Director of Public Health Annual Report 2022: Preventing heart disease and stroke in Buckinghamshire

Local primary care data are available as a snapshot taken in April 2022 for adults aged 18 and over resident in Buckinghamshire who are also registered with a Buckinghamshire CCG practice (424,446 individuals). Data from some nationally published sources refer to earlier time periods and have also been included to allow comparison with the national average.

Smoking status has been recorded in primary care for 86.5% of Buckinghamshire adults. 13.7% (50,358) adults are identified as a current smoker, with a further 24.4% (89,503) being ex-smokers. Nationally, data from the Annual Population Survey estimate that 13.5% of adults (aged 18 and over) were current smokers in 2019 (due to methodological changes during the pandemic, the latest year of comparable data for the Annual Population Survey is for 2019). The most recent data available for Buckinghamshire is 2018. The prevalence of smoking is falling – it has fallen at a similar pace in Buckinghamshire (a 31% fall between 2011 and 2018) to nationally (a 27% fall over the same period).

The prevalence of current smoking is 2.7 times higher in the most deprived quintile than the least deprived and rises with deprivation from 8.1% in the least deprived quintile to 21.8% in the most deprived quintile in Buckinghamshire.

Local primary care data show that 6.0% (25,287) of Buckinghamshire adults aged 18 and over have a recorded diagnosis of diabetes. Buckinghamshire has a lower prevalence of recorded diabetes than nationally in the Quality and Outcomes Framework (QOF) data for 2020/21: the prevalence in adults aged 17 and over was 6.3% in Buckinghamshire compared to 7.1% nationally. The QOF prevalence of diabetes is rising – it has risen at a similar rate in Buckinghamshire (a 16% rise between 2012/13 and 2020/21) to nationally (18% over the same period). The prevalence of diabetes is 1.6 times higher in the most deprived quintile than the least deprived quintile, rising with each deprivation quintile from 4.8% in the least deprived quintile to 7.5% in the most deprived.

Not all cases of diabetes present in the population will be detected and recorded. The prevalence of diabetes (both diagnosed and undiagnosed) for Buckinghamshire local authority was estimated to be 8.4% (for adults aged 16 and over) in 2020. This figure is 2.4 percentage points higher than the primary care recorded prevalence, which could equate to an additional 10,000 adults with unrecorded or undiagnosed diabetes who therefore may not be receiving treatment.

Local primary care data show that 15.9% (67,280) of Buckinghamshire adults have a diagnosis of high blood pressure. Buckinghamshire has a higher prevalence of recorded hypertension than the national average. This may be due to better detection or recording. The QOF prevalence of high blood pressure is rising, and it is rising faster in Buckinghamshire (8% between 2012/13 and 2020/21) than nationally (2% over the same period), such that it overtook the national level in 2019/20.

Not all cases of high blood pressure present in the population will be detected and recorded. Public Health England estimated that 26.9% of Buckinghamshire adults had high blood pressure in 2017. This figure is 11 percentage points higher than the primary care recorded prevalence, which could equate to an additional 47,000 adults with unrecorded or undiagnosed high blood pressure in Buckinghamshire.

Local primary care data show that 3.4% (14,220) of Buckinghamshire adults have coronary heart disease (CHD). Buckinghamshire has a similar prevalence of coronary heart disease to the national average – in the QOF 2020/21 the prevalence was 2.9% in Buckinghamshire compared to 3.0% nationally. Although the QOF prevalence of coronary heart disease has been falling, it has not fallen as quickly in Buckinghamshire (a 2% fall between 2012/13 and 2020/21) as it has done nationally (9% fall over the same period).

Local primary care data show that 1.9% (7,877) of Buckinghamshire adults have a history of stroke or transient ischaemic attack (TIA). Buckinghamshire has a similar prevalence of stroke to the national average – in the QOF 2020/21 the all-age prevalence was 1.7% in Buckinghamshire compared to 1.8% nationally. The QOF prevalence of stroke is rising and it is rising faster in Buckinghamshire (9% between 2012/13 and 2020/21) than nationally (6% over the same period).

The prevalence of high blood pressure, coronary heart disease and stroke/transient ischaemic attack do not show a clear relationship between deprivation and prevalence. This could be partly due to the younger age profile of the more deprived areas as these conditions are more commonly found in older age groups and these primary care datasets do not take the age of the practice population into account. Alternatively, this could potentially reflect under-recording or under-detection especially of high blood pressure as this often has no symptoms.