Life expectancy and risk of death in 6791 communities in England from 2002 to 2019: high-resolution spatiotemporal analysis of civil registration data

Abstract

Background: High-resolution data for how mortality and longevity have changed in England, UK are scarce. We aimed to estimate trends from 2002 to 2019 in life expectancy and probabilities of death at different ages for all 6791 middle-layer super output areas (MSOAs) in England.

Methods: We performed a high-resolution spatiotemporal analysis of civil registration data from the UK Small Area Health Statistics Unit research database using de-identified data for all deaths in England from 2002 to 2019, with information on age, sex, and MSOA of residence, and population counts by age, sex, and MSOA. We used a Bayesian hierarchical model to obtain estimates of age-specific death rates by sharing information across age groups, MSOAs, and years. We used life table methods to calculate life expectancy at birth and probabilities of death in different ages by sex and MSOA.

Findings: In 2002-06 and 2006-10, all but a few (0-1%) MSOAs had a life expectancy increase for female and male sexes. In 2010-14, female life expectancy decreased in 351 (5·2%) of 6791 MSOAs. By 2014-19, the number of MSOAs with declining life expectancy was 1270 (18·7%) for women and 784 (11·5%) for men. The life expectancy increase from 2002 to 2019 was smaller in MSOAs where life expectancy had been lower in 2002 (mostly northern urban MSOAs), and larger in MSOAs where life expectancy had been higher in 2002 (mostly MSOAs in and around London). As a result of these trends, the gap between the first and 99th percentiles of MSOA life expectancy for women increased from 10·7 years (95% credible interval 10·4-10·9) in 2002 to reach 14·2 years (13·9-14·5) in 2019, and for men increased from 11·5 years (11·3-11·7) in 2002 to 13·6 years (13·4-13·9) in 2019.

Interpretation: In the decade before the COVID-19 pandemic, life expectancy declined in increasing numbers of communities in England. To ensure that this trend does not continue or worsen, there is a need for pro-equity economic and social policies, and greater investment in public health and health care throughout the entire country.

Funding: Wellcome Trust, Imperial College London, Medical Research Council, Health Data Research UK, and National Institutes of Health Research.

Figure 1

Life expectancy in 6791 MSOAs, 2002–19 (A) Ranked MSOA life expectancies in 2002 and 2019. Each point shows the posterior median life expectancy estimate for each MSOA, forming a curve; error bars are 95% credible intervals. Arrows indicate national life expectancies in England and selected comparator countries with life expectancies within the range of English MSOAs. Hong Kong had the highest global female and male life expectancies. In the EU, Bulgaria had the lowest and Spain had the highest life expectancies for women; Latvia had the lowest and Switzerland had the highest life expectancies for men. Life expectancy for England was calculated from the the UK Small Area Health Statistics Unit research database, and for other countries from World Bank estimates in 2019. (B) Distribution of MSOA life expectancies in each year from 2002 to 2019. Each point shows one MSOA and the upper and lower lines show the first and 99th percentiles of life expectancy. The height of the shaded area is the first to 99th percentile range. The central line shows national life expectancy. MSOA=middle-layer super output area.

Figure 2

Maximum (highest) to minimum (lowest) and 99th to first percentile differences in life expectancy across 6791 MSOAs, 2002–19 The large difference in 2017 is due to the low life expectancy in the MSOA where the deaths in the Grenfell Tower (Kensington and Chelsea, London) fire took place. MSOA=middle-layer super output area.

Figure 3

Geography of life expectancy in 6791 MSOAs in England, 2002–19 (A) Map of life expectancy and the distribution of life expectancy in 2019. (B) Change in life expectancy from 2002 to 2019. (C) Posterior probability that the estimated change represents a true increase or decrease in life expectancy from 2002 to 2019. In A, the areas in white have a life expectancy equal to the national life expectancy. In C, posterior probability represents the uncertainty in estimated life expectancy change. MSOA=middle-layer super output area.

Figure 3

Geography of life expectancy in 6791 MSOAs in England, 2002–19 (A) Map of life expectancy and the distribution of life expectancy in 2019. (B) Change in life expectancy from 2002 to 2019. (C) Posterior probability that the estimated change represents a true increase or decrease in life expectancy from 2002 to 2019. In A, the areas in white have a life expectancy equal to the national life expectancy. In C, posterior probability represents the uncertainty in estimated life expectancy change. MSOA=middle-layer super output area.

Figure 4

Comparison of female and male life expectancy Life expectancy in 2019 (A) and change from 2002 to 2019 (B).

Figure 5

Change in MSOA life expectancy in different time periods, 2002–19 Each point shows the posterior median change in one MSOA. MSOAs are coloured by their life expectancy at the beginning of each period (eg, for 2014–19, they are coloured by life expectancy in 2014). The inner box shows the 25th, 50th, and 75th percentiles, and the outer lines the first, fifth, 95th, and 99th percentiles. MSOA=middle-layer super output area.

Figure 6

MSOA life expectancy in relation to measures of socioeconomic deprivation in the MSOA in 2002 and 2019 The socioeconomic measures are poverty, unemployment, and education, as defined in the Methods. The lines show the smooth relationship fitted with locally estimated scatterplot smoothing for each year. MSOA=middle-layer super output area.