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.

Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1

Age-standardised YLL, YLD, and DALY rates per 100 000 population for all causes combined and leading ten causes in UK countries, women, men, and both sexes, 2016 YLLs=years of life lost. YLDs=years lived with disability. DALY=disability-adjusted life-year.

Figure 1

Age-standardised YLL, YLD, and DALY rates per 100 000 population for all causes combined and leading ten causes in UK countries, women, men, and both sexes, 2016 YLLs=years of life lost. YLDs=years lived with disability. DALY=disability-adjusted life-year.

Figure 2

PAF for risk factors for all-cause YLLs rate per 100 000 population for England, Scotland, Wales, and Northern Ireland, both sexes, 2016 PAF=population attributable fraction. YLLs=years of life lost.

Figure 3

All-cause age-standardised YLL and YLD rates per 100 000 population by UK country and English Upper Tier Local Authorities, 2016 YLLs=years of life lost. YLDs=years lived with disability.

Figure 4

Age-standardised YLL rate per 100 000 people for the 20 causes with the highest national YLL burden (order of decreasing burden), in the 15 (10%) most deprived, and 15 (10%) least deprived UTLAs in England, both sexes, 2016 YLLs=years of life lost. UTLAs=Upper-Tier Local Authorities. IMD=Index of Multiple Deprivation. UI=uncertainty interval. NA=not applicable.

Figure 5

Age-standardised YLD rate per 100 000 population for the 20 causes with the highest national YLD burden (order of decreasing burden), in the 15 (10%) most deprived, and 15 (10%) least deprived UTLAs in England, both sexes, 2016 No estimates were significantly different from the mean for England. YLDs=years lived with disability. UTLAs=Upper-Tier Local Authorities. IMD=Index of Multiple Deprivation. UI=uncertainty interval. NA=not applicable.

Figure 6

Attributable risk for age-standardised all-cause YLL rate per 100 000 population for nine major risk factors, and UTLA level IMD score, for UTLAs in three regions of England, 2016 YLL=years of life lost. UTLAs=Upper-Tier Local Authorities. IMD=Index of Multiple Deprivation.

Figure 7

Life expectancy at birth for England, Scotland, Wales, and Northern Ireland 1990–2016, by sex

Figure 8

Annual percentage change in YLL rate per 100 000 people for the nine causes with the highest national burden, 1990–2016 in England Ribbons are 95% uncertainty intervals. The percentage contribution of each condition to all-cause YLLs is given in brackets. YLLs=years of life lost.