Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018: an observational study
Summary: Background: Low socioeconomic position is consistently associated with increased risk of premature death. The aim of this study is to measure the aggregate scale of inequality in premature mortality for the whole population of England. Methods: We used mortality records from the UK Office...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2020-01-01
|
| Series: | The Lancet Public Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468266719302191 |
| _version_ | 1811216807297548288 |
|---|---|
| author | Dan Lewer, MSc Wikum Jayatunga, MSc Robert W Aldridge, PhD Chantal Edge, MSc Michael Marmot, ProfFRCP Alistair Story, PhD Andrew Hayward, ProfMD |
| author_facet | Dan Lewer, MSc Wikum Jayatunga, MSc Robert W Aldridge, PhD Chantal Edge, MSc Michael Marmot, ProfFRCP Alistair Story, PhD Andrew Hayward, ProfMD |
| author_sort | Dan Lewer, MSc |
| collection | DOAJ |
| description | Summary: Background: Low socioeconomic position is consistently associated with increased risk of premature death. The aim of this study is to measure the aggregate scale of inequality in premature mortality for the whole population of England. Methods: We used mortality records from the UK Office for National Statistics to study all 2 465 285 premature deaths (defined as those before age 75 years) in England between Jan 1, 2003, and Dec 31, 2018. Socioeconomic position was defined using deciles of the Index of Multiple Deprivation: a measure of neighbourhood income, employment, education levels, crime, health, availability of services, and local environment. We calculated the number of expected deaths by applying mortality in the least deprived decile to other deciles, within the strata of age, sex, and time. The mortality attributable to socioeconomic inequality was defined as the difference between the observed and expected deaths. We also used life table modelling to estimate years-of-life lost attributable to socioeconomic inequality. Findings: 35·6% (95% CI 35·3–35·9) of premature deaths were attributable to socioeconomic inequality, equating to 877 082 deaths, or one every 10 min. The biggest contributors were ischaemic heart disease (152 171 excess deaths), respiratory cancers (111 083) and chronic obstructive pulmonary disease (83 593). The most unequal causes of death were tuberculosis, opioid use, HIV, psychoactive drugs use, viral hepatitis, and obesity, each with more than two-thirds attributable to inequality. Inequality was greater among men and peaked in early childhood and at age 40–49 years. The proportion of deaths attributable to inequality increased during the study period, particularly for women, because mortality rates among the most deprived women (excluding cardiovascular diseases) plateaued, and for some diseases increased. A mean of 14·4 months of life before age 75 years are lost due to socioeconomic inequality. Interpretation: One in three premature deaths are attributable to socioeconomic inequality, making this our most important public health challenge. Interventions that address upstream determinants of health should be prioritised. Funding: National Institute of Health Research; Wellcome Trust. |
| first_indexed | 2024-04-12T06:44:26Z |
| format | Article |
| id | doaj.art-156855ac39624fd9a9c75041cfc8c9e3 |
| institution | Directory Open Access Journal |
| issn | 2468-2667 |
| language | English |
| last_indexed | 2024-04-12T06:44:26Z |
| publishDate | 2020-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Public Health |
| spelling | doaj.art-156855ac39624fd9a9c75041cfc8c9e32022-12-22T03:43:37ZengElsevierThe Lancet Public Health2468-26672020-01-0151e33e41Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018: an observational studyDan Lewer, MSc0Wikum Jayatunga, MSc1Robert W Aldridge, PhD2Chantal Edge, MSc3Michael Marmot, ProfFRCP4Alistair Story, PhD5Andrew Hayward, ProfMD6UCL Collaborative Centre for Inclusion Health, University College London, London, UK; Institute for Health Informatics, University College London, London, UK; Institute of Epidemiology and Health Care, University College London, London, UK; Correspondence to: Mr Dan Lewer, UCL Collaborative Centre for Inclusion Health, University College London, London WC1E 7HB, UKInstitute for Health Informatics, University College London, London, UKUCL Collaborative Centre for Inclusion Health, University College London, London, UK; Institute for Health Informatics, University College London, London, UKUCL Collaborative Centre for Inclusion Health, University College London, London, UK; Institute of Epidemiology and Health Care, University College London, London, UKInstitute of Epidemiology and Health Care, University College London, London, UKUCL Collaborative Centre for Inclusion Health, University College London, London, UK; Find and Treat, University College London Hospitals, London, UKUCL Collaborative Centre for Inclusion Health, University College London, London, UK; Institute of Epidemiology and Health Care, University College London, London, UKSummary: Background: Low socioeconomic position is consistently associated with increased risk of premature death. The aim of this study is to measure the aggregate scale of inequality in premature mortality for the whole population of England. Methods: We used mortality records from the UK Office for National Statistics to study all 2 465 285 premature deaths (defined as those before age 75 years) in England between Jan 1, 2003, and Dec 31, 2018. Socioeconomic position was defined using deciles of the Index of Multiple Deprivation: a measure of neighbourhood income, employment, education levels, crime, health, availability of services, and local environment. We calculated the number of expected deaths by applying mortality in the least deprived decile to other deciles, within the strata of age, sex, and time. The mortality attributable to socioeconomic inequality was defined as the difference between the observed and expected deaths. We also used life table modelling to estimate years-of-life lost attributable to socioeconomic inequality. Findings: 35·6% (95% CI 35·3–35·9) of premature deaths were attributable to socioeconomic inequality, equating to 877 082 deaths, or one every 10 min. The biggest contributors were ischaemic heart disease (152 171 excess deaths), respiratory cancers (111 083) and chronic obstructive pulmonary disease (83 593). The most unequal causes of death were tuberculosis, opioid use, HIV, psychoactive drugs use, viral hepatitis, and obesity, each with more than two-thirds attributable to inequality. Inequality was greater among men and peaked in early childhood and at age 40–49 years. The proportion of deaths attributable to inequality increased during the study period, particularly for women, because mortality rates among the most deprived women (excluding cardiovascular diseases) plateaued, and for some diseases increased. A mean of 14·4 months of life before age 75 years are lost due to socioeconomic inequality. Interpretation: One in three premature deaths are attributable to socioeconomic inequality, making this our most important public health challenge. Interventions that address upstream determinants of health should be prioritised. Funding: National Institute of Health Research; Wellcome Trust.http://www.sciencedirect.com/science/article/pii/S2468266719302191 |
| spellingShingle | Dan Lewer, MSc Wikum Jayatunga, MSc Robert W Aldridge, PhD Chantal Edge, MSc Michael Marmot, ProfFRCP Alistair Story, PhD Andrew Hayward, ProfMD Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018: an observational study The Lancet Public Health |
| title | Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018: an observational study |
| title_full | Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018: an observational study |
| title_fullStr | Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018: an observational study |
| title_full_unstemmed | Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018: an observational study |
| title_short | Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018: an observational study |
| title_sort | premature mortality attributable to socioeconomic inequality in england between 2003 and 2018 an observational study |
| url | http://www.sciencedirect.com/science/article/pii/S2468266719302191 |
| work_keys_str_mv | AT danlewermsc prematuremortalityattributabletosocioeconomicinequalityinenglandbetween2003and2018anobservationalstudy AT wikumjayatungamsc prematuremortalityattributabletosocioeconomicinequalityinenglandbetween2003and2018anobservationalstudy AT robertwaldridgephd prematuremortalityattributabletosocioeconomicinequalityinenglandbetween2003and2018anobservationalstudy AT chantaledgemsc prematuremortalityattributabletosocioeconomicinequalityinenglandbetween2003and2018anobservationalstudy AT michaelmarmotproffrcp prematuremortalityattributabletosocioeconomicinequalityinenglandbetween2003and2018anobservationalstudy AT alistairstoryphd prematuremortalityattributabletosocioeconomicinequalityinenglandbetween2003and2018anobservationalstudy AT andrewhaywardprofmd prematuremortalityattributabletosocioeconomicinequalityinenglandbetween2003and2018anobservationalstudy |