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

Global Burden of Disease for England Collaboration

Research output: Contribution to journalArticle

157 Citations (Scopus)

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.
Original languageEnglish
Pages (from-to)2257-2274
Number of pages18
JournalLancet
Volume386
Issue number10010
Early online date14 Sep 2015
DOIs
Publication statusPublished - 5 Dec 2015

Keywords

  • Aged Aged, 80 and over Cause of Death/trends England/epidemiology Female *Health Status Health Status Disparities Humans Incidence Life Expectancy/trends Life Tables Male *Poverty Areas Prevalence Risk Factors

Cite this

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. / Global Burden of Disease for England Collaboration.

In: Lancet, Vol. 386, No. 10010, 05.12.2015, p. 2257-2274.

Research output: Contribution to journalArticle

@article{c4cc8265466b46ac9e5b75f8a6a51a4b,
title = "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",
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.",
keywords = "Aged Aged, 80 and over Cause of Death/trends England/epidemiology Female *Health Status Health Status Disparities Humans Incidence Life Expectancy/trends Life Tables Male *Poverty Areas Prevalence Risk Factors",
author = "{Global Burden of Disease for England Collaboration} and Newton, {J. N.} and Briggs, {A. D.} and Murray, {C. J.} and D. Dicker and Foreman, {K. J.} and H. Wang and M. Naghavi and Forouzanfar, {M. H.} and Ohno, {S. L.} and Barber, {R. M.} and T. Vos and Stanaway, {J. D.} and Schmidt, {J. C.} and Hughes, {A. J.} and Fay, {D. F.} and R. Ecob and C. Gresser and M. McKee and H. Rutter and I. Abubakar and R. Ali and Anderson, {H. R.} and A. Banerjee and Bennett, {D. A.} and E. Bernabe and Bhui, {K. S.} and Biryukov, {S. M.} and Bourne, {R. R.} and Brayne, {C. E.} and Bruce, {N. G.} and Brugha, {T. S.} and M. Burch and S. Capewell and D. Casey and R. Chowdhury and Coates, {M. M.} and C. Cooper and Critchley, {J. A.} and Dargan, {P. I.} and Dherani, {M. K.} and P. Elliott and M. Ezzati and Fenton, {K. A.} and Fraser, {M. S.} and T. Furst and F. Greaves and Green, {M. A.} and Gunnell, {D. J.} and Hannigan, {B. M.} and Hay, {R. J.}",
note = "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, Jurgen 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 Bernabe, 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 Furst, 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, Frederic 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 Davis, Adrian C J eng 098504/Wellcome Trust/United Kingdom MC_U147585819/Medical Research Council/United Kingdom MC_UP_A620_1014/Medical Research Council/United Kingdom MC_UU_12011/1/Medical Research Council/United Kingdom MR/K006525/1/Medical Research Council/United Kingdom Research Support, Non-U.S. Gov't England 2015/09/19 06:00 Lancet. 2015 Dec 5;386(10010):2257-74. doi: 10.1016/S0140-6736(15)00195-6. Epub 2015 Sep 14.",
year = "2015",
month = "12",
day = "5",
doi = "10.1016/S0140-6736(15)00195-6",
language = "English",
volume = "386",
pages = "2257--2274",
journal = "The Lancet",
issn = "0140-6736",
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}

TY - JOUR

T1 - 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

AU - Global Burden of Disease for England Collaboration

AU - Newton, J. N.

AU - Briggs, A. D.

AU - Murray, C. J.

AU - Dicker, D.

AU - Foreman, K. J.

AU - Wang, H.

AU - Naghavi, M.

AU - Forouzanfar, M. H.

AU - Ohno, S. L.

AU - Barber, R. M.

AU - Vos, T.

AU - Stanaway, J. D.

AU - Schmidt, J. C.

AU - Hughes, A. J.

AU - Fay, D. F.

AU - Ecob, R.

AU - Gresser, C.

AU - McKee, M.

AU - Rutter, H.

AU - Abubakar, I.

AU - Ali, R.

AU - Anderson, H. R.

AU - Banerjee, A.

AU - Bennett, D. A.

AU - Bernabe, E.

AU - Bhui, K. S.

AU - Biryukov, S. M.

AU - Bourne, R. R.

AU - Brayne, C. E.

AU - Bruce, N. G.

AU - Brugha, T. S.

AU - Burch, M.

AU - Capewell, S.

AU - Casey, D.

AU - Chowdhury, R.

AU - Coates, M. M.

AU - Cooper, C.

AU - Critchley, J. A.

AU - Dargan, P. I.

AU - Dherani, M. K.

AU - Elliott, P.

AU - Ezzati, M.

AU - Fenton, K. A.

AU - Fraser, M. S.

AU - Furst, T.

AU - Greaves, F.

AU - Green, M. A.

AU - Gunnell, D. J.

AU - Hannigan, B. M.

AU - Hay, R. J.

N1 - 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, Jurgen 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 Bernabe, 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 Furst, 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, Frederic 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 Davis, Adrian C J eng 098504/Wellcome Trust/United Kingdom MC_U147585819/Medical Research Council/United Kingdom MC_UP_A620_1014/Medical Research Council/United Kingdom MC_UU_12011/1/Medical Research Council/United Kingdom MR/K006525/1/Medical Research Council/United Kingdom Research Support, Non-U.S. Gov't England 2015/09/19 06:00 Lancet. 2015 Dec 5;386(10010):2257-74. doi: 10.1016/S0140-6736(15)00195-6. Epub 2015 Sep 14.

PY - 2015/12/5

Y1 - 2015/12/5

N2 - 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.

AB - 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.

KW - Aged Aged, 80 and over Cause of Death/trends England/epidemiology Female Health Status Health Status Disparities Humans Incidence Life Expectancy/trends Life Tables Male Poverty Areas Prevalence Risk Factors

U2 - 10.1016/S0140-6736(15)00195-6

DO - 10.1016/S0140-6736(15)00195-6

M3 - Article

VL - 386

SP - 2257

EP - 2274

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 10010

ER -