Social Deprivation 'Driving Premature Mortality Rates'

Peter Russell

October 25, 2018

Premature death rates in the most deprived part of England were around twice those of the wealthiest area, according to new research into early mortality and inequality across the UK.

However, England had better life expectancy than the rest of the UK, with outcomes worst in Scotland, the study in The Lancet found.

The analysis also suggested that health systems would have to adjust to deal with an increasing burden from morbidity. "As death rates decrease, people continue to live with long-term, often multiple, conditions," said lead author Prof Nicholas Steel from the University of East Anglia. "Our findings show a significant shift from mortality to morbidity, yet our health services are still designed to deal with the big killers."

Despite that, the slowdown in the rate of improvement in UK life expectancy required investigation, researchers said.

Global Burden of Disease Data

Data from the Global Burden of Disease was extracted to estimate years of life lost, years lived with disability, and attributable risks, from 1990 to 2016 for England, Scotland, Wales, Northern Ireland, the UK as a whole, and 150 English upper-tier local authorities.

The leading causes of premature deaths across the UK were ischaemic heart disease, lung cancers, cerebrovascular disease, chronic obstructive pulmonary disease (COPD), and Alzheimer's disease and other

More than half of all premature deaths in the UK were linked to risk factors including tobacco use, unhealthy diet, obesity, alcohol and drug use, low physical activity, and environmental factors, such as air pollution.

Some regional variations were observed, such as higher tobacco use in Scotland, and higher alcohol and drug use in Scotland and Northern Ireland, compared with the other UK nations.

Inequalities of Health and Mortality

Professor John Newton, author and director of health improvement at Public Health England, said: "This comprehensive assessment of health across the country highlights the stark division between rich and poor areas, which sees poorer people dying earlier and getting sicker quicker."

Rates of premature mortality from all causes were 14,274 per 100,000 of the population in Blackpool, Lancashire, compared with 6888 per 100,000 in Wokingham, Berkshire.

Rates of premature mortality were consistently higher for the 15 most deprived areas of England, compared to the 15 least deprived, according to the researchers, who noted that the association with deprivation was particularly strong for lung cancer, and COPD.

In England, some local authorities performed better than expected for their level of deprivation. For instance, Birmingham, and the London boroughs of Tower Hamlets and Hackney, had lower rates of early mortality than those with similar levels of deprivation in Liverpool and Manchester. Prof Newton said it showed "the improvements to health that could be achieved by addressing underlying causes, such as poverty, education and other resources needed for good health".

Between 1990 and 2016, life expectancy improved in all four countries of the UK, but the rate of improvement had slowed since 2010, driven mainly by gradual disappearance of improvements in heart disease, cerebrovascular disease, and to a lesser extent colorectal cancer, lung cancer, and breast cancer

"The worsening trend in mortality for some cancers is a concern, especially given evidence that survival from some common cancers in the UK is worse than in other European countries," Prof Steel said.


Non-fatal conditions were identified as increasingly important contributors to the overall health burden across the UK, particularly in England, Wales, and Northern Ireland.

Low back and neck pain, skin diseases, migraine, sense organ diseases, and depressive and anxiety disorders were identified as leading causes of disability and ill health.

The authors concluded that their local, regional and national breakdown should "allow policy makers to match resources and priorities to levels of burden and risk factors".

They called for action to restore the rate of improvement in life expectancy, and a "targeted policy response" to "address the increasing proportion of burden due to morbidity, such as musculoskeletal problems and depression".

Funding for the study was provided by the Bill and Melinda Gates Foundation and Public Health England.

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 N et al, The Lancet. Full text.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: