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Changes in health in England, with analysis by English regions and areas of deprivation, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

Changes in health in England, with analysis by English regions and areas of deprivation, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013
Changes in health in England, with analysis by English regions and areas of deprivation, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013
Background

In the Global Burden of Disease Study 2013 (GBD 2013), knowledge about health and its determinants has been integrated into a comparable framework to inform health policy. Outputs of this analysis are relevant to current policy questions in England and elsewhere, particularly on health inequalities. We use GBD 2013 data on mortality and causes of death, and disease and injury incidence and prevalence to analyse the burden of disease and injury in England as a whole, in English regions, and within each English region by deprivation quintile. We also assess disease and injury burden in England attributable to potentially preventable risk factors. England and the English regions are compared with the remaining constituent countries of the UK and with comparable countries in the European Union (EU) and beyond.

Methods

We extracted data from the GBD 2013 to compare mortality, causes of death, years of life lost (YLLs), years lived with a disability (YLDs), and disability-adjusted life-years (DALYs) in England, the UK, and 18 other countries (the first 15 EU members [apart from the UK] and Australia, Canada, Norway, and the USA [EU15+]). We extended elements of the analysis to English regions, and subregional areas defined by deprivation quintile (deprivation areas). We used data split by the nine English regions (corresponding to the European boundaries of the Nomenclature for Territorial Statistics level 1 [NUTS 1] regions), and by quintile groups within each English region according to deprivation, thereby making 45 regional deprivation areas. Deprivation quintiles were defined by area of residence ranked at national level by Index of Multiple Deprivation score, 2010. Burden due to various risk factors is described for England using new GBD methodology to estimate independent and overlapping attributable risk for five tiers of behavioural, metabolic, and environmental risk factors. We present results for 306 causes and 2337 sequelae, and 79 risks or risk clusters.

Findings

Between 1990 and 2013, life expectancy from birth in England increased by 5·4 years (95% uncertainty interval 5·0–5·8) from 75·9 years (75·9–76·0) to 81·3 years (80·9–81·7); gains were greater for men than for women. Rates of age-standardised YLLs reduced by 41·1% (38·3–43·6), whereas DALYs were reduced by 23·8% (20·9–27·1), and YLDs by 1·4% (0·1–2·8). For these measures, England ranked better than the UK and the EU15+ means. Between 1990 and 2013, the range in life expectancy among 45 regional deprivation areas remained 8·2 years for men and decreased from 7·2 years in 1990 to 6·9 years in 2013 for women. In 2013, the leading cause of YLLs was ischaemic heart disease, and the leading cause of DALYs was low back and neck pain. Known risk factors accounted for 39·6% (37·7–41·7) of DALYs; leading behavioural risk factors were suboptimal diet (10·8% [9·1–12·7]) and tobacco (10·7% [9·4–12·0]).

Interpretation

Health in England is improving although substantial opportunities exist for further reductions in the burden of preventable disease. The gap in mortality rates between men and women has reduced, but marked health inequalities between the least deprived and most deprived areas remain. Declines in mortality have not been matched by similar declines in morbidity, resulting in people living longer with diseases. Health policies must therefore address the causes of ill health as well as those of premature mortality. Systematic action locally and nationally is needed to reduce risk exposures, support healthy behaviours, alleviate the severity of chronic disabling disorders, and mitigate the effects of socioeconomic deprivation.

Funding

Bill & Melinda Gates Foundation and Public Health England.
0140-6736
2257-2274
Newton, John N.
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Briggs, Adam D.M.
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Murray, Christopher J.L.
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Dicker, Daniel
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Foreman, Kyle J.
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Wang, Haidong
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Naghavi, Mohsen
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Forouzanfar, Mohammad H.
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Newton, John N.
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Naghavi, Mohsen
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Vos, Theo
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Stanaway, Jeffrey D.
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Ecob, Russell
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Gresser, Charis
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Newton, John N., Briggs, Adam D.M., Murray, Christopher J.L., Dicker, Daniel, Foreman, Kyle J., Wang, Haidong, Naghavi, Mohsen, Forouzanfar, Mohammad H., Ohno, Summer Lockett, Barber, Ryan M., Vos, Theo, Stanaway, Jeffrey D., Schmidt, Jürgen C., Hughes, Andrew J., Fay, Derek F.J., Ecob, Russell, Gresser, Charis, McKee, Martin, Rutter, Harry, Abubakar, Ibrahim, Ali, Raghib, Anderson, H. Ross, Banerjee, Amitava, Bennett, Derrick A., Bernabé, Eduardo, Bhui, Kamaldeep S., Biryukov, Stanley M., Bourne, Rupert R., Brayne, Carol E.G., Bruce, Nigel G., Brugha, Traolach S., Burch, Michael, Capewell, Simon, Casey, Daniel, Chowdhury, Rajiv, Coates, Matthew M., Cooper, Cyrus, Critchley, Julia A., Dargan, Paul I., Dherani, Mukesh K., Elliott, Paul, Ezzati, Majid, Fenton, Kevin A., Fraser, Maya S., Fürst, Thomas, Greaves, Felix, Green, Mark A., Gunnell, David J., Hannigan, Bernadette M., Hay, Roderick J., Hay, Simon I., Hemingway, Harry, Larson, Heidi J., Looker, Katharine J., Lunevicius, Raimundas, Lyons, Ronan A., Marcenes, Wagner, Mason-Jones, Amanda J., Matthews, Fiona E., Moller, Henrik, Murdoch, Michele E., Newton, Charles R., Pearce, Neil, Piel, Frédéric B., Pope, Daniel, Rahimi, Kazem, Rodriguez, Alina, Scarborough, Peter, Schumacher, Austin E., Shiue, Ivy, Smeeth, Liam, Tedstone, Alison, Valabhji, Jonathan, Williams, Hywel C., Wolfe, Charles D.A., Woolf, Anthony D. and Davis, Adrian C.J. (2015) Changes in health in England, with analysis by English regions and areas of deprivation, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 386 (10010), 2257-2274. (doi:10.1016/S0140-6736(15)00195-6). (PMID:26382241)

Record type: Article

Abstract

Background

In the Global Burden of Disease Study 2013 (GBD 2013), knowledge about health and its determinants has been integrated into a comparable framework to inform health policy. Outputs of this analysis are relevant to current policy questions in England and elsewhere, particularly on health inequalities. We use GBD 2013 data on mortality and causes of death, and disease and injury incidence and prevalence to analyse the burden of disease and injury in England as a whole, in English regions, and within each English region by deprivation quintile. We also assess disease and injury burden in England attributable to potentially preventable risk factors. England and the English regions are compared with the remaining constituent countries of the UK and with comparable countries in the European Union (EU) and beyond.

Methods

We extracted data from the GBD 2013 to compare mortality, causes of death, years of life lost (YLLs), years lived with a disability (YLDs), and disability-adjusted life-years (DALYs) in England, the UK, and 18 other countries (the first 15 EU members [apart from the UK] and Australia, Canada, Norway, and the USA [EU15+]). We extended elements of the analysis to English regions, and subregional areas defined by deprivation quintile (deprivation areas). We used data split by the nine English regions (corresponding to the European boundaries of the Nomenclature for Territorial Statistics level 1 [NUTS 1] regions), and by quintile groups within each English region according to deprivation, thereby making 45 regional deprivation areas. Deprivation quintiles were defined by area of residence ranked at national level by Index of Multiple Deprivation score, 2010. Burden due to various risk factors is described for England using new GBD methodology to estimate independent and overlapping attributable risk for five tiers of behavioural, metabolic, and environmental risk factors. We present results for 306 causes and 2337 sequelae, and 79 risks or risk clusters.

Findings

Between 1990 and 2013, life expectancy from birth in England increased by 5·4 years (95% uncertainty interval 5·0–5·8) from 75·9 years (75·9–76·0) to 81·3 years (80·9–81·7); gains were greater for men than for women. Rates of age-standardised YLLs reduced by 41·1% (38·3–43·6), whereas DALYs were reduced by 23·8% (20·9–27·1), and YLDs by 1·4% (0·1–2·8). For these measures, England ranked better than the UK and the EU15+ means. Between 1990 and 2013, the range in life expectancy among 45 regional deprivation areas remained 8·2 years for men and decreased from 7·2 years in 1990 to 6·9 years in 2013 for women. In 2013, the leading cause of YLLs was ischaemic heart disease, and the leading cause of DALYs was low back and neck pain. Known risk factors accounted for 39·6% (37·7–41·7) of DALYs; leading behavioural risk factors were suboptimal diet (10·8% [9·1–12·7]) and tobacco (10·7% [9·4–12·0]).

Interpretation

Health in England is improving although substantial opportunities exist for further reductions in the burden of preventable disease. The gap in mortality rates between men and women has reduced, but marked health inequalities between the least deprived and most deprived areas remain. Declines in mortality have not been matched by similar declines in morbidity, resulting in people living longer with diseases. Health policies must therefore address the causes of ill health as well as those of premature mortality. Systematic action locally and nationally is needed to reduce risk exposures, support healthy behaviours, alleviate the severity of chronic disabling disorders, and mitigate the effects of socioeconomic deprivation.

Funding

Bill & Melinda Gates Foundation and Public Health England.

Other
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More information

e-pub ahead of print date: 14 September 2015
Published date: 5 December 2015
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 384732
URI: http://eprints.soton.ac.uk/id/eprint/384732
ISSN: 0140-6736
PURE UUID: 3e34a2fa-9456-4773-ab47-852d2b048bbe
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

Catalogue record

Date deposited: 11 Dec 2015 14:54
Last modified: 17 Dec 2019 01:56

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Contributors

Author: John N. Newton
Author: Adam D.M. Briggs
Author: Christopher J.L. Murray
Author: Daniel Dicker
Author: Kyle J. Foreman
Author: Haidong Wang
Author: Mohsen Naghavi
Author: Mohammad H. Forouzanfar
Author: Summer Lockett Ohno
Author: Ryan M. Barber
Author: Theo Vos
Author: Jeffrey D. Stanaway
Author: Jürgen C. Schmidt
Author: Andrew J. Hughes
Author: Derek F.J. Fay
Author: Russell Ecob
Author: Charis Gresser
Author: Martin McKee
Author: Harry Rutter
Author: Ibrahim Abubakar
Author: Raghib Ali
Author: H. Ross Anderson
Author: Amitava Banerjee
Author: Derrick A. Bennett
Author: Eduardo Bernabé
Author: Kamaldeep S. Bhui
Author: Stanley M. Biryukov
Author: Rupert R. Bourne
Author: Carol E.G. Brayne
Author: Nigel G. Bruce
Author: Traolach S. Brugha
Author: Michael Burch
Author: Simon Capewell
Author: Daniel Casey
Author: Rajiv Chowdhury
Author: Matthew M. Coates
Author: Cyrus Cooper ORCID iD
Author: Julia A. Critchley
Author: Paul I. Dargan
Author: Mukesh K. Dherani
Author: Paul Elliott
Author: Majid Ezzati
Author: Kevin A. Fenton
Author: Maya S. Fraser
Author: Thomas Fürst
Author: Felix Greaves
Author: Mark A. Green
Author: David J. Gunnell
Author: Bernadette M. Hannigan
Author: Roderick J. Hay
Author: Simon I. Hay
Author: Harry Hemingway
Author: Heidi J. Larson
Author: Katharine J. Looker
Author: Raimundas Lunevicius
Author: Ronan A. Lyons
Author: Wagner Marcenes
Author: Amanda J. Mason-Jones
Author: Fiona E. Matthews
Author: Henrik Moller
Author: Michele E. Murdoch
Author: Charles R. Newton
Author: Neil Pearce
Author: Frédéric B. Piel
Author: Daniel Pope
Author: Kazem Rahimi
Author: Alina Rodriguez
Author: Peter Scarborough
Author: Austin E. Schumacher
Author: Ivy Shiue
Author: Liam Smeeth
Author: Alison Tedstone
Author: Jonathan Valabhji
Author: Hywel C. Williams
Author: Charles D.A. Wolfe
Author: Anthony D. Woolf
Author: Adrian C.J. Davis

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