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

John Newton*, Adam D.M. Briggs, Christopher J.L. Murray, Daniel Dicker, Kyle J. Foreman, Haidong Wang, Mohsen Naghavi, Mohammad H. Forouzanfar, Summer Lockett Ohno, Ryan M. Barber, Theo Vos, Jeffrey D. Stanaway, Jürgen C. Schmidt, Andrew J. Hughes, Derek F.J. Fay, Russell Ecob, Charis Gresser, Martin McKee, Harry Rutter, Ibrahim AbubakarRaghib Ali, H. Ross Anderson, Amitava Banerjee, Derrick A. Bennett, Eduardo Bernabé, Kamaldeep S. Bhui, Stanley M. Biryukov, Rupert R. Bourne, Carol E.G. Brayne, Nigel G. Bruce, Traolach S. Brugha, Michael Burch, Simon Capewell, Daniel Casey, Rajiv Chowdhury, Matthew M. Coates, Cyrus Cooper, Julia A. Critchley, Paul I. Dargan, Mukesh K. Dherani, Paul Elliott, Majid Ezzati, Kevin Fenton, Maya S. Fraser, Thomas Fürst, Felix Greaves, Mark A. Green, David J. Gunnell, Bernadette Hannigan, Roderick J. Hay, Simon I. Hay, Harry Hemingway, Heidi J. Larson, Katharine J. Looker, Raimundas Lunevicius, Ronan A. Lyons, Wagner Marcenes, Amanda J. Mason-Jones, Fiona E. Matthews, Henrik Moller, Michele E. Murdoch, Charles R. Newton, Neil Pearce, Frédéric B. Piel, Daniel Pope, Kazem Rahimi, Alina Rodriguez, Peter Scarborough, Austin E. Schumacher, Ivy Shiue, Liam Smeeth, Alison Tedstone, Jonathan Valabhji, Hywel C. Williams, Charles D.A. Wolfe, Anthony D. Woolf, Adrian C.J. Davis

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

235 Citations (Scopus)


Background In 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. Methods We 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. Findings Between 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]). Interpretation Health in England is improving although substantial opportunities exist for further reductions in the burden of preventable disease. The gap in mortality rates between men and women has reduced, but marked health inequalities between the least deprived and most deprived areas remain. Declines in mortality have not been matched by similar declines in morbidity, resulting in people living longer with diseases. Health policies must therefore address the causes of ill health as well as those of premature mortality. Systematic action locally and nationally is needed to reduce risk exposures, support healthy behaviours, alleviate the severity of chronic disabling disorders, and mitigate the effects of socioeconomic deprivation. Funding Bill & Melinda Gates Foundation and Public Health England.

Original languageEnglish
Pages (from-to)2257-2274
Number of pages18
JournalThe Lancet
Issue number10010
Publication statusPublished - 5 Dec 2015

Bibliographical note

Funding Information:
JNN, JCS, AJH, DFJF, RE, CG, FG, KAF, BMH, AT, and ACJD were employed by Public Health England during the study. ADMB is a Wellcome Trust-funded Research Training Fellow. CG reports personal fees from Meteos outside the submitted work. DJG is a member of the England National Suicide Prevention Strategy Advisory Group. KJL reports personal fees from WHO during the study and personal fees from WHO outside the submitted work. LS reports grants from the Wellcome Trust during the study, grants from the Wellcome Trust, Medical Research Council, and National Institute for Health Research outside the submitted work, and personal fees from GlaxoSmithKline outside the submitted work. ADW is the Chair of the Global Alliance for Musculoskeletal Health of the Bone and Joint Decade. All other authors declare no competing interests.


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