| Costs of stroke in England | |||
| Cost (£million) | 2015 | 2025 | 2035 |
|---|---|---|---|
| Health care | 2,983 | 5,189 | 9,015 |
| Social care - Public | 2,148 | 4,163 | 7,936 |
| Social care - Private | 2,403 | 4,733 | 9,130 |
| Social care - Total | 13,675 | 21,453 | 37,300 |
| Unpaid care | 4,551 | 8,896 | 17,066 |
| Lost productivity | 1,305 | 2,012 | 3,106 |
| Total | 22,514 | 37,550 | 66,487 |
| Source: Stroke.org, 2018 | |||
Stroke
Healthy People
Physical Health Conditions
Stroke
Cardiovascular Disease
Atrial Fibrillation
Hypertension
Smoking
Obesity
Weight Management
Alcohol
Physical Activity
Diabetes
Introduction
A stroke occurs when the blood supply stops flowing to the brain, causing brain cells to die. 87% of strokes are ischemic, where a blockage in the brain has occurred, caused by a piece of plaque or blood clot. Plaque is made up of fat, cholesterol, calcium and other substances. This plaque builds on the lining of the arteries, causing the arteries to narrow, reducing or totally blocking the blood flow and oxygen to the heart, brain and other parts of the body. Where the blockage occurs in the brain this is known as thrombosis. If the clot has travelled from elsewhere in the body, this is known as embolism.1
The term mini stoke refers to a transient ischemic attack (TIA), which similarly to an ischemic stroke is caused by a blockage in the brain. This blockage is temporary, breaking up before causing lasting damage but can lead to a full stroke.
Symptoms of a stroke are well known via the acronym of FAST 2
- Face weakness- one side of the face my droop and it may be hard to smile
- Arm weakness- Difficulty or unable to raise both arms and keep them there due to weakness or numbness in 1 arm
- Speech problems- slurring or confusion when speaking.
- Time- to call 999
There are other signs and symptoms of stoke which may include:
- Numbness or weakness to 1 side of the body
- Blurred vision or loss of sight in 1 or both eyes
- Difficulty in speaking or thinking of words
- Confusion or memory loss
- Dizziness or falling over
- Severe headache
- Feeling sick (nausea or vomiting)
Symptoms can very amongst different people, may appear suddenly and may stop after a short time too, in any case urgent medical care should be sought.3
Risk factors of stroke can vary, with some being preventable (modifiable) and others (non-modifiable). Some of the preventable risk factors, which account for 82% to 90% of all strokes are linked to:
- High blood pressure (hypertension)
- Smoking
- Diabetes
- Diet
- Physical activity
- Obesity
With other lifestyle factors such as:
- Age
- Increased Stress/anxiety
- Environmental air pollution
- Alcohol
- Drug use
Comorbidities such as:
- Carotid artery disease
- Peripheral artery disease (PAD)
- Sickle cell disease
- And other heart related diseases4
Non modifiable risk factors such as:
- Family history
- Race
- Gender
- And previous health history of stroke, TIA’s or heart attack
Why is it important to Population Health?
Stroke is one of four known types of cardiovascular disease, along with coronary heart disease, peripheral arterial disease and aortic disease.
Cardiovascular disease causes a quarter of all deaths each year (170,000 deaths each year), equating to 480 deaths a day or one every 3 minutes. And with 7.6 million people in the Uk estimated to be living with cardiovascular disease the NHS have made cardiovascular disease a key priority and focus in recent years.5
Quality of life: Strokes are the biggest cause of severe disability in the UK, and cause around 34,000 deaths each year. People that have experienced and survived a stroke can be affected differently, from a quick recovery and little impact to lengthy recovery times and a significant impact on their lives and also those around them. 73% of people experience a fall in the first year following a severe stroke.6
Inequalities: Evidence suggests that older adults (over 50 years), people of black African-Caribbean or south Asian backgrounds are more at risk of an incident of stroke.
Costs: strokes are estimated to cost the NHS £2.98 billion annually, with additional social care costs of £4.55 billion.A quarter of all strokes occur in people of working age (Under 65), with a third of stroke survivors have to give up work, and a further 15% reducing their hours; the economic impact of which will be felt individually and to wider society.7
Burden: 1 in 12 stroke survivors are significantly impacted by its effects and have to move into a care home. The 2019-2024 NHS long term plan highlighted the importance of stroke care.
In 2018 Stroke.org predicted future costs of a stroke, aged 45 and over:8
Care UK estimate there are around 5.8 million unpaid carer in the UK, with 50% of stroke survivors requiring a carer.9
The Derbyshire Population Health Approach
The Derbyshire Population Health Approach focuses on prevention, population health, evidence-informed practices, causes, and collaboration. It emphasises proactive measures to prevent health issues, tailors interventions to specific populations, incorporates evidence-informed practices, addresses underlying causes, and promotes collaboration for effective action.
When considering the topic of stroke within The Derbyshire Population Health Approach:
• Prevention
The NHS 10-year plan sets out a shift from treating illness to preventing it. Stroke prevention fits well within this approach and can be understood through the three recognised levels of prevention: primary, secondary and tertiary.
Primary (preventing the first stroke): Primary prevention aims to stop a first stroke by reducing risk factors before symptoms appear. At a population level, this includes raising awareness of modifiable risks through public campaigns, education programmes and community resources that promote healthier lifestyles.
In Derbyshire, the Live Life Better service supports people to make positive lifestyle changes, including weight management, stopping smoking, increasing physical activity, alcohol awareness and mental wellbeing.
Nationally, the NHS Health Check programme helps identify early risk factors for cardiovascular disease, including stroke. Health checks are available via GP practices, and Derbyshire County Council also offers workplace-based NHS Health Checks to increase accessibility.10
If people are experiencing early risk factors such as high blood pressure or high cholesterol, they can be prescribed medication to help control these and reduce the risk of stroke occurring.
Secondary (reducing the risk of another stroke): Secondary prevention focuses on people who have already had a stroke or TIA, aiming to prevent another event.
Some individuals may have had surgical treatment, but most secondary prevention involves medication management, such as cholesterol-lowering or antithrombotic therapies; management of related conditions, including diabetes and high blood pressure; and rehabilitation, supporting recovery and reinforcing healthy lifestyle changes. People are encouraged to continue improving their diet, activity levels, smoking status and alcohol intake to further lower their risk.
Tertiary (reducing disability and supporting recovery): Tertiary prevention supports people living with the long-term effects of stroke, aiming to prevent recurrence, minimise disability and maximise quality of life. This is typically delivered by specialist stroke and rehabilitation services, which work to improve functional independence, prevent complications such as muscle tightening, swallowing difficulties or depression, support re-engagement in daily activities and meaningful roles, and provide ongoing medical and lifestyle support to reduce future stroke risk.
Effective prevention can reduce cardiovascular disease by 70%.
• Population
Public health is committed to supporting its ageing population by increasing healthy life expectancy through many targeted interventions. The public health approach also aims to break down barriers with minority populations, working with trusted voices in the community, to ensure they have access to relevant information and services.
• Evidence
Governmental policies continue to try and combat many of the identified risk factors for stroke. This includes a smoke free generation11, sugar tax on foods and drinks12, and the get active strategy.13
Public health relies on these national policies and associated funding to create localised policies and targeted projects to address and support the risk factors associated to stroke, as well as other health conditions.
• Causes
Research shows that people on lower incomes are at greater risk of stroke than those in higher income households. The key risk factors, such as smoking, alcohol use, physical inactivity and unhealthy diets, are more common in these communities not simply because of personal choices, but because of the wider circumstances people live in.
Things like the cost and availability of healthy food, housing conditions, higher levels of stress, and fewer opportunities for physical activity can all make these risk factors harder to avoid. A public health approach focuses on working with these communities, often through targeted support, to help people access services and reduce these inequalities.
• Collaboration
Working together with partners and colleagues is crucial to establishing effective prevention strategies. Collaboration understands the value and joined up working of ICB, NHS, GP’s, public health and local and voluntary services in prevention, secondary prevention and recovery.
Primary, secondary and tertiary prevention require a coordinated approach to ensure that systems and people talk to each other, services developed and delivered are what’s needed, and those services are available and accessible to those that need them. Continuing to offer community-based care, support and services allows the barriers and inequalities to be reduced, reaching those that are more at risk.
Latest Derbyshire Data
Trend Data
Derbyshire Quilt
Prevalence Maps of Derbyshire
The maps below illustrate various geographies for Derbyshire. LSOAs and MSOAs are geographical divisions used for statistical purposes, allowing for more detailed analysis of local data. In these maps, you can explore various health indicators and data for Derbyshire, providing valuable insights into the area’s health and wellbeing.