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Part of: Ill Health and Disability

Related to: Ageing Population,Diabetes, Diet and Malnutrition, [[Health Checks]], Heart Failure, Hypertension, Major Causes of Mortality, Healthy Weight, Physical Activity, Smoking, Food Poverty

Key Facts:

  • There were 3,488 people in 2012/13 (financial year)  who suffered from a stroke or transient ischaemic attack in B&NES
  • The rate of stroke or Transient Ischaemic Attacks in B&NES is significantly lower than the South West but higher than the England Average
  • The observed rate of strokes in Bath & North East Somerset is 92% of the estimated rate. This compares to 83% for England.
  • The emergency admission rates for strokes in Bath and North East Somerset are higher than England and the South West
  • Early Deaths due to Stroke are reducing in line with national figures.  In fact, premature deaths (in terms of potential years of life lost) from cerebrovascular diseases is significantly lower in B&NES compared to the national average.

A stroke is a condition that occurs when the blood supply to part of the brain is cut off. Strokes are a medical emergency and prompt treatment is essential because the sooner a person receives treatment for a stroke, the less damage is likely to happen. If the supply of blood is restricted or stopped, brain cells begin to die. This can lead to brain damage and possibly death. A stroke can affect many different body functions, depending on the part of the brain that is involved. The symptoms of stroke can include: numbness, weakness or lack of movement on one side of the body, slurred speech, difficulty finding words or understanding speech, problems with vision, confusion and severe headache.

There are two main causes of strokes:

  • ischaemic (accounting for over 80% of all cases) – the blood supply is stopped due to a blood clot
  • haemorrhagic – a weakened blood vessel supplying the brain bursts and causes brain damage

There is also a related condition known as a transient ischaemic attack (TIA), where the supply of blood to the brain is temporarily interrupted, causing a 'mini-stroke'. TIAs should be treated seriously as they are often a warning sign that a stroke iscoming. 1

What does the data say?

In England, strokes are a major health problem. Every year over 150,000 people have a stroke and it is the third largest cause of death, afterheart disease and cancer. The brain damage caused by strokes means that they are the largest causeof adult disability in the UK. 2

People over 65 years of age are most at risk from having strokes, although 25% of strokes occur in people who are under 65. It is also possible forchildren to have strokes. 3

If you are south Asian, African or Caribbean, your risk of stroke is higher. This is partly because of a predisposition (a natural tendency) to developingdiabetes and heart disease, which are two conditions that can cause strokes. 4

Smoking, being overweight, lack of exercise and a poor diet are also risk factors for stroke. Also, conditions that affect the circulation of the blood,such as high blood pressure, high cholesterol, atrial fibrillation (an irregular heartbeat) and diabetes,increase your risk of having a stroke. 5

Bath and North East Somerset

There are 3,488 people (2012/13 financial year) who have suffered from a stroke or transient ischaemic attack registered with a GP practise in Bath and North EastSomerset.* 6

The prevalence rate of stroke or Transient Ischaemic Attacks in B&NES remained at 1.8% between 2008-2013 (financial years)* . 7

The prevalence rate of stroke or Transient Ischaemic Attacks in B&NES has been significantly lower than the South West which has had a prevalence rate of 1.9% - 2.1% between 2008-2012 (financial years) . Nevertheless, the prevalence of stroke or Transient Ischaemic Attacks in B&NES has remained slightly higher than England as a whole, which had a prevalence rate of 1.7% between 2008-2013 (financial years).* 8

stroke_-_rates_of_in_bnes_and_england_gp_pop_from_qof_2008-13

Figure 1: Stroke or transient ischaemic attacks (TIA) prevalence in B&NES and England GP registered populations (2008/09 – 2012/13 financial years) 9

*It is important to note that the above prevalence rates are based on the GP registered population of Bath and North East Somerset and so some of these people may not be residents of Bath North East Somerset. Nevertheless, the vast majority of people will be registered with a GP in their county of residence.

For more up to date prevalence figures for stroke recorded as part of the NHS Quality and Outcomes Framework (QOF), see the Ill Health and Disability section. 

The observed rate of strokes in Bath & North East Somerset is 92% of the estimated rate. This compares to 83% for England. 10

In terms of potential Years of Life Lost (YLL), B&NES CCG has a significantly lower rate of annual years of life lost to cerebrovascular diseases compared to the comparable rate for England - see Major Causes of Mortality (Premature Mortality) for further information.

Variation of stroke rates at Primary Care Trust cluster level:

  • 1.1% Bath Central,
  • 2.26% Chew/Keynsham 11

However, Bath Central has a lower ratio of recorded: expected prevalence of stroke, whereas Chew/Keynsham has very high ratio of recorded: expectedprevalence. 12

The emergency admission rates for strokes in Bath and North East Somerset are higher than England and the South West. 13

There is a lower proportion of stroke patients 75 years and over discharged back to their home or usual place of residence compared to the national picture

Emergency admission rates for strokes are higher for more deprived communities; however the gap has decreased since 2003/2004. The directly standardised rate for most deprived quintile in Bath and North East Somerset is 98.2 compared with 79.9 directly standardised rate for the least deprived quintile. This means that it is 1.2 times greater in the most deprived areas compared with the least deprived, but this gap is smaller than nationally (1.7 times greater nationally). 14

Are we meeting the needs?

Mortality from stroke in Bath and North East Somerset has decreased since 1993. 15

The rate of mortality from strokes has not been as great as comparator areas since 2006 and mortality in Bath and North East Somerset is now at a similar level to comparators (1993 rate was 81.58 per 100,000 (249) and in 2010 45.74 per 100,000 (180) (nationally and regionally about 45 per 100,000). 16

Mortality from stroke in under 65 year olds is also decreasing, although in Bath and North East Somerset this decrease is less marked than in comparator areas and there is also significant year on year variation making it difficult to discern a reliable trend, whereas nationally and regionally there is a more distinct downward trend. Currently 6 per 100,000 (nationally 6 per 100,000, regionally 5 per 100,000). 17

What can we realistically change?

National Institute for Health and Clinical Excellence (NICE)(2011-2013) guidance