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

Newton, John N. and Briggs, Adam D. M. and Murray, Christopher J. L. and Dicker, Daniel and Foreman, Kyle J. and Wang, Haidong and Naghavi, Mohsen and Forouzanfar, Mohammad H. and Ohno, Summer L. and Barber, Ryan M. and Vos, Theo and Stanaway, Jeffrey D. and Schmidt, Jürgen C. and Hughes, Andrew J. and Fay, Derek F. J. and Ecob, Russell and Gresser, Charis and McKee, Martin and Rutter, Harry and Abubakar, Ibrahim and Ali, Raghib and Anderson, H Ross and Banerjee, Amitava and Bennett, Derrick A. and Bernabé, Eduardo and Bhui, Kamaldeep S. and Biryukov, Stanley M. and Bourne, Rupert R. A. and Brayne, Carol E. G. and Bruce, Nigel G. and Brugha, Traolach S. and Burch, Michael and Capewell, Simon and Casey, Daniel and Chowdhury, Rajiv and Coates, Matthew M. and Cooper, Cyrus and Critchley, Julia A and Dargan, Paul I. and Dherani, Mukesh K. and Elliott, Paul and Ezzati, Majid and Fenton, Kevin A. and Fraser, Maya S. and Fürst, Thomas and Greaves, Felix and Green, Mark A. and Gunnell, David J. and Hannigan, Bernadette M. and Hay, Roderick J. and Hay, Simon I. and Hemingway, Harry and Larson, Heidi J. and Looker, Katharine J. and Lunevicius, Raimundas and Lyons, Ronan A. and Marcenes, Wagner and Mason-Jones, Amanda J. and Matthews, Fiona E. and Moller, Henrik and Murdoch, Michele E. and Newton, Charles R. and Pearce, Neil and Piel, Frédéric B. and Pope, Daniel and Rahimi, Kazem and Rodriguez, Alina and Scarborough, Peter and Schumacher, Austin E. and Shiue, Ivy and Smeeth, Liam and Tedstone, Alison and Valabhji, Jonathan and Williams, Hywel C. and Wolfe, Charles D. A. and 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). pp. 2257-2274. ISSN 1474-547X

[img]
Preview
Text
Published Version
Available under the following license: Creative Commons Attribution Non-commercial No Derivatives.

Download (881kB) | Preview
Official URL: https://doi.org/10.1016/S0140-6736(15)00195-6

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.

Item Type: Journal Article
Faculty: ARCHIVED Faculty of Health, Social Care & Education (until September 2018)
Depositing User: Lisa Blanshard
Date Deposited: 07 Feb 2020 16:01
Last Modified: 07 Feb 2020 16:01
URI: http://arro.anglia.ac.uk/id/eprint/705167

Actions (login required)

Edit Item Edit Item