Changing mortality trends in countries and cities of the UK: a population-based trend analysis

Abstract

Objectives: Previously improving life expectancy and all-cause mortality in the UK has stalled since the early 2010s. National analyses have demonstrated changes in mortality rates for most age groups and causes of death, and with deprived populations most affected. The aims here were to establish whether similar changes have occurred across different parts of the UK (countries, cities), and to examine cause-specific trends in more detail.

Design: Population-based trend analysis.

Participants/setting: Whole populations of countries and selected cities of the UK.

Primary and secondary outcome measures: European age-standardised mortality rates (calculated by cause of death, country, city, year (1981-2017), age group, sex and-for all countries and Scottish cities-deprivation quintiles); changes in rates between 5-year periods; summary measures of both relative (relative index of inequality) and absolute (slope index of inequality) inequalities.

Results: Changes in mortality from around 2011/2013 were observed throughout the UK for all adult age groups. For example, all-age female rates decreased by approximately 4%-6% during the 1980s and 1990s, approximately 7%-9% during the 2000s, but by <1% between 2011/2013 and 2015/2017. Equivalent figures for men were 4%-7%, 8%-12% and 1%-3%, respectively. This later period saw increased mortality among the most deprived populations, something observed in all countries and cities analysed, and for most causes of death: absolute and relative inequalities therefore increased. Although similar trends were seen across all parts of the UK, particular issues apply in Scotland, for example, higher and increasing drug-related mortality (with the highest rates observed in Dundee and Glasgow).

Conclusions: The study presents further evidence of changing mortality in the UK. The timing, geography and socioeconomic gradients associated with the changes appear to support suggestions that they may result, at least in part, from UK Government 'austerity' measures which have disproportionately affected the poorest.

Keywords: epidemiology; public health; social medicine.

Figure 1

European age-standardised mortality rates (all ages, all causes) per 100 000 population, 3-year rolling averages, by UK country and city, 1981–2017, for (a) males and (b) females. EASR, European age-standardised mortality rate.

Figure 2

All-cause deaths, all ages: percentage change in standardised mortality rates between 5-year periods for (a) males and (b) females. n/a, not applicable.

Figure 3

European age-standardised mortality rates (males, all ages, all causes) per 100 000 population, 3-year rolling averages by selected country, city and country/city-specific deprivation quintiles. EASR, European age-standardised mortality rate.

Figure 4

European age-standardised mortality rates (females, all ages) per 100 000 population, 3-year rolling averages for 10 causes of death, Scotland and most and least deprived deprivation quintiles. EASR, European age-standardised mortality rate.

Figure 5

European age-standardised mortality rates (males, all ages) per 100 000 population, 3-year rolling averages, for all-cause deaths, ischaemic heart disease, alcohol-related causes and drug-related poisonings, UK countries and cities, 1981–2017. EASR, European age-standardised mortality rate.