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Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016
Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Background: Previous studies have reported national and regional Global Burden of Disease (GBD) estimates for the UK. Because of substantial variation in health within the UK, action to improve it requires comparable estimates of disease burden and risks at country and local levels. The slowdown in the rate of improvement in life expectancy requires further investigation. We use GBD 2016 data on mortality, causes of death, and disability to analyse the burden of disease in the countries of the UK and within local authorities in England by deprivation quintile. Methods: We extracted data from the GBD 2016 to estimate years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and attributable risks from 1990 to 2016 for England, Scotland, Wales, Northern Ireland, the UK, and 150 English Upper-Tier Local Authorities. We estimated the burden of disease by cause of death, condition, year, and sex. We analysed the association between burden of disease and socioeconomic deprivation using the Index of Multiple Deprivation. We present results for all 264 GBD causes of death combined and the leading 20 specific causes, and all 84 GBD risks or risk clusters combined and 17 specific risks or risk clusters. Findings: The leading causes of age-adjusted YLLs in all UK countries in 2016 were ischaemic heart disease, lung cancers, cerebrovascular disease, and chronic obstructive pulmonary disease. Age-standardised rates of YLLs for all causes varied by two times between local areas in England according to levels of socioeconomic deprivation (from 14 274 per 100 000 population [95% uncertainty interval 12 791–15 875] in Blackpool to 6888 [6145–7739] in Wokingham). Some Upper-Tier Local Authorities, particularly those in London, did better than expected for their level of deprivation. Allowing for differences in age structure, more deprived Upper-Tier Local Authorities had higher attributable YLLs for most major risk factors in the GBD. The population attributable fractions for all-cause YLLs for individual major risk factors varied across Upper-Tier Local Authorities. Life expectancy and YLLs have improved more slowly since 2010 in all UK countries compared with 1990–2010. In nine of 150 Upper-Tier Local Authorities, YLLs increased after 2010. For attributable YLLs, the rate of improvement slowed most substantially for cardiovascular disease and breast, colorectal, and lung cancers, and showed little change for Alzheimer's disease and other dementias. Morbidity makes an increasing contribution to overall burden in the UK compared with mortality. The age-standardised UK DALY rate for low back and neck pain (1795 [1258–2356]) was higher than for ischaemic heart disease (1200 [1155–1246]) or lung cancer (660 [642–679]). The leading causes of ill health (measured through YLDs) in the UK in 2016 were low back and neck pain, skin and subcutaneous diseases, migraine, depressive disorders, and sense organ disease. Age-standardised YLD rates varied much less than equivalent YLL rates across the UK, which reflects the relative scarcity of local data on causes of ill health. Interpretation: These estimates at local, regional, and national level will allow policy makers to match resources and priorities to levels of burden and risk factors. Improvement in YLLs and life expectancy slowed notably after 2010, particularly in cardiovascular disease and cancer, and targeted actions are needed if the rate of improvement is to recover. A targeted policy response is also required to address the increasing proportion of burden due to morbidity, such as musculoskeletal problems and depression. Improving the quality and completeness of available data on these causes is an essential component of this response. Funding: Bill & Melinda Gates Foundation and Public Health England.

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Steel, Nicholas, Ford, John A., Newton, John N., Davis, Adrian C.J., Vos, Theo, Naghavi, Mohsen, Glenn, Scott, Hughes, Andrew, Dalton, Alice M., Stockton, Diane, Humphreys, Ciaran, Dallat, Mary, Schmidt, Jürgen, Flowers, Julian, Fox, Sebastian, Abubakar, Ibrahim, Aldridge, Robert W., Baker, Allan, Brayne, Carol, Brugha, Traolach, Capewell, Simon, Car, Josip, Cooper, Cyrus, Ezzati, Majid, Fitzpatrick, Justine, Greaves, Felix, Hay, Roderick, Hay, Simon, Kee, Frank, Larson, Heidi J., Lyons, Ronan A., Majeed, Azeem, McKee, Martin, Rawaf, Salman, Rutter, Harry, Saxena, Sonia, Sheikh, Aziz, Smeeth, Liam, Viner, Russell M., Vollset, Stein Emil, Williams, Hywel C., Wolfe, Charles, Woolf, Anthony and Murray, Christopher J.L. (2018) Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet, 392 (10158), 1647-1661. (doi:10.1016/S0140-6736(18)32207-4).

Record type: Article

Abstract

Background: Previous studies have reported national and regional Global Burden of Disease (GBD) estimates for the UK. Because of substantial variation in health within the UK, action to improve it requires comparable estimates of disease burden and risks at country and local levels. The slowdown in the rate of improvement in life expectancy requires further investigation. We use GBD 2016 data on mortality, causes of death, and disability to analyse the burden of disease in the countries of the UK and within local authorities in England by deprivation quintile. Methods: We extracted data from the GBD 2016 to estimate years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and attributable risks from 1990 to 2016 for England, Scotland, Wales, Northern Ireland, the UK, and 150 English Upper-Tier Local Authorities. We estimated the burden of disease by cause of death, condition, year, and sex. We analysed the association between burden of disease and socioeconomic deprivation using the Index of Multiple Deprivation. We present results for all 264 GBD causes of death combined and the leading 20 specific causes, and all 84 GBD risks or risk clusters combined and 17 specific risks or risk clusters. Findings: The leading causes of age-adjusted YLLs in all UK countries in 2016 were ischaemic heart disease, lung cancers, cerebrovascular disease, and chronic obstructive pulmonary disease. Age-standardised rates of YLLs for all causes varied by two times between local areas in England according to levels of socioeconomic deprivation (from 14 274 per 100 000 population [95% uncertainty interval 12 791–15 875] in Blackpool to 6888 [6145–7739] in Wokingham). Some Upper-Tier Local Authorities, particularly those in London, did better than expected for their level of deprivation. Allowing for differences in age structure, more deprived Upper-Tier Local Authorities had higher attributable YLLs for most major risk factors in the GBD. The population attributable fractions for all-cause YLLs for individual major risk factors varied across Upper-Tier Local Authorities. Life expectancy and YLLs have improved more slowly since 2010 in all UK countries compared with 1990–2010. In nine of 150 Upper-Tier Local Authorities, YLLs increased after 2010. For attributable YLLs, the rate of improvement slowed most substantially for cardiovascular disease and breast, colorectal, and lung cancers, and showed little change for Alzheimer's disease and other dementias. Morbidity makes an increasing contribution to overall burden in the UK compared with mortality. The age-standardised UK DALY rate for low back and neck pain (1795 [1258–2356]) was higher than for ischaemic heart disease (1200 [1155–1246]) or lung cancer (660 [642–679]). The leading causes of ill health (measured through YLDs) in the UK in 2016 were low back and neck pain, skin and subcutaneous diseases, migraine, depressive disorders, and sense organ disease. Age-standardised YLD rates varied much less than equivalent YLL rates across the UK, which reflects the relative scarcity of local data on causes of ill health. Interpretation: These estimates at local, regional, and national level will allow policy makers to match resources and priorities to levels of burden and risk factors. Improvement in YLLs and life expectancy slowed notably after 2010, particularly in cardiovascular disease and cancer, and targeted actions are needed if the rate of improvement is to recover. A targeted policy response is also required to address the increasing proportion of burden due to morbidity, such as musculoskeletal problems and depression. Improving the quality and completeness of available data on these causes is an essential component of this response. Funding: Bill & Melinda Gates Foundation and Public Health England.

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Accepted/In Press date: 1 January 2018
e-pub ahead of print date: 24 October 2018
Published date: 3 November 2018

Identifiers

Local EPrints ID: 426502
URI: https://eprints.soton.ac.uk/id/eprint/426502
ISSN: 0140-6736
PURE UUID: 3e76a1fd-febe-45db-8c54-6001901435fc
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 29 Nov 2018 17:30
Last modified: 10 Dec 2019 01:53

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Contributors

Author: Nicholas Steel
Author: John A. Ford
Author: John N. Newton
Author: Adrian C.J. Davis
Author: Theo Vos
Author: Mohsen Naghavi
Author: Scott Glenn
Author: Andrew Hughes
Author: Alice M. Dalton
Author: Diane Stockton
Author: Ciaran Humphreys
Author: Mary Dallat
Author: Jürgen Schmidt
Author: Julian Flowers
Author: Sebastian Fox
Author: Ibrahim Abubakar
Author: Robert W. Aldridge
Author: Allan Baker
Author: Carol Brayne
Author: Traolach Brugha
Author: Simon Capewell
Author: Josip Car
Author: Cyrus Cooper ORCID iD
Author: Majid Ezzati
Author: Justine Fitzpatrick
Author: Felix Greaves
Author: Roderick Hay
Author: Simon Hay
Author: Frank Kee
Author: Heidi J. Larson
Author: Ronan A. Lyons
Author: Azeem Majeed
Author: Martin McKee
Author: Salman Rawaf
Author: Harry Rutter
Author: Sonia Saxena
Author: Aziz Sheikh
Author: Liam Smeeth
Author: Russell M. Viner
Author: Stein Emil Vollset
Author: Hywel C. Williams
Author: Charles Wolfe
Author: Anthony Woolf
Author: Christopher J.L. Murray

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