Official Statistics

Cardiovascular disease and diabetes profiles: statistical commentary

Published 5 March 2024

Applies to England

What’s new

The following indicators have been updated with one or some of the following geographies of England, local authority, integrated care board, sub-integrated care board, and regional area:

• renal replacement therapy and dialysis for people with kidney conditions
• times to hospital treatment for severe heart attack patients
• effectiveness of diabetes healthcare against guidelines
• hospital admissions for coronary heart disease (CHD), heart failure and stroke
• mortality for coronary heart disease, heart failure and stroke

The hospital admission and mortality indicators for England, counties and local unitary authority (UA) areas between 2012 and 2023 have been calculated using the 2021 census-based populations. They are no longer comparable with previous data that was based on 2011 census-based populations. Data from 2012 has been recalculated using these new populations.

Introduction 

The cardiovascular disease (CVD) and diabetes profiles bring together data on the pathway of care and the outcomes for people with CVD and diabetes, including risk factors, management of the disease and its risk conditions in primary care, emergency care, hospitalisation and mortality.

These profiles provide a single summary of the burden of CVD and diabetes to:

• bring together data on the pathway of healthcare in one tool to enable users to access and utilise the intelligence more easily
• support health professionals to assess the impact of the disease on their local population and make decisions about services
• identify and address inequalities in care between local areas

Data on the following conditions are included in this commentary:

• kidney disease. When someone has kidney disease, their heart needs to pump harder to get blood to the kidneys and this can lead to heart disease
• type 1 and type 2 diabetes. Diabetes is a lifelong metabolic condition in which the body does not produce sufficient insulin to regulate blood glucose levels
• coronary heart disease (CHD), where the arteries that supply blood to the heart become clogged up with fatty substances. CHD data includes heart attack, which is a serious medical emergency in which the supply of blood to the heart is suddenly blocked
• heart failure, a condition where the heart is unable to pump blood around the body properly
• stroke, a serious life-threatening medical condition that happens when the blood supply to part of the brain is cut off

Main findings

This update shows for England:

• between the 15 months ending March 2022 and the 15 months ending March 2023, the percentage of people with type 1 diabetes receiving 8 care processes increased 22% and for type 2 diabetes it increased by 21%
• between the 15 months ending March 2022 and the 15 months ending March 2023, the percentage of people with type 1 diabetes achieving target blood glucose (HbA1c) levels increased to 37.9%, the highest value ever reported by the National Diabetes Audit (NDA)
• the average time from a 999 call for help until first hospital treatment procedure for patients with severe heart attack increased from the financial year ending 2022 to the financial year ending 2023
• the hospital admission rate for CHD decreased by 46% from the financial year ending 2003 to the financial year ending 2023
• in the 6 years ending 2021 there was an increase in the acceptance rate of patients on to kidney replacement therapy (KRT), compared to the fall over the 6 years ending in 2020
• from 2019 to 2022 the CHD mortality rate in persons aged under 75 years increased 14.3%

Detailed findings

Diabetes

The National Institute for Health and Care Excellence (NICE) recommends 9 care processes for diabetes. Data for 8 care processes (excluding eye screening) are reported here from the NDA. The NDA is a national clinical audit of primary care data, which measures the effectiveness of diabetes healthcare against NICE guidelines

In the 15 months ending in March 2023, among GP practices that participate in the NDA, the percentage of people with type 1 diabetes in England receiving 8 care processes increased to 43.8% from 35.2% in the previous year (Figure 1). This is also higher than the percentage in the 15 months ending in 2020, which was 42.3%. For people with type 2 diabetes, participation increased to 57.9% from 48.9% the previous year. However, this is below the percentage in the 15 months ending in 2020 (58.5%).

The percentage of people with diabetes receiving a blood glucose test, blood pressure check or foot check are still below the level in the 15 months ending in 2020.

For people with type 1 diabetes, the percentage of people that achieved their recommended HbA1c target (of less than or equal to 58 mmol/mol) continued to increase in the 15 months ending March 2023 (Figure 2). This increased by 4.4% from the previous 15 month period. For people with type 2 diabetes, the percentage achieving the HbA1c target also increased, but only by 1.4% from the previous 15 month period.

The percentage of people achieving the blood pressure target of less than or equal to 140/80 increased in the 15 months ending in 2023 for both type 1 (2.0%) and type 2 (4.2%) diabetes when compared to the previous period. However, both are still below the percentage achieving the target in the 15 months ending in 2020.

Figure 1: percentage of people with type 1 and type 2 diabetes that received 8 care processes, all ages, England, 15 months ending March 2018 to the 15 months ending March 2023

Figure 2: percentage of people with type 1 and type 2 diabetes that achieved HbA1c and blood pressure treatment targets, all ages, England, 15 months ending March 2018 to the 15 months ending March 2023

Kidney disease

In the financial year ending 2023 there were just under 2,093,000 people aged 18 years and over with a GP diagnosis of chronic kidney disease in England (4.2%). This is an increase from 1,963,000 from the previous year.

KRT can be used as a replacement for lost kidney function in people with end stage kidney disease. Kidney transplants continued as the most common KRT treatment type (56%) in 2021, while 36% of people received hospital dialysis and 8% home based dialysis. There was little change in the modality breakdown between 2020 and 2021.

Coronary heart disease and heart failure

In the financial year ending 2023 there were just over 1,862,500 people (3%) with a GP diagnosis of CHD in England. The percentage of people in England with a recorded GP diagnosis of CHD has decreased since the financial year ending 2010.

Hospital admission rates for CHD have decreased by 46% over the past 20 years to the financial year ending 2023 and this downward trend can be seen in figure 3. There was also a 2.9-fold difference in admission rates for coronary heart disease between the counties and UAs in England in the financial year ending 2023. The highest rate of 676.2 per 100,000 population was in Tameside and the lowest of 233.5 per 100,000 population in Bath and North East Somerset.

Figure 3: age standardised rate of CHD admissions, persons, England, in the financial year ending 2010 to the financial year ending 2023

The range in admission rates for heart failure between local authorities was larger than CHD with a 3.5-fold difference between counties and UAs in England. The highest rate of 376.8 per 100,000 population was in Sefton and the lowest of 107.7 per 100,000 in Rutland .

The rate of mortality from CHD in England in those aged under 75 has decreased every year from 2001 to 2019. However, between 2019 and 2022 the rate increased for males by 14.6% and for females by 14% (Figure 4). There was also a 3.3-fold difference in mortality rates for CHD in 2022 between the counties and UAs with highest and lowest rates in England. The highest rate of 78.1 per 100,000 was in in Blackpool and lowest rate of 23.9 per 100,000in Richmond upon Thames.

Figure 4: age standardised mortality rate for CHD for males, females and persons aged under 75 years, England, 2001 to 2022

Stroke

In the financial year ending 2023 there were just over 1,152,000 people (1.8%) with a GP diagnosis of stroke or transient ischaemic attack (TIA) in England. A TIA is often referred to as a mini stroke and is caused by a temporary disruption in the blood supply to part of the brain. The number of people with a recorded GP diagnosis of stroke or TIA in England has continued to rise every year since the financial year ending 2010.

There was a 3.5-fold difference in admission rates for stroke between the counties and UAs in England with the highest and lowest rate with 329.8 per 100,000 population in Gateshead and 103.2 per 100,000 population in Bromley in the financial year ending 2023.

Revisions

The March 2024 update included a full revision for the England data for all hospital admission and mortality rates. This was required due to the update of population estimates to the 2021 census-based populations. These are no longer comparable with previous data that was based on 2011 census-based populations. Data from 2012 has been recalculated using these new populations.

Further information

Further details about the profile methodology are available within the definitions section of the online version of the CVD disease profile and the online version of the diabetes profile.

For queries relating to this document, please contact: [email protected]