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

Nicholas Steel, John A. Ford, John N. Newton, Adrian C.J. Davis, Theo Vos, Mohsen Naghavi, Scott Glenn, Andrew Hughes, Alice M. Dalton, Diane Stockton, Ciaran Humphreys, Mary Dallat, Jürgen Schmidt, Julian Flowers, Sebastian Fox, Ibrahim Abubakar, Robert W. Aldridge, Allan Baker, Carol Brayne, Traolach Brugha & 24 others Simon Capewell, Josip Car, Cyrus Cooper, Majid Ezzati, Justine Fitzpatrick, Felix Greaves, Roderick Hay, Simon Hay, Frank Kee, Heidi J. Larson, Ronan A. Lyons, Azeem Majeed, Martin McKee, Salman Rawaf, Harry Rutter, Sonia Saxena, Aziz Sheikh, Liam Smeeth, Russell M. Viner, Stein Emil Vollset, Hywel C. Williams, Charles Wolfe, Anthony Woolf, Christopher J.L. Murray

Research output: Contribution to journalArticle

10 Citations (Scopus)

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.

LanguageEnglish
Pages1647-1661
Number of pages15
JournalThe Lancet
Volume392
Issue number10158
Early online date24 Oct 2018
DOIs
StatusPublished - 3 Nov 2018

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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. / 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; Murray, Christopher J.L.

In: The Lancet, Vol. 392, No. 10158, 03.11.2018, p. 1647-1661.

Research output: Contribution to journalArticle

Steel, N, Ford, JA, Newton, JN, Davis, ACJ, Vos, T, Naghavi, M, Glenn, S, Hughes, A, Dalton, AM, Stockton, D, Humphreys, C, Dallat, M, Schmidt, J, Flowers, J, Fox, S, Abubakar, I, Aldridge, RW, Baker, A, Brayne, C, Brugha, T, Capewell, S, Car, J, Cooper, C, Ezzati, M, Fitzpatrick, J, Greaves, F, Hay, R, Hay, S, Kee, F, Larson, HJ, Lyons, RA, Majeed, A, McKee, M, Rawaf, S, Rutter, H, Saxena, S, Sheikh, A, Smeeth, L, Viner, RM, Vollset, SE, Williams, HC, Wolfe, C, Woolf, A & Murray, CJL 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, vol. 392, no. 10158, pp. 1647-1661. https://doi.org/10.1016/S0140-6736(18)32207-4
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 ; Murray, Christopher J.L. / 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. In: The Lancet. 2018 ; Vol. 392, No. 10158. pp. 1647-1661.
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title = "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",
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.",
author = "Nicholas Steel and Ford, {John A.} and Newton, {John N.} and Davis, {Adrian C.J.} and Theo Vos and Mohsen Naghavi and Scott Glenn and Andrew Hughes and Dalton, {Alice M.} and Diane Stockton and Ciaran Humphreys and Mary Dallat and J{\"u}rgen Schmidt and Julian Flowers and Sebastian Fox and Ibrahim Abubakar and Aldridge, {Robert W.} and Allan Baker and Carol Brayne and Traolach Brugha and Simon Capewell and Josip Car and Cyrus Cooper and Majid Ezzati and Justine Fitzpatrick and Felix Greaves and Roderick Hay and Simon Hay and Frank Kee and Larson, {Heidi J.} and Lyons, {Ronan A.} and Azeem Majeed and Martin McKee and Salman Rawaf and Harry Rutter and Sonia Saxena and Aziz Sheikh and Liam Smeeth and Viner, {Russell M.} and Vollset, {Stein Emil} and Williams, {Hywel C.} and Charles Wolfe and Anthony Woolf and Murray, {Christopher J.L.}",
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TY - JOUR

T1 - Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016

T2 - The Lancet

AU - Steel, Nicholas

AU - Ford, John A.

AU - Newton, John N.

AU - Davis, Adrian C.J.

AU - Vos, Theo

AU - Naghavi, Mohsen

AU - Glenn, Scott

AU - Hughes, Andrew

AU - Dalton, Alice M.

AU - Stockton, Diane

AU - Humphreys, Ciaran

AU - Dallat, Mary

AU - Schmidt, Jürgen

AU - Flowers, Julian

AU - Fox, Sebastian

AU - Abubakar, Ibrahim

AU - Aldridge, Robert W.

AU - Baker, Allan

AU - Brayne, Carol

AU - Brugha, Traolach

AU - Capewell, Simon

AU - Car, Josip

AU - Cooper, Cyrus

AU - Ezzati, Majid

AU - Fitzpatrick, Justine

AU - Greaves, Felix

AU - Hay, Roderick

AU - Hay, Simon

AU - Kee, Frank

AU - Larson, Heidi J.

AU - Lyons, Ronan A.

AU - Majeed, Azeem

AU - McKee, Martin

AU - Rawaf, Salman

AU - Rutter, Harry

AU - Saxena, Sonia

AU - Sheikh, Aziz

AU - Smeeth, Liam

AU - Viner, Russell M.

AU - Vollset, Stein Emil

AU - Williams, Hywel C.

AU - Wolfe, Charles

AU - Woolf, Anthony

AU - Murray, Christopher J.L.

PY - 2018/11/3

Y1 - 2018/11/3

N2 - 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.

AB - 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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U2 - 10.1016/S0140-6736(18)32207-4

DO - 10.1016/S0140-6736(18)32207-4

M3 - Article

VL - 392

SP - 1647

EP - 1661

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 10158

ER -