, provides statistics in relation to diagnosed angina (either
from studies which asked people whether they recalled a diagnosis of angina or which relied
upon a diagnosis of angina recorded in a doctor’s notes). It is likely that many cases of angina
remain undiagnosed. In the British Regional Heart Study about 4% of men aged 52-75 had
symptoms indicative of angina1 but no recall of a diagnosis of angina and no diagnosis of angina
recorded in their notes indicating that up to a third of angina could be undiagnosed.2 Men who
have symptoms of angina but no diagnosis of angina recorded in their notes – like those with
diagnosed angina – are at increased risk of heart attack and stroke.3
2.1 IncidenceTable 2.1 shows that different studies give different estimates of the incidence of angina. The
Southampton Chest Pain Clinic Study gives much lower figures for the incidence of angina than
the other two studies - Morbidity Statistics from General Practice and a study of the practice
population of one general practice in Oxford.
It is likely that the Southampton Chest Pain Clinic Study definition of angina was more technically
accurate than that of the GPs involved in the Morbidity Statistics from General Practice study or
the Oxford study. (The Southampton Chest Pain Clinic Study involved assessing patients with
chest pain, which in their GP’s opinion could be stable angina, but only 24% were found to have
angina as defined by the study.) On the other hand it is not clear that GPs involved in the
Southampton Chest Pain Clinic Study referred all their patients with angina to the clinic carrying
out the study so the study’s estimates of incidence are probably conservative. The Oxford study,
unlike Morbidity Statistics from General Practice, did not rely on a single diagnosis of angina by
the GPs, but confirmed the diagnosis with a second opinion.
The Oxford study indicates that the incidence rate for men aged 45-74 is about 1043 per 100,000
and for women it is about 903 per 100,000. From these incidence rates we estimate that there
are about 93,000 new cases of angina in men aged under 75 living in the UK and about 85,000
in women giving a total of about 180,000. Equivalent estimates derived from incidence rates
from Morbidity Statistics from General Practice are very similar.
Using data from Morbidity Statistics from General Practice we estimate that there are about
174,0000 new cases of angina in all men living in the UK and about 158,000 in women giving a
total of about 330,000.4
Table 2.1 also shows that incidence of angina is higher in men than in women and increases with age.
Note that the incident rates for angina are similar to the incidence rates for heart attack (Table 1.1).
2.2 PrevalenceTable 2.2 shows the Health Survey for England, the British Regional Heart Study, the Oxford
study and the ASSIST trial all give similar prevalence rates for angina. It seems that differences
between these studies in the methods of data collection have less effect on the estimates of
prevalence of angina than they do with heart attack.5 As with the estimates of prevalence of
Coronary heartdisease statistics:
morbiditysupplement
22
heart attack, Morbidity Statistics from General Practice give much lower estimates of prevalence
of angina than other studies, probably because this study only counts a case as prevalent if the
person attended their GP during the survey year.
Table 2.2 indicates that the ASSIST trial suggests that about 9% of men and 4% of women aged
55-75 have angina. From these prevalence rates we estimate that there are about 450,000 men
aged under 75 living in the UK who have had angina and about 250,000 women giving a total of
about 700,000.
Table 2.2a, with further data from the Health Survey for England, shows that about 5% of men
and 4% of women have or have had angina. From the prevalence rates in this table we estimate
that there are about 1.1 million men living in the UK who have or have had angina and about 1
million women giving a total of about 2.1 million.6
Table 2.2a also shows that the prevalence of angina is higher in men than in women but that the
difference declines with age so that the prevalence of angina in women aged 75 and over is nearly
the same as that in men (17% and 18% respectively).
As with heart attack there are only a few studies which have examined the change in the prevalence
of angina over time and these studies do not present a clear or complete picture.
Table 2.2b, with data from Morbidity Statistics from General Practice, suggests an increase in the
prevalence of angina in all age groups. This may reflect a real increase in prevalence or it might just
reflect an increase in the number of people with angina who attend their GP on a regular basis.
In contrast to Morbidity Statistics from General Practice, the British Regional Heart Study, shows
a recent fall in the prevalence of angina symptoms (in this case as measured by chest pain
questionnaire) in men aged 50-64 (Table 2.2c). But of course this does not preclude an increase
in the prevalence of angina symptoms in older age groups.
2.3 PrognosisThere have been few studies which have followed-up angina cases arising in the population.
The British Regional Heart Study found that of 157 men aged 42-65 who were diagnosed with
angina between 1978 and 1985, and had no history of heart attack, 89% were alive 5 years after
the diagnosis, and 73% were alive at 10 years. Of men of the same age without any evidence of
CHD, 96% and 91% survived for 5 and 10 years respectively.7,8
1 As measured by the Rose Questionnaire and as defined using standard criteria.
2 Lampe FC, Walker M, Lennon LT, Whincup PH, Ebrahim S (1999) Validity of a self-reported history of doctor-diagnosed angina.Journal of Clinical Epidemiology 52; 73-81.
3 Lampe FC, Whincup PH, Wannamathee SG, Shaper AG, Walker M, Ebrahim S (2000) The natural history of prevalent ischaemicheart disease in middle-aged men. European Heart Journal 21; 1052-1062.
4 The Oxford study did not include people over 75 so cannot be used to derive estimates of the total number of new cases in the wholepopulation.
5 The British Regional Heart Study has shown that 30% of patients who recall a doctor-diagnosis of angina will not have anginarecorded in their notes and that 20% of patients will not recall having a diagnosis of angina recorded in their notes. (Lampe FC,Walker M, Lennon LT, Whincup PH, Ebrahim S (1999) Validity of a self-reported history of doctor-diagnosed angina. Journal ofClinical Epidemiology 52; 73-81.)
6 These estimates are higher than our previous estimates (e.g. Petersen S, Rayner M, Press V (2000) Coronary heart disease statistics.British Heart Foundation: London) because here we are estimating prevalence from the numbers of people who report ever havinghad angina rather than from the numbers of people who report having angina in the last 12 months. Some people who have hadangina in the past will not have had angina recently because their angina is controlled with drugs.
7 FC Lampe on behalf of the British Regional Heart Study team, personal communication.
8 Other sources of data on prognosis:Gandhi MM, Lampe FC, Wood DA (1995) Incidence, clinical characteristics, and short-term prognosis of angina pectoris. BritishHeart Journal 73; 193-198;Clarke KW, Gray D, Hampton JR (1994) Implication of prescriptions for nitrates: 7 year follow up of patients treated for angina ingeneral practice. Heart 71; 38-40.
Coronary heartdisease statistics:
morbiditysupplement
23
Table 2.1 Incidence of angina in adults, latest available year, UK studiescompared
Source Study Year Place Sex Age group Incidence/100,000
Ghandi et al, 1995 Southampton Chest Pain Clinic Study 1990/92 Southampton Men 31-40 4041-50 6351-60 14761-70 262
Total 113
Women 31-40 641-50 4751-60 8561-70 91
Total 53
Gill et al, 1999 One general practice in Oxford 1989/91 Oxford Men 45-54 83055-64 135365-74 930
Total 1043
Women 45-54 64355-64 125765-74 827
Total 903
Royal College of General Morbidity Statistics from 1991/92 England and Wales Men <25 0Practitioners et al, 1995 General Practice 25-44 90
45-64 108065-74 225075-84 2730
>85 2020
Total 550
Women <25 025-44 4045-64 66065-74 176075-84 2240
>85 2150
Total 490
Total population for Southampton Chest Pain Clinic Study was 191,677; total number of cases were 110 (70 for men and 40 for women);Total population for Oxford study was 1984; total number of cases was 58 (31 for men, 27 for women).
Sources: Ghandhi MM, Lampe FA, Wood DA (1995) Incidence, clinical characteristics, and short term prognosis of angina pectoris. British Heart Journal; 73; 193-198;
Gill D, Mayou R, Dawes M and Mant D (1999) Presentation, management and course of angina and suspected angina in primary care. Journal of PsychosomaticResearch; 46; 349-358;
Royal College of General Practitioners, the Office of Population Censuses and Surveys and the Department of Health (1995) Morbidity Statistics from GeneralPractice, Fourth National Study 1991-1992. HMSO: London.
Coronary heartdisease statistics:
morbiditysupplement
24
Tabl
e 2.
2Pr
eval
ence
of a
ngin
a, a
dults
age
d be
twee
n 55
and
74*
, lat
est a
vaila
ble
year
, UK
stud
ies c
ompa
red
MEN
WO
MEN
Sour
ceSt
udy
Year
Plac
e55
-64
65-7
455
-64
65-7
4
Join
t Hea
lth S
urve
ys U
nit,
1999
HSE
1998
Engl
and
10.5
15.6
5.5
9.9
Pers
onal
com
mun
icat
ion
ASS
IST
1997
/98
War
wic
kshi
re6.
511
.52.
56.
2
Roy
al C
olle
ge o
f Gen
eral
Pra
ctiti
oner
s et
al,
1995
Mor
bidi
ty S
tatis
tics
from
Gen
eral
Pra
ctic
e19
91/9
2En
glan
d an
d W
ales
2.6*
*5.
81.
3**
3.6
Gill
et a
l, 19
99O
ne g
ener
al p
ract
ice
in O
xfor
d19
91O
xfor
d10
.413
.66.
17.
4
Pers
onal
com
mun
icat
ion
BRH
S19
92G
reat
Bri
tain
9.2
16.2
*D
ata
from
Mor
bidi
ty S
tatis
tics
from
Gen
eral
Pra
ctic
e is
for
adul
ts a
ged
betw
een
45 a
nd 7
4;**
for
thos
e ag
ed 4
5-64
.
Sour
ces:
Join
t Hea
lth S
urve
ys U
nit (
1999
) Hea
lth S
urve
y fo
r E
ngla
nd 1
998.
The
Sta
tione
ry O
ffic
e: L
ondo
n;
M M
oher
on
beha
lf of
the
ASS
IST
tria
l tea
m, D
epar
tmen
t of P
rim
ary
Hea
lth C
are,
Uni
vers
ity o
f Oxf
ord,
per
sona
l com
mun
icat
ion;
Roy
al C
olle
ge o
f G
ener
al P
ract
ition
ers,
the
Off
ice
of P
opul
atio
n C
ensu
ses
and
Surv
eys
and
the
Dep
artm
ent
of H
ealth
(19
95)
Mor
bidi
ty S
tatis
tics
from
Gen
eral
Pra
ctic
e, F
ourt
h N
atio
nal S
tudy
199
1-19
92.
HM
SO:L
ondo
n;
Gill
D, M
ayou
R, D
awes
M, M
ant D
(199
9) P
rese
ntat
ion,
man
agem
ent a
nd c
ours
e of
ang
ina
and
susp
ecte
d an
gina
in p
rim
ary
care
. Jou
rnal
of P
sych
osom
atic
Res
earc
h; 4
0; 3
49-3
58;
F L
ampe
on
beha
lf of
the
BR
HS
team
, Dep
artm
ent o
f Pri
mar
y C
are
and
Popu
latio
n Sc
ienc
es, R
oyal
Fre
e an
d U
nive
rsity
Col
lege
Med
ical
Sch
ool,
Lon
don,
per
sona
l com
mun
icat
ion.
Oth
er s
ourc
es o
f pre
vale
nce
data
:Sm
ith W
C, K
enic
er M
B, T
unst
all-P
edoe
H, C
lark
EC
, Cro
mbi
e IK
(199
0) P
reva
lenc
e of
cor
onar
y he
art d
isea
se in
Sco
tland
: Sco
ttis
h H
eart
Hea
lth S
tudy
. Bri
tish
Hea
rt J
ourn
al 6
4; 2
95-2
98;
Can
non
PJ, C
onne
ll PA
, Sto
ckle
y IH
, Gar
ner
ST, H
ampt
on J
R (1
988)
Pre
vale
nce
of a
ngin
a as
ass
esse
d by
a s
urve
y of
pre
scri
ptio
ns fo
r ni
trat
es. L
ance
t i; 9
79-9
78.
Coronary heartdisease statistics:
morbiditysupplement
25
Table 2.2c Change in prevalence of angina, men aged 40-75, between1978 and 1996, Great Britain
Annual % change inAge group Population angina symptoms
50-54 4182 -2.955-59 6089 -1.960-64 4732 -2.5
40-75 7735 -1.8
* all changes signficantly different from 0 (no change), p<0.05, angina assessed by Rose questionnaire, angina defined as current chest pain on exertion.
Source: Lampe FC, Morris RW, Whincup PH, Walker M, Ebrahim S and Shaper AG (2000) Is the prevalence of coronary heart disease falling in Britishmen? The British Regional Heart Study, 1978 to 1996. Poster at Cardiovascular Disease Prevention V conference, 4th-7th April, KensingtonTown Hall, London.
Table 2.2a Percentage who report experience of angina (ever andrecently), by sex and age, 1998, England
All ages 16-24 25-34 35-44 45-54 55-64 65-74 75 & over% % % % % % % %
MEN
Ever experienced 5.3 0.0 0.1 0.7 2.8 10.5 15.6 18.3Recently experienced (in last 12 months) 3.2 0.0 0.1 0.5 1.9 7.1 8.2 11.3
Base 7193 875 1338 1305 1289 987 837 562
WOMEN
Ever experienced 3.9 0.0 0.2 0.4 1.4 5.5 9.9 17.0Recently experienced (in last 12 months) 2.5 0.0 0.0 0.3 1.0 3.7 6.7 10.3
Base 8715 1006 1630 1573 1484 1148 967 907
Source: Joint Health Surveys Unit (1999) Health Survey for England 1998. The Stationery Office: London.
Table 2.2b Prevalence of angina by sex and age, 1981/82 and1991/2, England and Wales
All ages 15-24 25-44 45-64 65-74 75 & over% % % % % %
MEN 1981 / 82 0.81 0.00 0.09 1.72 3.54 3.191991 / 92 1.30 0.00 0.14 2.57 5.80 5.73
Change +60% - +56% +49% +64% +80%
WOMEN 1981 / 82 0.58 0.00 0.07 0.91 2.15 2.281991 / 92 0.98 0.00 0.07 1.33 3.64 4.40
Change +69% - - +46% +69% +93%
ICD (9th Revision) code 413.
Source: Royal College of General Practitioners, the Office of Population Censuses and Surveys, and the Department of Health (1995) Morbidity Statisticsfrom General Practice, Fourth National Study, 1991-1992. HMSO: London.
Coronary heartdisease statistics:
morbiditysupplement
26
3. All coronaryheart disease
This section looks at the prevalence of all CHD. This is because some studies on the prevalence
of CHD do not give separate data for heart attack and angina but give only prevalence rates for
all CHD.
Table 3 compares two studies that report prevalence of all CHD by sex and age – Morbidity
Statistics from General Practice and Key Health Statistics from General Practice. It also includes
two studies – the British Regional Heart Study and the ASSIST trial - which while reporting
separate prevalence rates for heart attack and angina, also report rates of heart attack or angina.
A prevalence rate for ‘all CHD’ is approximately equivalent to a prevalence rate for heart attack
or angina. Table 3 shows that all four studies give similar prevalence rates for all CHD.
Although people who have had a heart attack are likely to have angina not all will do so. The
ASSIST trial, for example, found that 68% of men and 66% of women aged 55-75 who had
suffered a heart attack had angina (and similarly that 47% of men and 27% of women aged 55-
75 who had angina had experienced a heart attack.1
Table 3a, with further data from Key Health Statistics from General Practice, suggests that
prevalence of CHD – like mortality from CHD - is higher in lower socio-economic groups. The
table shows that prevalence of treated CHD in general practices in deprived areas is higher than
in affluent areas. Deprivation was assessed using information on unemployment, overcrowding,
car availability and home ownership.
Table 3b, with data from a survey of the health of Britain’s ethnic minorities, suggests that
prevalence of CHD – again like mortality from CHD - varies with ethnic group, with Bangladeshi
and Pakistani men and women reporting the highest levels.
Table 3c, with further data from Key Health Statistics from General Practice, suggests that
prevalence of CHD – again like mortality from CHD is higher in the North of England and in
Wales than it is in the South of England. The table shows, for example that prevalence of treated
CHD in the Northern and Yorkshire Region is 44% higher for men and 72% higher for women
that it is in the South Thames Region. This north/south gradient is illustrated in Figs 3c(1) and
(2).
Table 3d, with data from the British Regional Heart Study, suggests that there has been no
change in the prevalence of all diagnosed CHD over the period 1978-1996 in men aged 50-64.
Morbidity Statistics from General Practice, however, suggest an increase in the prevalence of all
Coronary heartdisease statistics:
morbiditysupplement
27
CHD because the increase in the prevalence of angina (Table 2.2b) is greater than the decrease in
prevalence of heart attack (Table 1.2b).2
There are few studies that allow comparisons to be made between the prevalence of cardiovascular
diseases and conditions with that of other diseases and health-related conditions. Table 3e and
Fig 3e with data from the General Household Survey suggests that 19% of all reported longstanding
illness is cardiovascular.3 Cardiovascular illness was the second most important cause of morbidity
in this survey, after musculo-skeletal problems.
There is a growing body of literature that seeks to compare morbidity from different diseases
and health-related conditions. The most well known study is that of the World Health
Organisation’s Global Burden of Disease Project. This shows that in Established Market
Economies, such as the UK, 6% of years lost in disability are due to cardiovascular diseases
(1.6% are due to CHD and 3.2% are due to stroke). This is more than cancer (4%), similar to
that from musculo-skeletal problems (6%), but less than depression (14%) and road traffic and
other injuries (8%).4
1 M Moher on behalf of the ASSIST trial team, Department of Primary Health Care, University of Oxford, personal communication.
2 Other studies which have examined temporal trends in prevalence of CHD (though over a much shorter period of time than theBritish Regional Heart Study or Morbidity Statistics from General Practice);Office for National Statistics (2000) Key Health Statistics from General Practice. The Stationery Office: London;Joint Health Surveys Unit (1999) Health Survey for England 1998. The Stationery Office: London.
3 Note that in this instance coronary heart disease cannot usefully be separated from all cardiovascular disease.
4 Murray CJL, Lopez AD (1996) The Global Burden of Disease. WHO: Geneva.See also Table 2.2. in British Heart Foundation(2000) European cardiovascular disease statistics. BHF: London.
Coronary heartdisease statistics:
morbiditysupplement
28
Tabl
e 3
Prev
alen
ce o
f all
CH
D, a
dults
age
d be
twee
n 55
and
74*
, lat
est a
vaila
ble
year
,U
K s
tudi
es c
ompa
red
MEN
WO
MEN
Sour
ceSt
udy
Year
Plac
e55
-64
65-7
455
-64
65-7
4
Pers
onal
com
mun
icat
ion
ASS
IST
1997
/98
War
wic
kshi
re8.
014
.02.
87.
2
Pers
onal
com
mun
icat
ion
BRH
S119
92G
reat
Bri
tain
12.6
22.2
Lam
pe e
t al,
2000
BRH
S119
96G
reat
Bri
tain
11.8
20.1
Off
ice
for
Nat
iona
l Sta
tistic
s, 2
000
Key
Hea
lth S
tatis
tics
from
Gen
eral
Pra
ctic
e219
98En
glan
d an
d W
ales
9.5
18.4
4.9
11.2
Roy
al C
olle
ge o
f Gen
eral
Pra
ctiti
oner
s et
al,
1995
Mor
bidi
ty S
tatis
tics
from
Gen
eral
Pra
ctic
e19
91/9
2En
glan
d an
d W
ales
4.0*
*9.
21.
8**
5.0
*D
ata
from
the
4th
Nat
iona
l Stu
dy o
f Mor
bidi
ty S
tatis
tics
from
Gen
eral
Pra
ctic
e is
for
adul
ts a
ged
bet
wee
n 45
and
74;
**fo
r th
ose
aged
45-
64;
1 Sub
ject
rec
all o
f a d
octo
r-di
agno
sis
of a
ngin
a or
hea
rt a
ttac
k;2 T
reat
ed C
HD
.
Sour
ces:
M M
oher
on
beha
lf of
the
ASS
IST
stu
dy te
am, D
epar
tmen
t of P
rim
ary
Hea
lth C
are,
Uni
vers
ity o
f Oxf
ord,
per
sona
l com
mun
icat
ion;
F L
ampe
on
beha
lf of
the
BR
HS
team
, Dep
artm
ent o
f Pri
mar
y C
are
and
Popu
latio
n Sc
ienc
es, R
oyal
Fre
e an
d U
nive
rsity
Col
lege
Med
ical
Sch
ool,
Lon
don,
per
sona
l com
mun
icat
ion;
Lam
pe F
C, M
orri
s RW
, Whi
ncup
PH
, Wal
ker
M, E
brah
im S
, Sha
per
AG
(200
0) I
s th
e pr
eval
ence
of c
oron
ary
hear
t dis
ease
falli
ng in
Bri
tish
men
? T
he B
ritis
h R
egio
nal H
ear t
Stu
dy, 1
978
to 1
996.
Post
er a
t Car
diov
ascu
lar
Dis
ease
Pr e
vent
ion
V c
onfe
renc
e, 4
th-7
th A
pril,
Ken
sing
ton
Tow
n H
all,
Lon
don;
Off
ice
for
Nat
iona
l Sta
tistic
s (2
000)
Key
Sta
tistic
s fr
om G
ener
al P
ract
ice.
The
Sta
tione
ry O
ffic
e: L
ondo
n;
Roy
al C
olle
ge o
f Gen
eral
Pra
ctiti
oner
s, th
e O
ffic
e of
Pop
ulat
ion
Cen
suse
s and
Sur
veys
and
the
Dep
artm
ent o
f Hea
lth (1
995)
Mor
bidi
ty S
tatis
tics f
rom
Gen
eral
Pra
ctic
e, F
ourt
h N
atio
nal S
tudy
199
1-19
92. H
MSO
: Lon
don.
Coronary heartdisease statistics:
morbiditysupplement
29
Table 3a Prevalence of treated CHD by sex, age and deprivationcategory, 1994/98, England and Wales
Deprivation Number All ages* 0-34 35-44 45-54 55-64 65-74 75-84 85 & overcategory of cases
% % % % % % % %
MEN Q1: least deprived 12856 3.13 0.01 0.37 2.12 7.40 15.92 22.47 19.06Q2 20739 3.38 0.01 0.48 2.54 8.26 17.04 21.68 21.46Q3 25738 3.56 0.01 0.43 2.80 9.15 17.54 22.03 20.89Q4 25120 3.63 0.01 0.51 3.02 10.01 17.32 21.17 19.93Q5: most deprived 23043 4.09 0.02 0.67 3.91 11.30 19.30 21.28 20.96
All 107777 3.58 0.01 0.50 2.90 9.34 17.51 21.68 20.53
WOMEN Q1: least deprived 9402 1.74 0.01 0.08 0.65 3.18 9.55 15.77 16.78Q2 16145 1.90 0.01 0.15 1.01 4.12 9.78 15.20 16.16Q3 21352 2.13 0.01 0.15 1.18 4.54 11.04 16.87 18.40Q4 21137 2.17 0.01 0.21 1.48 5.09 10.68 15.91 17.03Q5: most deprived 19145 2.60 0.01 0.27 1.90 6.77 12.63 16.95 17.23
All 87289 2.13 0.01 0.18 1.26 4.83 10.81 16.16 17.17
* Age-standardised using the European Standard Population;
Deprivation categories were derived from quintiles of Townsend Material Deprivation Scores for the wards in which the general practices were located.
Source: Office for National Statistics (2000) Key Health Statistics from General Practice: The Stationery Office: London.
Fig 3a Prevalence of treated CHD by sex and deprivationcategory, 1994/98, England and Wales
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
Q1: least deprived Q2 Q3 Q4 Q5: most deprived
Deprivation category
%
MenWomen
Coronary heartdisease statistics:
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Table 3b Prevalence of chest pain and diagnosed heart disease inadults aged 40 and above, by sex and ethnic group,1993/94, England and Wales
Caribbean Indian African Pakistani Bangladeshi Chinese White% reporting severe chest pain Asianor diagnosed heart disease*
Men 16 13 12 23 28 12 19Women 14 12 11 25 17 5 14
Total 15 13 12 24 24 8 16
Weighted base 586 531 282 260 102 126 1525Unweighted base 494 543 279 392 198 83 1592
* Respondents were asked whether they had ever had angina or ever had a heart attack "including a heart murmur or a rapid heart", or had experienced"severe chest pain which lasting more than half an hour".
Source: Nazroo JY (1997) The Health of Britain's Ethnic Minorities: Findings from a national survey. Policy Studies Institute: London.
Table 3c Prevalence of treated CHD by sex, age and region, 1994/98, England and Wales
Number of cases All ages* 0-34 35-44 45-54 55-64 65-74 75-84 85 & over% % % % % % % %
MEN Northern and Yorkshire 16566 4.2 0.01 0.7 3.6 11.1 20.3 25.0 24.5Trent 12810 3.6 0.01 0.4 3.0 9.9 16.9 21.8 18.5Anglia and Oxford 8678 3.2 0.01 0.5 2.3 7.5 16.1 22.0 19.6North Thames 5544 3.0 0.00 0.3 2.6 7.1 15.4 19.4 17.5South Thames 7190 2.9 0.01 0.4 2.4 7.3 14.6 18.3 16.2South and West 16106 3.3 0.01 0.4 2.3 8.1 16.6 21.8 21.1West Midlands 13447 3.3 0.01 0.5 2.6 8.5 16.5 19.7 19.6North West 20678 4.1 0.02 0.6 3.7 11.5 19.2 22.1 22.2
England 101019 3.6 0.01 0.5 2.9 9.2 17.3 21.6 20.4Wales 6758 4.2 0.01 0.5 3.2 11.7 20.6 23.7 23.4
England and Wales 107777 3.6 0.01 0.5 2.9 9.3 17.5 21.7 20.5
WOMEN Northern and Yorkshire 14998 2.8 0.00 0.2 1.9 6.9 14.0 19.6 21.7Trent 10046 2.2 0.01 0.2 1.4 5.0 11.0 16.4 16.3Anglia and Oxford 6678 1.8 0.01 0.1 1.0 3.8 9.5 15.2 16.5North Thames 4292 1.6 0.00 0.1 0.7 3.3 8.9 13.4 13.5South Thames 5696 1.6 0.00 0.1 1.1 3.1 8.4 13.6 15.9South and West 12036 1.7 0.01 0.1 0.8 3.3 9.3 14.9 15.2West Midlands 10405 1.9 0.01 0.2 1.2 4.3 9.7 14.7 16.2North West 17767 2.6 0.01 0.3 1.7 6.4 12.5 17.9 18.9
England 81918 2.1 0.01 0.2 1.2 4.8 10.8 16.1 17.1Wales 5371 2.4 0.00 0.1 1.6 6.1 11.8 17.6 17.7
England and Wales 87289 2.1 0.01 0.2 1.3 4.8 10.8 16.2 17.2
* Age-standardised using the European Standard Population.
Source: Office for National Statistics (2000) Key Health Statistics from General Practice. The Stationery Office: London.
Coronary heartdisease statistics:
morbiditysupplement
31
Fig 3c(1) Age-standardised prevalence of treated CHD formen, by region, 1994/98, England and Wales
>3.99
3.75 - 3.99
3.50 - 3.74
3.25 - 3.49
<3.25
Prevalence of treatedCHD (%)
Northern andYorkshire
NorthWest
Wales
Trent
WestMidlands Anglia and
Oxford
NorthThames
SouthThamesSouth and
West
Coronary heartdisease statistics:
morbiditysupplement
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Fig 3c(2) Age-standardised prevalence of treated CHD forwomen, by region, 1994/98, England and Wales
>2.59
2.35 - 2.59
2.10 - 2.34
1.85 - 2.09
<1.85
Prevalence of treatedCHD (%)
Northern andYorkshire
NorthWest
Wales
Trent
WestMidlands Anglia and
Oxford
NorthThames
SouthThamesSouth and
West
Coronary heartdisease statistics:
morbiditysupplement
33
Table 3e Percentage reporting longstanding illness by sex,age and condition group, 1998, Great Britain
All ages 16-44 45-64 65-74 75 & over
Heart and circulatory system (VII) Men 11.3 1.9 15.5 28.1 310Women 9.9 1.3 10.6 26.8 29.9Total 10.6 1.6 13 27.4 30.3
Heart attack Men 3.2 0.3 4.0 8.9 11.1Women 2.2 0.0 1.8 6.5 8.6
Other heart complaints Men 3.0 0.6 4.1 7.3 8.5Women 2.1 0.5 2.1 5.3 6.3
Hypertension Men 3.0 0.6 4.8 6.3 5.9Women 3.8 0.5 5.3 10.3 7.3
Stroke Men 0.8 0.1 0.8 2.6 3.0Women 0.8 0.1 0.5 1.5 4.1
Musculoskeletal system (XIII) Men 15.4 9.4 19.7 22.6 26.0Women 17.3 6.4 21.3 34.0 38.3Total 16.4 7.8 20.5 28.6 33.5
Arthritis and rheumatism Men 6.1 1.6 8.1 14.2 14.5Women 9.7 1.8 12.3 21.8 25.4
Back problems Men 4.7 4.0 6.6 4.0 2.6Women 3.9 3.0 5.5 4.8 2.9
Other bone and joint problems Men 4.6 3.8 4.9 4.4 8.9Women 3.7 1.6 3.5 7.4 10.1
Respiratory system (VIII) Men 7.2 6.6 6.2 10.0 11.5Women 7.6 7.0 7.8 8.3 8.4Total 7.4 6.8 7.0 9.1 9.6
Endocrine and metabolic (III) Men 3.9 1.3 5.3 8.1 8.2Women 5.0 1.8 6.5 11.4 8.6Total 4.5 1.5 5.9 9.9 8.4
Digestive system (IX) Men 3.4 2.0 4.6 5.2 5.9Women 3.9 1.8 4.6 6.4 8.4Total 3.7 1.9 4.6 5.8 7.4
Nervous system (VI) Men 3.1 2.6 3.4 3.8 4.1Women 3.5 3 4.2 3.3 4.2Total 3.3 2.8 3.8 3.5 4.1
Any longstanding illness Men 33.0 24.0 44.0 59.0 68.0Women 34.0 23.0 43.0 59.0 65.0Total 33.0 24.0 44.0 59.0 66.0
Bases Men 7531 3726 2393 873 539Women 8343 4020 2499 989 835
ICD chapters in parentheses.
Source: Office for National Statistics (2000) Living in Britain. Results from the 1998 General Household Survey. The StationeryOffice: London.
Table 3d Change in prevalence of diagnosed CHD, menaged 40-75, between 1978 and 1996, Great Britain
Agegroup Population Annual % change in diagnosed CHD
50-54 4213 -0.455-59 6169 -0.360-64 4839 0.4
40-75 7735 0.1
A diagnosis of either angina or heart attack; no changes signficantly different from 0 (no change), p>0.05.
Source: Lampe FC, Morris RW, Whincup PH, Walker M, Ebrahim S and Shaper AG (2000) Is the prevalence of coronary heartdisease falling in British men? The British Regional Heart Study, 1978 to 1996. Poster at Cardiovascular Disease PreventionV conference, 4th-7th April, Kensington Town Hall, London.
Coronary heartdisease statistics:
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34
Fig 3e Percentage of all reported longstanding illness bycondition group, adults, 1998, Great Britain
Nervous system6%
Digestive6%
Endocrine and metabolic8%Respiratory
13%
Musculo-skeletal29%
Heart and circulatory19%
Other19%
Coronary heartdisease statistics:
morbiditysupplement
35
4. Heartfailure
4.1 IncidencePopulation-based studies on heart failure are scarce and the studies that have been published are
particularly difficult to compare because of differences in methodology, notably in the diagnosis
of heart failure. The Hillingdon Heart Failure Study however used a combination of clinical
assessment, echocardiography and radiography to diagnose heart failure in the study population
and adhered to European Society of Cardiology guidelines for its definition of heart failure.
Table 4.1 shows that the crude incidence rate for men was 140 per 100,000 and for women it
was 120 per 100,000. From the incidence rates in this table we estimate that there are about
33,000 new cases of heart failure in men in the UK each year and about 30,000 cases in women
giving a total of about 63,000.
Table 4.1 shows that the incidence of heart failure increases steeply in the elderly and is more
common in men than in women.
4.2 PrevalenceThere are a number of different studies of the prevalence of heart failure in the community and
also of left ventricular dysfunction – the main cause of heart failure. Table 4.2 summarises the
results of the four most comparable studies of the prevalence of heart failure – a small scale study
of two general practice populations in Liverpool, a study of the MONICA Project population in
Glasgow, Morbidity Statistics from General Practice and Key Health Statistics from General
Practice. The four studies give similar estimates of prevalence, but it should be noted that only
the study carried out in Glasgow used a particularly systematic approach to the identification of
heart failure (symptomatic left ventricular dysfunction) but this study only looked at the prevalence
of heart failure in a comparatively young age group.
Table 4.2a, with further data from Key Health Statistics from General Practice, suggests that
about 1% of both men and women have heart failure. From these prevalence rates we estimate
that there are about 350,000 men living in the UK who have heart failure and about 410,000
women giving a total of about 760,000.
Table 4.2b shows the results of two studies of the prevalence of left ventricular dysfunction.
These studies are difficult to compare because the studies looked at different age groups.
It is often suggested that the incidence and prevalence of heart failure is increasing. This may well
be the case but there is no direct evidence that it is so.1
Coronary heartdisease statistics:
morbiditysupplement
36
4.3 PrognosisTable 4.3 with data from the Hillingdon Heart Failure Study shows that about 40% of people
die within one year of an initial diagnosis of heart failure. Comparing Table 4.3 with Table 1.3
indicates that this is only slightly less than the number of people who die within one year of a
heart attack.
1 Office for National Statistics (2000) Key Health Statistics from General Practice. The Stationery Office: London suggests that theprevalence of treated heart failure fell slightly between 1984 and 1988 in both men and women, but this finding may be because ofchanges in the way GPs have diagnosed heart failure over this period.
Coronary heartdisease statistics:
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37
Table 4.1 Incidence of heart failure, by sex and age,1995/96, Hillingdon
Age group Population Number of Incidence/cases 100,000
MEN
25-34 14042 0 035-44 11135 3 2045-54 9405 4 3055-64 7408 21 17065-74 5260 34 39075-84 2506 41 98085 & over 537 15 1680
Total 50293 118 140
WOMEN
25-34 13620 1 435-44 10056 3 2045-54 8827 1 1055-64 7157 8 7065-74 6243 24 23075-84 4254 42 59085 & over 1435 23 960
Total 51592 102 120
Source: Cowie MR, Wood DA, Coats AJS, Thompson SG, Poole-Wilson PA, Suresh V, Sutton GC (1999) Incidence and aetiology ofheart failure. A population-based study. European Heart Journal 20; 421-428.
Coronary heartdisease statistics:
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38
Tabl
e 4.
2Pr
eval
ence
of h
eart
failu
re, a
dults
age
d be
twee
n 45
and
84,
late
st a
vaila
ble
year
,U
K s
tudi
es c
ompa
red
MEN
WO
MEN
Sour
ceSt
udy
Year
Plac
e55
-64
65-7
475
-84
55-6
465
-74
75-8
4
Roy
al C
olle
ge o
f Gen
eral
4th
Nat
iona
l Stu
dy o
f Mor
bidi
tyPr
actit
ione
rs e
t al,
1995
Stat
istic
s fr
om G
ener
al P
ract
ice
1991
/92
Engl
and
and
Wal
es0.
5*3.
28.
00.
4*2.
37.
1
McD
onag
h et
al,
1997
MO
NIC
A19
92G
lasg
ow2.
53.
22.
03.
6
Mai
r et
al,
1996
Two
gene
ral p
ract
ices
in L
iver
pool
1994
Live
rpoo
l2.
75.
310
.4**
1.2
5.1
13.3
**
Off
ice
for
Nat
iona
l Sta
tistic
s, 2
000
Key
Hea
lth S
tatis
tics
from
Gen
eral
Pra
ctic
e19
98En
glan
d an
d W
ales
1.4
4.5
10.9
0.9
3.6
9.9
*fo
r th
ose
aged
45-
64 y
ears
**fo
r th
ose
aged
75
& o
ver
Sour
ces
Roy
al C
olle
ge o
f G
ener
al P
ract
ition
ers,
the
Off
ice
of P
opul
atio
n C
ensu
ses
and
Surv
eys
and
the
Dep
artm
ent
of H
ealth
(19
95)
Mor
bidi
ty S
tatis
tics
from
Gen
eral
Pra
ctic
e,Fo
urth
Nat
iona
l Stu
dy 1
991-
1992
. HM
SO: L
ondo
n;
Mai
r FS
, Cro
wle
y T,
Bun
dred
P (1
996)
Pre
vale
nce,
aet
iolo
gy a
nd m
anag
emen
t of h
eart
failu
re in
gen
eral
pra
ctic
e. B
ritis
h Jo
urna
l of G
ener
al P
ract
ice;
46:
77-
79;
McD
onag
h TA
, Mor
riso
n C
E, L
awre
nce
A, F
ord
I, T
unst
all-P
edoe
H, M
cMur
ray
JJV
(19
97) S
ypto
mat
ic a
nd a
sym
ptom
atic
left
ven
tric
ular
sys
tolic
dys
func
tion
in a
n ur
ban
popu
latio
n. L
ance
t; 35
0: 8
29-8
33;
Off
ice
for
Nat
iona
l Sta
tistic
s (2
000)
Key
Hea
lth S
tatis
tics
from
Gen
eral
Pra
ctic
e. T
he S
tatio
nery
Off
ice:
Lon
don.
Oth
er s
ourc
es o
f pre
vale
nce
data
:Pa
ram
eshw
ar J,
Sha
ckel
l MM
, Ric
hard
son
A, P
oole
-Wils
on P
A, S
utto
n G
C (1
992)
Pre
vale
nce
of h
eart
failu
re in
thre
e ge
nera
l pra
ctic
es in
nor
th w
est L
ondo
n. B
ritis
h Jo
urna
lof
Gen
eral
Pra
ctic
e 42
: 287
-289
.
Coronary heartdisease statistics:
morbiditysupplement
39
Table 4.2a Prevalence of treated heart failure, by sex andage, 1998, England and Wales
Age group Number of cases %
MEN
0-34 20 0.0135-44 39 0.0445-54 229 0.2755-64 876 1.3965-74 2118 4.4975-84 2798 10.8685+ 1151 19.07
Total* 7231 1.02*
WOMEN
0-34 26 0.0135-44 25 0.0345-54 145 0.1855-64 573 0.9265-74 1907 3.5875-84 3910 9.8685+ 3000 18.88
Total* 9586 0.85*
* Age-standardised using the the European Standard Population.
Source Office for National Statistics (2000) Key Health Statistics from General Practice. The Stationery Office: London.
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Table 4.3 Survival after initial diagnosis of heart failure,adults, 1995/96, Hillingdon
Number Percentage
All with initial diagnosis of heart failure 220 100%
Survive for longer than 1 month 178 81%
Survive for longer than 3 months 165 75%
Survive for longer than 6 months 154 70%
Survive until end of first year 136 62%
Survive for longer than 18 months 125 57%
Source: Cowie M R, Wood D A, Coats A J S, Thompson S G, Suresh V, Poole-Wilson P A, Sutton G C (2000) Survival of patientswith a new diagnosis of heart failure: a population based study. Heart; 83: 505-510.
Table 4.2b Prevalence of left ventricular dysfunction,adults, latest available year, UK studiescompared
Source Study Year Place Sex Age group Prevalence%
McDonagh et al, 1997 MONICA 1992 Glasgow Men 25-34 0.035-44 0.745-54 5.855-64 5.765-74 6.4
Women 25-34 0.035-44 0.045-54 2.455-64 2.065-74 4.9
Morgan et al, 1999 One general practice in 1995/96 Poole Men 70-74 9.4Poole, Dorset 75-79 13.1
80-84 20.5
Total 12.8
Women 70-74 2.275-79 2.480-84 5.4
Total 2.9
Total population for MONICA Project study was 1468;Total population for Poole study was 817; total number of cases was 61 (48 for men, 13 for women).
Sources McDonagh TA, Morrison CE, Lawrence A, Ford I, Tunstall-Pedoe H, McMurray JJV (1997) Symptomatic and asymptomaticleft ventricular systolic dysfunction in an urban population. Lancet 350: 829-833;
Morgan S, Smith H, Simpson G, Liddiard GS, Raphael H, Pickering RM, Mant D (1999) Prevalence and clinical characteristicsof left ventricular dysfunction among elderly patients in general practice setting: cross sectional study. British Medical Journal18: 366-372.
Other sources of prevalence data:Wheeldon NM, MacDonald TM, Flucker CJ, McDermitt DG, Struthers AD (1993) An echocardiographic study of chronicheart failure in the community. Quarterly Journal of Medicine 86; 17-23;
Hobbs FDR, Davis RC, McLeod et al (1998) Prevalence of LVD and valve disease in a typical English region. JournalAmmerican College of Cardiology 31(Suppl 5); 85C.
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Appendix 1. Performance indicators for morbidity fromCHD and related cardiovascular conditions
Section in Health Indicator CHD National HighSupplement Information National Performance Level
Authority Service Framework FrameworkRef No. Framework
MI 1A Population based heart attack rate for MIs (sic) ✔
MI 1B Annual hospital admission rate for all MIs ✔
MI 1C Annual hospital admission rate for first ever MI ✔
MI 7 Case fatality rates for patients admitted tohospital alive with MI ✔
MI 11A Rate of inpatient admission for MI within 1 yearof a previous hospitalised MI ✔
MI, Angina 11B Rate of inpatient admission for selectedHeart cardiovascular conditions within 1year of aFailure previous hospitalised MI ✔
MI 13 Impact of symptoms on function for patients6 months after first ever MI ✔
MI 20 Proportion of people aged 35-74 with adiagnosis of acute MI who die during theirindex admission to hospital ✔
MI 21 Proportion of people aged 35-74 with adiagnosis of acute MI who die in hospital within30 days of their infarct ✔
MI 27 30-day mortality following MI for people aged50 and over ✔
Heart Age-standardised admission rate for heart failure ✔Failure 29
MI, Angina 41 Rate of cardiovascular events in people with a ✔Heart prior diagnosis of CHD, PVD, TIA orFailure occlusive stroke
MI 42 Proportion of people aged 35-74 with adiagnosis of acute MI who die within 30 days ✔
Source: National Health Service Information Authority (2000) The Healthcare Frameworks Implementation Pack.HealthcareFramework for Coronary Heart Disease. NHS Information Authority: Winchester (Appendix 5.2).
Note that this table extracts from Appendix 5.2 only those performance indicators related to morbidity (incidence, prevalence,case fatality, subsequent disease) and only those performance indicators recognised by the National Service Framework forCoronary heart disease, the National Performance Framework and the High Level Performance Framework.
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Appendix 2. Sources of data for compiling tables and figures
1. Routinely collected national data:Key Health Statistics from General Practice1
2. National studiesThe General Household Survey2
The Health Survey for England (HSE)3
Morbidity Statistics from General Practice4
The British Regional Heart Study (BRHS)5,6
The Health of Britain’s Ethnic Minorities7
3. Local studiesHeart attackThe Oxford Myocardial Infarction Incidence Study (OXMIS) (568,800; Oxfordshire)8,9
The United Kingdom Heart Attack Study (UKHAS) (282,000; Brighton, 408,000; South
Glamorgan and 264,000; York)10,11
The WHO Monitoring trends and determinants of cardiovascular diseases (MONICA)
Project (158,000; Belfast and 130,000; Glasgow)12
Heart attack and anginaThe Assessment of Implementation Strategy (ASSIST) trial (27,396; Warwickshire)13
AnginaThe Southampton Chest Pain Clinic Study (191,677; Southampton)14
A study in one general practice in Oxford (1984; Oxford)15
Heart failureA study in two general practices in Liverpool (17,405; Liverpool)16
The Hillingdon Heart Failure Study (151,000; Hillingdon)17,18
The WHO Monitoring trends and determinants of cardiovascular diseases (MONICA)
Project (1468; Glasgow)19
A study in one general practice in Poole, Dorset (817, Poole)20
1 Office for National Statistics (2000) Key Health Statistics from General Practice. The Stationery Office: London.
2 Office for National Statistics (2000) Living in Britain. Results from the 1998 General Household Survey. The Stationery Office:London and previous editions.
3 Joint Health Surveys Unit (1999) Health Survey for England 1998. The Stationery Office: London.
4 Royal College of General Practitioners, the Office of Population Censuses and Surveys, and the Department of Health (1995)Morbidity Statistics from General Practice. Fourth National Study 1991-1992, HMSO: London.
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5 Lampe FC, Whincup PH, Wannamathee SG, Shaper AG, Walker M, Ebrahim S (2000) The natural history of prevalent ischaemicheart disease in middle-aged men. European Heart Journal 21; 1052-1062.
6 Lampe FC, Morris RW, Whincup PH, Walker M, Ebrahim S, Shaper AG (2000) Is the prevalence of coronary heart disease falling inBritish men? The British Regional Heart Study, 1978 to 1996. Poster at Cardiovascular Disease Prevention V conference, 4th-7thApril, Kensington Town Hall, London.
7 Nazroo JY (1997) The Health of Britain’s Ethnic Minorities: Findings from a national survey. Policy Studies Institute: London.
8 Volmink JA (1996) The Oxford Myocardial Infarctions Incidence Study. Doctorate thesis: University of Oxford.
9 Volmink JA, Newton JN, Hicks NR, Sleight P, Fowler GH, Neil HAW (1998) Coronary event and case fatality rates in an Englishpopulation: results of the Oxford myocardial infarction incidence study. Heart 80; 40-44.
10 The United Kingdom Heart Attack Study (UKHAS) Collaborative Group (1998) The falling mortality from coronary heart disease:a clinicopathological perspective. Heart 80; 121-126.
11 Norris RM on behalf of the United Kingdom Heart Attack Study Collaborative Group (1998) Fatality outside hospital from acutecoronary events in three British health districts, 1994-5. British Medical Journal 316; 1065-1070.
12 Tunstall-Pedoe H, Kuulasmaa K, Mahonen M, Tolonen H, Ruokokoski E, Amouyel P, for the WHO MONICA Project (1999)Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37MONICA Project populations. Lancet 353; 1547-1557.
13 Moher M, Yudkin P, Turner R, Schofield T, Mant D (2000) An assessment of morbidity registers for coronary heart disease inprimary care. British Journal of General Practice 50; 706-709.
14 Gandhi MM, Lampe FC, Wood DA (1995) Incidence, clinical characteristics, and short-term prognosis of angina pectoris. BritishHeart Journal 73; 193-198.
15 Gill D, Mayou R, Dawes M, Mant D (1999) Presentation, management and course of angina and suspected angina in primary care.Journal of Psychosomatic Research; 40; 349-358.
16 Mair FS, Crowley TS, Bundred PE (1996) Prevalence, aetiology and management of heart failure in general practice. British Journalof General Practice 46; 77-79.
17 Cowie MR, Wood DA, Coats AJ, Thompson SG, Poole-Wilson PA, Suresh V, Sutton GC (1999) Incidence and aetiology of heartfailure; a population-based study. European Heart Journal 20(6); 421-428.
18 Cowie MR, Wood DA, Coats AJS, Tompson SG, Suresh V, Poole-Wilson PA, Sutton GC (2000) Survival of patients with a newdiagnosis of heart failure: a population based study. Heart 83; 505-510.
19 McDonagh TA, Morrison CE, Lawrence A, Ford I, Tunstall-Pedoe H, McMurray JJV (1997) Syptomatic and asymptomatic leftventricular systolic dysfunction in an urban population. Lancet 350; 829-833.
20 Morgan S, Smith H, Simpson G, Liddiard GS, Raphael H, Pickering RM, Mant D (1999) Prevalence and clinical characteristics ofleft ventricular dysfunction among elderly patients in general practice setting: cross sectional study. British Medical Journal 18; 366-372.
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App
endi
x 3
Mid
-199
9 po
pula
tion
estim
ates
for E
ngla
nd, W
ales
, Sco
tland
, Nor
ther
n Ir
elan
d an
d th
e U
KM
ENW
OM
EN
Engl
and
Wal
esSc
otla
ndN
orth
ern
UK
Engl
and
Wal
esSc
otla
ndN
orth
ern
UK
Irel
and
Irel
and
0-4
1557
400
8780
015
4150
6172
918
6107
914
8070
083
500
1466
6758
662
1769
529
5-9
1671
400
9740
016
6372
6636
820
0154
015
9010
093
100
1590
5163
381
1905
632
10-1
416
4060
010
1500
1660
7569
146
1977
321
1556
400
9630
015
8309
6561
618
7662
515
-19
1564
700
9670
016
5394
6513
718
9193
114
7830
093
100
1582
0862
013
1791
621
20-2
414
9660
085
900
1631
6558
523
1804
188
1425
500
7730
015
6468
5498
117
1424
925
-29
1843
000
9790
019
0959
6551
321
9737
217
4260
090
700
1855
9361
548
2080
441
30-3
420
7450
010
7800
2075
7465
430
2455
304
1973
800
1039
0020
8414
6642
923
5254
335
-39
2021
700
1075
0020
1627
6178
823
9261
519
3580
010
6100
2020
9364
230
2308
223
40-4
416
9850
095
700
1764
1654
081
2024
697
1673
000
9580
017
9770
5592
820
0449
845
-49
1589
600
9530
016
4292
4915
318
9834
515
8520
095
800
1676
3949
592
1898
231
50-5
416
7890
010
1200
1615
5147
483
1989
134
1685
600
1020
0016
5748
4907
620
0242
455
-59
1306
600
8230
013
1588
4080
715
6129
513
2340
083
900
1415
9442
586
1591
480
60-6
411
6880
074
300
1217
0134
772
1399
573
1209
400
7690
013
5441
3772
314
5946
465
-69
1029
300
6670
010
8205
2939
112
3359
611
2630
073
300
1291
6735
174
1363
941
70-7
487
8900
5850
088
315
2472
610
5044
110
6330
070
900
1161
5232
419
1282
771
75-7
971
0000
4640
063
504
1854
583
8449
1017
000
6670
099
636
2823
512
1157
180
-84
3497
0022
900
3247
098
6641
4936
6303
0041
800
6481
218
144
7550
5685
+26
2600
1590
021
043
6139
3056
8271
3200
4420
060
837
1749
083
5727
All
Age
s24
5429
0014
4170
024
8440
182
8597
2929
7598
2521
0000
1495
300
2635
599
8632
2730
2041
26
Sour
ces:
Off
ice
for
Nat
iona
l Sta
tistic
s (2
000)
per
sona
l com
min
icat
ion;
Reg
iste
r G
ener
al fo
r Sc
otla
nd (2
000)
Ann
ual R
epor
t 199
9. G
ener
al R
egis
ter
Off
ice:
Edi
nbur
gh;
Gen
eral
Reg
iste
r O
ffic
e (2
000)
Ann
ual R
epor
t 199
9. S
tatis
tics
and
Res
earc
h A
genc
y: N
orth
ern
Irel
and.