SummaryBackgroundIn 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.MethodsWe 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.FindingsBetween 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]).InterpretationHealth in England is improving although substantial opportunities exist for further reductions in the burden of preventable disease. T...

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Contrasting with prevalent assumptions, the period from mid-adolescence to early adulthood is important for uptake of regular smoking, and in particular reveals friends' smoking to be of continuing significance, especially around school-leaving when friendship networks often change markedly.

There is a considerable body of evidence from earlier research to show that offending is associated with an increased risk of victimization, and being a victim with an increased risk of offending. There have been few earlier studies of the link. These have generally set out to test specific explanations, for example, the idea that the same lifestyles or routine activities may be associated with both victimization and offending. In a current study of a cohort of 4,300 adolescents in Edinburgh we have found a correlation of 0.421 between crime victimization and self-reported offending at the age of 15 when offending peaks. Variables chosen to test three broad types of theory -life-style and routine activities, weak social bonds, aspects of personality -are shown to be related both to victimization and to offending in adolescence. The present analysis uses latent class growth mixture models to track the dynamic relationships over time between adolescent victimization and offending both before and after controlling for these explanatory variables. In the short term, offending is strongly related to a later rise in victimization, but in the longer term to a fall that tends to cancel out the earlier rise. These findings remain the same after controlling for the ten explanatory variables. Victimization is associated with a later rise in offending in the longer term. The theoretical perspectives suggested by earlier researchers are fairly successful in explaining this linkage running from victimization to offending. Future research should focus on the role of peer influence in linking victimization and offending, and should push forward the analysis into the adult years. The implications for criminal justice policy could be far-reaching.