Cerebrovascular disease

Cerebrovascular disease (CBVD) is the death of brain tissue that occurs when the brain does not receive enough blood flow and oxygen.  It is the third largest killer and a major cause of hospital admission in Herefordshire.  There are a number of different types of cerebrovascular disease. The four most common types are:

• Stroke – a serious medical condition where one part of the brain is damaged by a lack of blood supply or bleeding into the brain from a burst blood vessel
• Transient ischaemic attack (TIA) – a temporary fall in the blood supply to one part of the brain, resulting in brief symptoms similar to stroke
• Subarachnoid haemorrhage – a type of stroke where blood leaks out of the brain's blood vessels on to the surface of the brain
• Vascular dementia – persistent impairment in mental ability resulting from stroke or other problems with blood circulation to the brain

Hypertension prevalence higher in Herefordshire than across England

Hypertension (high blood pressure) is the single biggest risk factor for stroke, and it also plays a significant role in heart attacks. Risk factors for hypertension include being overweight or obese, lack of physical activity, and being diabetic. In 2017/18 hypertension prevalence in Herefordshire was 16.4% compared to 13.9% across England as a whole, while prevalence in Herefordshire GP practices ranged between 14.0% and 19.1%.

Stroke prevalence remains unchanged but higher than across England

Since 2009/10 the stroke prevalence in Herefordshire has not changed appreciably, ranging between 2.2 and 2.3%, although the local figure has been consistently higher than that reported for England as a whole. In 2017/18 there were 4,369 people who have previously been diagnosed with a stroke in Herefordshire which represents a local prevalence of 2.3% compared to 1.8% nationally. Stroke prevalence ranged between 1.4% and 3.2% across Herefordshire GP practices in 2017/18.

In the Herefordshire CCG area, the rate of hospital admissions (all ages) with a primary diagnosis of stroke fell from 247 to 144 per 100,000 between 2010/11 and 2012/13 although the figure has risen slowly since. In 2017/18 the local admission rate was 168 per 100,000, a figure not significantly different from that recorded for England as a whole.

Local premature mortality rate similar to national figure

The Herefordshire premature mortality rate (under 75 years of age) for stroke in 2015-17 was 12.3 per 100,000, a figure not significantly different from those recorded over the previous decade; the most recent local rate was similar to that reported for England (13.1 per 100,000). While the local stroke mortality rate in those aged 75 has fallen by almost a half since 2004-06 the figure for 2015-17 (612 per 100,000) was significantly higher than recorded nationally (541 per 100,000).

Those living in the most deprived areas of Herefordshire are over 70% more likely to die prematurely (under 75 years of age) of cerebrovascular disease compared to those from the least deprived areas.