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

Nicholas Steel*, John A. Ford, John Newton, Adrian C.J. Davis, Theo Vos, Mohsen Naghavi, Scott Glenn, Andrew Hughes, Alice M. Dalton, Diane Stockton, Ciaran Humphreys, Mary Dallat, Jürgen Schmidt, Julian Flowers, Sebastian Fox, Ibrahim Abubakar, Robert W. Aldridge, Allan Baker, Carol Brayne, Traolach BrughaSimon Capewell, Josip Car, Cyrus Cooper, Majid Ezzati, Justine Fitzpatrick, Felix Greaves, Roderick Hay, Simon Hay, Frank Kee, Heidi J. Larson, Ronan A. Lyons, Azeem Majeed, Martin McKee, Salman Rawaf, Harry Rutter, Sonia Saxena, Aziz Sheikh, Liam Smeeth, Russell M. Viner, Stein Emil Vollset, Hywel C. Williams, Charles Wolfe, Anthony Woolf, Christopher J.L. Murray

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

120 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)1647-1661
Number of pages15
JournalThe Lancet
Issue number10158
Publication statusPublished - 3 Nov 2018

Bibliographical note

Funding Information:
RWA reports grants from Wellcome Trust during the conduct of the study. CC reports personal fees from Alliance for Better Bone Health, Amgen, Eli Lilly, GlaxoSmithKline, Medtronic, Merck, Novartis, Pfizer, Roche, Servier, Takeda, and UCB, outside the submitted work. ME reports a charitable grant from AstraZeneca's Young Health Programme, and personal fees from Prudential, Scor, and Third Bridge, outside the submitted work. JAF reports grants from Public Health England during the conduct of the study. FK reports non-financial support from Queens University Belfast during the conduct of the study. HJL reports financial support from GlaxoSmithKline, outside the submitted work. RAL is supported by the Farr Institute. The Farr Institute is supported by a 10-funder consortium: Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute of Health Research, the Health and Care Research Wales (Welsh Assembly Government), the Chief Scientist Office (Scottish Government Health Directorates), and the Wellcome Trust, (Medical Research Council grant number MR/K006525/1). AM's institution (Imperial College London) receives financial support from the NW London National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research & Care. HR reports grants from the London School of Hygiene & Tropical Medicine during the conduct of the study. LS reports grants from Wellcome during the conduct of the study; grants from Wellcome, Medical Research Council, NIHR, British Heart Foundation, and Diabetes UK, outside the submitted work; grants and personal fees from GSK; and is a Trustee of the British Heart Foundation. NS reports grants from Public Health England during the conduct of the study. RMV is President of the Royal College of Paediatrics & Child Health and is a member of the Lancet Commission on Adolescent Health. AW reports grants from Pfizer and non-financial support from Grunenthal, outside the submitted work. All other authors declare no competing interests.

Funding Information:
We thank Elizabeth Lenaghan for project support to the University of East Anglia and Public Health England GBD team, Meghan Mooney for leadership of the Institute for Health Metrics and Evaluation UK liaison team, Julia Gall for project support to the Institute for Health Metrics and Evaluation UK liaison team, and Hannah Gregory for editing of the manuscript. Harry Rutter was supported by the NIHR Collaboration for Leadership in Applied Health Research and Care North Thames at Bart's Health NHS Trust (NIHR CLAHRC North Thames). The views expressed in this Article are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.

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


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