joint strategic needs assessment foundation profile - JSNA

Interative Hull Atlas: www.hullpublichealth.org/Pages/hull_atlas.htm More information: www.jsnaonline.org and www.hullpublichealth.org
There are many issues around having AAACMR targets, and whilst the following are not
considered „excuses‟ it is useful to have some knowledge about the difficulties involved
around the targets and achieving the targets (some based on speculation). The
following are more general comments that could be applied to any geographical area.
Calculating the AAACMR is more complex relative to the calculation of other
targets such as the 18 week treatment waiting target.
Life expectancy at birth, AAACMR and standardised mortality ratios (SMRs) all
measure slightly different aspects of mortality and differ due to differences in the
calculation and standard population. Therefore, just because one measure
improves does not necessarily mean that another measure will improve (to the
same degree).
AAACMR is used as a proxy for life expectancy. The Department of Health
changed their targets from life expectancy to AAACMR. They used statistical
modelling to obtain the AAACMR targets from original life expectancy targets.
Their methodology contained serious statistical flaws as well as a very small
number of minor numerical errors.
AAACMR (and other measures of mortality such as SMRs) are dependent on the
age structure (and therefore choice of) the „standard‟ population. This is less of
an issue for the AAACMR it is generally standardised to the European Standard
Population (ESP) which is fixed, although it is an artificial population that is not
representative of Hull‟s or England‟s population as there are too few people in the
older age groups for the ESP.
The AAACMR is an annual measure, which it must be in order to be useful, as
the number of deaths changes with seasonality (generally more deaths in winter).
However, this means that one year is a relatively long time to wait to assess
progress towards the target.
A major issue with using such mortality measures as targets as AAACMR and life
expectancy measure, is that they are targets on dying and not quality of life. It
may be possible to extend the life of terminally ill patients by a few weeks and
improve mortality rates, but quality of life would be poor. A good target should be
to delay mortality by extending the period of high quality life.
Age is considered as a five year age band, so it is possible that improvements
may not register. For example, increasing the age at death from 72 years to 74
years will make relatively little difference to the AAACMR. However, increasing
the age at death from 74 years to 75 years will make a bigger difference as the
death is included in the next five year age band.
The AAACMR and life expectancy are subject to year-on-year variability, due to
local influenza outbreaks, major accidents, mild winters, etc.
AAACMR and life expectancy are difficult to influence in the short-term. With
smoking cessation, the probability of death is reduced over time for most causes
of death, but it can take up to 30 years for the risk to reduce to the same as a
„never‟ smoker for some particular causes of death. For example, reducing the
prevalence of obesity may improve prognosis in relation to diabetes, but it may
Joint Strategic Needs Assessment Foundation Profile – Hull Health Profile: Release 3. March 2011. 225