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

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...

Carga do diabetes mellitus tipo 2 no Brasil

“…According to Newton et al 27 , who analyzed burden of disease in England, there was an important reduction in the burden of mortality due to diabetes, from 1990 (17 th place), to 2005 (27 th place), to 2013 (not ranking among the first 31 places).…”

Regionale Unterschiede in der Prävalenz von kardiovaskulären Risikofaktoren bei Männern und Frauen in Deutschland

“…Auch haben soziale und gesellschaftliche Faktoren wie z. B. Arbeitslosigkeit oder auch Lebens-und Wohnverhältnis-se einen weitgehenden Einfluss auf die gesundheitliche Lage und das Gesundheitsverhalten der Bevölkerung [30][31][32][33] und sollten zukünftig miteinbezogen werden. Zudem ist es wünschenswert, psychische Belastungen und Störungen, die ebenfalls als wesentliche Risikofaktoren für Herz-Kreislauf-Erkrankungen gelten, in weiteren Untersuchungen nä-her zu betrachten [34,35] …”

A recipe for future research

“…2 Despite a significant reduction in deaths from CVD in the past 20 years, it remains the leading cause of disability years of life lost in England, 3 and the second highest cause of death in England being responsible for 26% of all deaths in the UK; nearly 160,000 deaths each year 2 • Diabetes: Affects around 3.8 million people aged 16 years and over (diagnosed and undiagnosed), equal to 8.6% of the population of this age group. Although mortality rates from diabetes have fallen, the prevalence of people with disability years of life lost is rising.…”

“…Although mortality rates from diabetes have fallen, the prevalence of people with disability years of life lost is rising. 3 • Pulmonary disease (inc. common obstructive pulmonary disease [COPD]): COPD is seen in around 2% of the population (at all ages), 4 and is the fourth most common cause of death and years of life lost in England. 3 Pneumonia was the cause of 5% of all deaths in 2014 5 • Dementia: Currently found in approximately 1 in 14 of the UK population over 65 years and is expected to affect over 1 million people by 2025.…”

“…3 • Pulmonary disease (inc. common obstructive pulmonary disease [COPD]): COPD is seen in around 2% of the population (at all ages), 4 and is the fourth most common cause of death and years of life lost in England. 3 Pneumonia was the cause of 5% of all deaths in 2014 5 • Dementia: Currently found in approximately 1 in 14 of the UK population over 65 years and is expected to affect over 1 million people by 2025. 6 Three of the four topic areas that were selected are long-term conditions characterised by major mortality and morbidity in the UK.…”