What is Chronic Obstructive Pulmonary Disease and who does it affect?

Across England there are almost 1.1 million people diagnosed with Chronic Obstructive Pulmonary Disease (COPD), encompassing a group of lung conditions that cause breathing difficulties, such as emphysema and chronic bronchitis.

That’s almost one in every 50 people registered with a GP, or around 1.9% of the population and it costs the NHS more than £800 million per year.

COPD is a degenerative disease, mainly affecting middle-aged and older adults who smoke, and can go undiagnosed for some time. Symptoms include breathlessness, a chesty cough, high risk of chest infections and persistent wheezing.

Although GP-level data for COPD registrations is available for Scotland, Wales and Northern Ireland, there is no corresponding data on where patients live. As such, comparable estimates for small areas can only be produced for England, however national prevalence levels can be provided for the rest of the UK. For Scotland it’s 2.3% (2015/16), Wales is 2.3%, and Northern Ireland is 2.0% (As shown here).

High rates in the North of England

Across England, COPD rates are higher in the North and in deprived areas and areas with higher smoking rates.

COPD rates in England

 

The table below lists the constituencies that are estimated as having the highest COPD prevalence. All 10 of these are in the North of England other than Clacton in the East of England.

Methodologies for producing these estimates are included at the end of this post.

Where is COPD highest?

 

Neighbourhoods (LSOAs) with the highest COPD prevalence are Jaywick (near Clacton, Essex), Shotton & South Hetton (Country Durham) and Mablethorpe (East Lincolnshire).

Blackpool to Bolsover

Some of the highest rates of COPD are found in what can be described as the urban North –encompassing Merseyside, Manchester, West Yorkshire and South Yorkshire. Knowsley and Liverpool have COPD prevalence rates almost double the expected levels, based on the age structure of their populations. Some places in this region with high COPD prevalence, such as the areas around Liverpool and Blackpool, also have high rates of deprivation and smoking.

Starting in the North West, Liverpool and Blackpool can be identified as hotspots for COPD (see table), and cover areas with high levels of smoking. Blackpool is ranked highest for smoking prevalence in England, with an estimated rate of just over 26% for persons 15 years of age and above (the 2016 national average was 15.5%). Knowsley CCG ranks as 6th for smoking prevalence.

Constituencies in Liverpool are ranked as some of the highest areas of deprivation in England, with three falling in the top 10 deprived constituencies during the 2011 census (Liverpool Walton; Knowsley; and Liverpool West Derby).

Manchester and its surrounds also rank highly in the deprivation register, as well as South Yorkshire. High deprivation levels can be found in Bolsover and Barnsley also. These areas also have some of the highest levels of smoking in the country. The map below shows estimates for Lower Super Output Area (LSOA) areas based on GP practice data, and highlights that many of the areas with high smoking and deprivation levels also have a high COPD prevalence.

COPD in the north

 

North East coast

As noted above, some of the highest levels of COPD are found in the North East. Easington and South Shields have the highest estimated COPD prevalence in the county – levels are more than double the national average. Not far behind are Sunderland, areas surrounding Durham and Middlesbrough and its surrounds. Within these areas, there are also high levels of smoking prevalence (around the 20% mark in many areas).

COPD in the north east of England

 

Lower levels in London

London has lower COPD prevalence than other regions of England. COPD rates tend to be higher in older people and London has a younger than average population. However, some areas in London have higher COPD prevalence than expected based on the age structure of their population. Tower Hamlets has prevalence two thirds higher than expected for its age structure, and Barking & Dagenham and Islington have prevalence around 40% higher than expected. Baring this in mind, there are some areas with a much lower prevalence than their age profile would predict, namely Richmond and Ealing.

In the wider South East, South Thanet is the constituency with the highest COPD prevalence (2.9%).

COPD in London and the south east

 

A note on data sources and methods

NHS Digital publishes an annual figure on the number of people at each GP practice with a diagnosis of COPD. Data is also published on the areas that GP patients live in, which allows for estimates of disease prevalence in small areas.

COPD prevalence estimates in this blog are calculated by combining these two sources. Estimates are made for each LSOA based on the GP practices that residents are registered with. Therefore, if all residents of an LSOA attend a GP practice where the COPD prevalence is 2%, we assume that the prevalence in that LSOA is 2%. Most LSOAs include people registered in multiple practices, in which case we weight according to the average prevalence recorded at each practice. Constituency data is aggregated from LSOA-level data.

LSOAs where less than 60% of patients attend practices which are included in this blog were excluded from the analysis.

Age-standardised prevalence rates referenced above are estimated using the age-specific rates published by the British Lung Foundation in 2012 and adjusted for changes in COPD prevalence since then. Note that this estimated age distribution covers the whole of the UK rather than just England, so the results of this calculation are subject to some uncertainty.

Whilst there are limitations to these estimations, they allow for comparison across areas and provide us with the most detailed picture of COPD prevalence with the available data.