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Lancet. 2015 Dec 5;386(10010):2257-74. doi: 10.1016/S0140-6736(15)00195-6. Epub 2015 Sep 14.

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.

Author information

  • 1Public Health England, London, UK; University of Manchester, Manchester, UK. Electronic address: john.newton@phe.gov.uk.
  • 2University of Oxford, Oxford, UK.
  • 3Institute for Health Metrics and Evaluation, Seattle, WA, USA.
  • 4Public Health England, London, UK.
  • 5Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
  • 6London School of Hygiene & Tropical Medicine, Oxford Martin School, University of Oxford, Oxford, UK.
  • 7Public Health England, London, UK; Centre for Infectious Disease Epidemiology and MRC Clinical Trials Unit, London, UK.
  • 8INDOX Cancer Research Network, Oxford, UK; John Radcliffe Hospital, Oxford, UK; Green-Templeton College, University of Oxford, Oxford, UK.
  • 9Population Health Research Institute, Hamilton, ON, Canada; MRC-PHE Centre for Environment and Health, London, UK; St George's, University of London, London, UK.
  • 10University of Birmingham, Birmingham, UK.
  • 11Clinical Trials Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
  • 12King's College London Dental Institute, London, UK.
  • 13Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, UK.
  • 14Vision & Eye Research Unit, Anglia Ruskin University, Cambridge, UK.
  • 15Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK.
  • 16University of Liverpool, Liverpool, UK.
  • 17University of Leicester, Leicester, UK.
  • 18Great Ormond Street Hospital for Children, London, UK.
  • 19University of Cambridge, Cambridge, UK.
  • 20MRC Lifecourse Epidemiology Unit, University of Southampton, Southhampton, UK.
  • 21St George's, University of London, London, UK.
  • 22Guy's and St Thomas' NHS Foundation Trust, London, UK.
  • 23Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK.
  • 24MRC-PHE Centre for Population Health, School of Public Health, Imperial College London, London, UK.
  • 25Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
  • 26Public Health England, London, UK; Department of Primary Care and Public Health, Imperial College London, London, UK.
  • 27School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
  • 28School of Social and Community Medicine, University of Bristol, Bristol, UK.
  • 29Public Health England, London, UK; Ulster University, Coleraine, Northern Ireland.
  • 30International Foundation for Dermatology, London, UK.
  • 31Institute for Health Metrics and Evaluation, Seattle, WA, USA; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK.
  • 32University College London, London, UK; Farr Institute of Health Informatics Research, London, UK.
  • 33Institute for Health Metrics and Evaluation, Seattle, WA, USA; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
  • 34University of Liverpool, Liverpool, UK; Aintree University Hospital NHS Foundation Trust, University of Liverpool, Liverpool, UK.
  • 35Farr Institute, College of Medicine, Swansea University, Swansea, UK.
  • 36Queen Mary University of London.
  • 37Department of Health Sciences, University of York, York, UK; Adolescent Health Research Unit, University of Cape Town, Cape Town, South Africa.
  • 38Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Institute of Health and Society, Newcastle University, Newcastle, UK.
  • 39Cancer Epidemiology and Population Health, King's College London, London, UK.
  • 40West Hertfordshire Hospitals NHS Trust, Hertfordshire, UK.
  • 41George Institute for Global Health and Division of Cardiovascular Medicine, Oxford Martin School, University of Oxford, Oxford, UK.
  • 42Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Mid Sweden University, Sundsvall, Sweden.
  • 43British Heart Foundation Centre on Population Approaches for NCD Prevention, University of Oxford, Oxford, UK.
  • 44University of Edinburgh, Edinburgh, Scotland; Northumbria University, Newcastle upon Tyne.
  • 45Farr Institute of Health Informatics Research, London, UK; London School of Hygiene & Tropical Medicine, Oxford Martin School, University of Oxford, Oxford, UK.
  • 46NHS England, Leeds, UK; Imperial College Healthcare NHS Trust, London, UK; Imperial College London, London, UK.
  • 47University of Nottingham, Nottingham, UK.
  • 48King's College London, London, UK.
  • 49Royal Cornwall Hospital, Treliske, UK.
  • 50Public Health England, London, UK; London School of Economics, London, UK; University College London, London, UK.

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.

Copyright © 2015 Newton et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

PMID:
26382241
[PubMed - indexed for MEDLINE]
PMCID:
PMC4672153
Free PMC Article
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