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Common causes of death & disability

Introduction

Reading has a higher rate than average of premature death, with a particularly high rate of deaths from heart attack and stroke and cancer. The number of people with a disability or other limiting condition is similar to national average, but still represents a significant proportion of the population. There is strong evidence that those living in more deprived areas are more likely to die prematurely and more likely to be affected by disability. Prevention interventions, especially those focusing on increasing physical activity and improving diet and weight management, reducing smoking and alcohol use are likely to be effective in addressing many of the common causes of disability and premature death.

What do we know?

The most common causes of death

The most common cause of death in England and Wales in 2014 was cancer (29%), followed by circulatory diseases, such as heart attack and stroke (27%). Age-standardised mortality rates (the proportionate number of people dying in each age group) continued to decline in 2014, continuing an ongoing trend (see Figure 1) (Office for National Statistics (ONS), 2015)

Figure 1: Age-standardised mortality rates 2001-2014

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Source: Deaths Registered in England and Wales: 2014. Office for National Statistics.

Public Health England (PHE, 2015) publishes data about premature mortality (deaths of people under the age of 75. Life expectancy is linked to levels of deprivation and how long we live depends greatly on where we live. Understanding trends and patterns in premature mortality can be used to highlight health inequalities and how they affect local authority areas.

Overall, Reading has an above-average premature death rate. As shown in Figure 1, Reading ranks 95th out of the 150 local authorities in England with 379 deaths for every 100,000 people aged under 75 each year. The highest rate is in Manchester (535 deaths per 100,000 people) and the lowest is in Kensington and Chelsea (244 deaths per 100,000 people). Reading is ranked 13th out of 15 local authorities with similar levels of deprivation (lowest in this group is Redbridge (288 deaths for every 100,000) and highest is Bury (397 deaths for every 100,000).

Figure 1: Rates of premature deaths per 100,000 population by Local Authority

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Source: Public Health England - Mortality Rankings http://healthierlives.phe.org.uk/topic/mortality

Closer examination of the main causes of premature death show that:

  • the commonest cause of premature death in Reading is cancer. Between 2012 and 2014, there were142 deaths per 100,000 people aged under 75 in Reading. Reading is ranked 72nd highest of 150 local authorities. The highest rate was in Manchester (196 deaths for every 100,000 people) and the lowest in Harrow (106 deaths for every 100,000 people).
  • the next most common cause of premature death is heart attack and stroke (92 deaths per 100,000). Reading is ranked very high - 115th out of 150 local authorities in the country. The highest rate was in Manchester (135 deaths per 100,000) and the lowest in Kensington and Chelsea (48 deaths per 100,000);
  • the third most common cause of death in Reading is respiratory disease (37 deaths per 100,000), Reading ranks 89th highest out of 150 local authorities. The highest rate was in Manchester (72 deaths per 100,000) and the lowest in Bath and North East Somerset (18 deaths per 100,000).
  • the fourth most common cause of death is liver disease (23 deaths per 100,000). Reading ranks 109th highest out of 150 local authorities. The highest rate was in Blackpool (40 deaths per 100,000) and the lowest in Buckinghamshire (10 deaths per 100,000).

As elsewhere, premature death is more common in areas where deprivation is higher. Figure 2 shows a high correlation (0.86, close to 'perfect' correlation of '1') between ward IMD score and premature death. The difference in life expectancy between the most and least deprived in Reading is 9.1 years (PHE, 2016).

Figure 2: The relationship between premature mortality and deprivation in Reading

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Source: Primary Care Mortality Database and IMD rankings (ONS)

Mapping rates of premature deaths from cardiovascular disease, for which Reading is ranked particularly high, demonstrates that there tend to be higher rates in those wards where deprivation is also higher (see Figure 3, below) (high deprivation is particularly notable in: the far south of Whitley ward and the Northumberland Avenue area in the south of the borough; throughout Abbey ward and around the town centre; around Dee Road in Norcot ward; around Coronation Square in Southcote ward; and around Amersham Road in Lower Caversham - see Deprivation by Ward and LSOA section).

Figure 3: Low, medium and high death rates from cardiovascular disease under the age of 75 years in Reading

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The most common causes of disability

The 2013 Global Burden of Disease Study (Vos et al, 2015) reports on the incidence, prevalence and years lived with disability of 301 acute and chronic diseases in 188 countries (including the UK) over a period of 23 years. The study shows that between 1990 and 2013 an increasing number have been living with more than one long-term condition or disability as they get older. Put another way, people are living longer and many are experiencing increasing disability and poorer health as they do so. This has obvious implications for health and social care services.

In common with most other high income countries such as Australia, New Zealand, Japan, Canada, the USA, western Europe and the Scandinavian countries, the top ten causes of disability and years lived with disability in the UK are, in order:

  1. back pain;
  2. neck pain;
  3. falls;
  4. major depressive disorder;
  5. diabetes;
  6. hearing problems;
  7. migraine;
  8. anxiety;
  9. other musculoskeletal disorders; and
  10. chronic obstructive pulmonary disease (chronic bronchitis and emphysema).

In the most recent Census, Reading is reported to have an age-standardised rate of 17% of residents who reported that their activities were limited by a disability in some way. This is similar to the rate of 16% for the South East and slightly lower than the rate of 19% for all of England (ONS, 2013). Applied crudely to the total population at the time of the Census, this would equate to around 26,500 people who are reporting that their daily life is effected by a disability .

Disability-free life expectancy, like life expectancy itself, tends to be lower as deprivation increases (ONS, 2012), meaning that those living in the more deprived areas of Reading are more likely to be living with a disability or limiting condition.

Whilst the various conditions and disabilities in this list are rarely direct causes of death, they cause substantial problems for the people suffering from them and will have an impact on demand for health and social care services. Many of the most common conditions (notably back pain, the rate of falls, and depression) can be avoided or ameliorated by increased physical exercise (DoH, 2004; Royal College of Physicians, 2012; Gillespie et al, 2012; Age UK, 2013a; WHO, 2004; Age UK, 2013b; Rimer et al, 2012).

What is this telling us?

Reading has a higher rate than average of premature death, with a particularly high rate of deaths from heart attack and stroke. The number of people with disability or other limiting condition is similar to national average, but still a significant proportion of the population.

What are the key inequalities?

There is strong evidence that those living in more deprived areas are more likely to die prematurely and more likely to be affected by disability. In addition, a local analysis of premature mortality rates and IMD score by ward shows high correlation. Mapping of rates of deaths from cardiovascular disease for those aged under 75 shows that the most deprived areas of Reading tend to have higher rates.

What are the unmet needs / service gaps?

Prevention interventions, especially those focusing on increasing physical activity and improving diet and weight management, reducing smoking and alcohol use are likely to be effective with many of the common causes of disability and premature death.

This section links to the following sections in the JSNA:

Deprivation by Ward and Lower Super Output Area

Cardiovascular Disease

Cancer

Diabetes

Drugs & Alcohol

Mental health

References

Age UK (2013a). Falls Prevention Exercise - following the evidence. Age UK. London. 2013. Available at: http://www.ageuk.org.uk/Documents/EN-GB/For-professionals/Research/Falls_Prevention_Guide_2013.pdf?dtrk=true (accessed 14 December 2015)

Age UK (2013b). Stop falling: start saving lives and money. Age UK. London. Available at: http://www.ageuk.org.uk/Documents/EN-GB/Falls/Stop_falling_report_web.pdf (accessed 14 December 2015)

Department of Health (DoH) (2004). At least five a week. Evidence on the impact of physical activity and its relationship to health - a report from the Chief Medical Officer. Department of Health. London.

Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S et al. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. Issue 9 No: CD007146. DOI: 10.1002/14651858.CD007146.pub3

National Centre for Social Research, Department of Epidemiology and Public Health (University College Medical School) (2009). Health Survey for England 2008: Physical Activity and Fitness.The Health and Social Care Information Centre. London. Available at: http://www.hscic.gov.uk/catalogue/PUB00430/heal-surv-phys-acti-fitn-eng-2008-rep-v1.pdf  [accessed 16 December 2015]

Office for National Statistics (ONS) (2015). Deaths Registered in England and Wales: 2014.ONS, London.Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregistrationsummarytables/2015-07-15#deaths-in-the-uk (Accessed 10th March 2016).

ONS (2013). 2011 Census Analysis, Local Authority Variations in Self-Assessed Activity Limitations (Disability) for Males and Females, England and Wales, 2011. London, ONS.

Public Health England. Public Health Outcomes Framework. PHE, London. Available at http://www.phoutcomes.info/ (Accessed 16th March 2016).

Public Health England. Longer Lives. Available at: http://healthierlives.phe.org.uk/topic/mortality (Accessed 18th December 2015)

Rimer J, Dwan K, Lawlor DA, Greig CA, McMurdo M et al (2012). Exercise for depression. Cochrane Database of Systematic Reviews.Jul 11;7: CD004366. doi: 10.1002/14651858.CD004366.pub5

Royal College of Physicians (2012). Exercise for life: physical activity in health and disease. Royal College of Physicians. London. 2012

Vos, T et al. (2015). Global, regional and national incidence, prevalence and years lived with a disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 386, 9995, pp743-800.

World Health Organisation (WHO) (2004). What are the main risk factors for falls amongst older people and what are the most effective interventions to prevent these falls? World Health Organisation. Geneva. Available at: http://www.euro.who.int/__data/assets/pdf_file/0018/74700/E82552.pdf (accessed 14 December 2015)

  

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