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Health improves in England, preventable disease burden remains

Between 1990 and 2013, England improved its health compared with other industrialized nations. However, inequality in life expectancy remains varied within regions based on level of depravity, according to recent data.

“England has done well over the past 23 years in many areas. But there is still plenty of room for bold action to reduce the significant toll of preventable conditions,” John Newton, FRCP, from Public Health England, said in a press release. “The country has done a good job preventing premature deaths, but this has not been matched by declines in disability and illness, resulting in people living longer with disease. If the levels of health seen in the best-performing English regions could be achieved in the worst, then England could have a level of overall disease burden as low as any country in the industrialized world.”

The researchers used the 2013 Global Burden of Disease study, which covers 1990 to 2013, to compare mortality, causes of death, years of life lost (YLLs), years lived with a disability (YLDs), and disability-adjusted life-years (DALYs) between England, the UK, and 15 other countries of the European Union, Australia, Canada and Norway. Researchers used data split by the nine English regions and by quintile groups within each region according to deprivation level, creating 45 regions in total.

During the study period, life expectancy from birth increased by 5.4 years (95% CI, 5-5.8); greater gains were seen among men vs. women. Rates of age-standardized YLLs reduced by 41.1% (95% CI, 38.3-43.6), DALYs reduced by 23.8% (95% CI, 20.9-27.1), and YLDs reduced by 1.4% (95% CI, 0.1-2.8). However, in 2013 the gap in life expectancy between the most and least deprived regional groups remained at 8.2 years for men but decreased from 7.2 years to 6.9 years among women.

“Inequality within regions is greater than it is among them,” Newton said in the press release. “In 2013, those living in the most deprived areas still hadn’t reached the levels of life expectancy that less deprived groups experienced in 1990.”

Researchers reported ischemic heart disease was the main cause of YLLs, while low back and neck pain accounted for the majority of DALYs. Additionally, nearly half of DALYs were caused by known risk factors (39.6%; 95% CI, 37.7-41.7), including suboptimal diet (10.8%; 95% CI, 9.1-12.7) and tobacco use (10.7%; 95% CI, 9.4-12.0).

“If England can make progress with smoking, alcohol, dietary risk factors, physical inactivity, and obesity, it will see massive reductions in disability,” Newton said in the release. “This will require new approaches to support healthy behaviors, modify known risk factors, and alleviate the severity of chronic disabling conditions.” – by Will Offit

Disclosures: Newton reports employment with Public Health England during the study. Please see the full study for a list of all other authors’ relevant financial disclosures.