Changes in health in England, with analysis by English regions and areas of deprivation, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013

John N. Newton, Adam D.M. Briggs, Christopher J.L. Murray, Daniel Dicker, Kyle J. Foreman, Haidong Wang, Mohsen Naghavi, Mohammad H. Forouzanfar, Summer Lockett Ohno, Ryan M. Barber, Theo Vos, Jeffrey D. Stanaway, Jürgen C. Schmidt, Andrew J. Hughes, Derek F.J. Fay, Russell Ecob, Charis Gresser, Martin McKee, Harry Rutter, Ibrahim AbubakarRaghib Ali, H. Ross Anderson, Amitava Banerjee, Derrick A. Bennett, Eduardo Bernabé, Kamaldeep S. Bhui, Stanley M. Biryukov, Rupert R. Bourne, Carol E.G. Brayne, Nigel G. Bruce, Traolach S. Brugha, Michael Burch, Simon Capewell, Daniel Casey, Rajiv Chowdhury, Matthew M. Coates, Cyrus Cooper, Julia A. Critchley, Paul I. Dargan, Mukesh K. Dherani, Paul Elliott, Majid Ezzati, Kevin A. Fenton, Maya S. Fraser, Thomas Fürst, Felix Greaves, Mark A. Green, David J. Gunnell, Bernadette M. Hannigan, Roderick J. Hay, Simon I. Hay, Harry Hemingway, Heidi J. Larson, Katharine J. Looker, Raimundas Lunevicius, Ronan A. Lyons, Wagner Marcenes, Amanda J. Mason-Jones, Fiona E. Matthews, Henrik Moller, Michele E. Murdoch, Charles R. Newton, Neil Pearce, Frédéric B. Piel, Daniel Pope, Kazem Rahimi, Alina Rodriguez, Peter Scarborough, Austin E. Schumacher, Ivy Shiue, Liam Smeeth, Alison Tedstone, Jonathan Valabhji, Hywel C. Williams, Charles D.A. Wolfe, Anthony D. Woolf, Adrian C.J. Davis

Research output: Contribution to journalReview article

Abstract

Background In the Global Burden of Disease Study 2013 (GBD 2013), knowledge about health and its determinants has been integrated into a comparable framework to inform health policy. Outputs of this analysis are relevant to current policy questions in England and elsewhere, particularly on health inequalities. We use GBD 2013 data on mortality and causes of death, and disease and injury incidence and prevalence to analyse the burden of disease and injury in England as a whole, in English regions, and within each English region by deprivation quintile. We also assess disease and injury burden in England attributable to potentially preventable risk factors. England and the English regions are compared with the remaining constituent countries of the UK and with comparable countries in the European Union (EU) and beyond. Methods We extracted data from the GBD 2013 to compare mortality, causes of death, years of life lost (YLLs), years lived with a disability (YLDs), and disability-adjusted life-years (DALYs) in England, the UK, and 18 other countries (the first 15 EU members [apart from the UK] and Australia, Canada, Norway, and the USA [EU15+]). We extended elements of the analysis to English regions, and subregional areas defined by deprivation quintile (deprivation areas). We used data split by the nine English regions (corresponding to the European boundaries of the Nomenclature for Territorial Statistics level 1 [NUTS 1] regions), and by quintile groups within each English region according to deprivation, thereby making 45 regional deprivation areas. Deprivation quintiles were defined by area of residence ranked at national level by Index of Multiple Deprivation score, 2010. Burden due to various risk factors is described for England using new GBD methodology to estimate independent and overlapping attributable risk for five tiers of behavioural, metabolic, and environmental risk factors. We present results for 306 causes and 2337 sequelae, and 79 risks or risk clusters. Findings Between 1990 and 2013, life expectancy from birth in England increased by 5·4 years (95% uncertainty interval 5·0-5·8) from 75·9 years (75·9-76·0) to 81·3 years (80·9-81·7); gains were greater for men than for women. Rates of age-standardised YLLs reduced by 41·1% (38·3-43·6), whereas DALYs were reduced by 23·8% (20·9-27·1), and YLDs by 1·4% (0·1-2·8). For these measures, England ranked better than the UK and the EU15+ means. Between 1990 and 2013, the range in life expectancy among 45 regional deprivation areas remained 8·2 years for men and decreased from 7·2 years in 1990 to 6·9 years in 2013 for women. In 2013, the leading cause of YLLs was ischaemic heart disease, and the leading cause of DALYs was low back and neck pain. Known risk factors accounted for 39·6% (37·7-41·7) of DALYs; leading behavioural risk factors were suboptimal diet (10·8% [9·1-12·7]) and tobacco (10·7% [9·4-12·0]). Interpretation Health in England is improving although substantial opportunities exist for further reductions in the burden of preventable disease. The gap in mortality rates between men and women has reduced, but marked health inequalities between the least deprived and most deprived areas remain. Declines in mortality have not been matched by similar declines in morbidity, resulting in people living longer with diseases. Health policies must therefore address the causes of ill health as well as those of premature mortality. Systematic action locally and nationally is needed to reduce risk exposures, support healthy behaviours, alleviate the severity of chronic disabling disorders, and mitigate the effects of socioeconomic deprivation. Funding Bill & Melinda Gates Foundation and Public Health England.

Original languageEnglish (US)
Pages (from-to)2257-2274
Number of pages18
JournalThe Lancet
Volume386
Issue number10010
DOIs
StatePublished - Dec 5 2015

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England
Health
Quality-Adjusted Life Years
Mortality
European Union
Health Policy
Life Expectancy
Cause of Death
Wounds and Injuries
Global Burden of Disease
New England
Premature Mortality
Neck Pain
Norway
Low Back Pain
Terminology
Uncertainty
Tobacco
Canada
Myocardial Ischemia

ASJC Scopus subject areas

  • Medicine(all)

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Changes in health in England, with analysis by English regions and areas of deprivation, 1990-2013 : A systematic analysis for the Global Burden of Disease Study 2013. / Newton, John N.; Briggs, Adam D.M.; Murray, Christopher J.L.; Dicker, Daniel; Foreman, Kyle J.; Wang, Haidong; Naghavi, Mohsen; Forouzanfar, Mohammad H.; Ohno, Summer Lockett; Barber, Ryan M.; Vos, Theo; Stanaway, Jeffrey D.; Schmidt, Jürgen C.; Hughes, Andrew J.; Fay, Derek F.J.; Ecob, Russell; Gresser, Charis; McKee, Martin; Rutter, Harry; Abubakar, Ibrahim; Ali, Raghib; Anderson, H. Ross; Banerjee, Amitava; Bennett, Derrick A.; Bernabé, Eduardo; Bhui, Kamaldeep S.; Biryukov, Stanley M.; Bourne, Rupert R.; Brayne, Carol E.G.; Bruce, Nigel G.; Brugha, Traolach S.; Burch, Michael; Capewell, Simon; Casey, Daniel; Chowdhury, Rajiv; Coates, Matthew M.; Cooper, Cyrus; Critchley, Julia A.; Dargan, Paul I.; Dherani, Mukesh K.; Elliott, Paul; Ezzati, Majid; Fenton, Kevin A.; Fraser, Maya S.; Fürst, Thomas; Greaves, Felix; Green, Mark A.; Gunnell, David J.; Hannigan, Bernadette M.; Hay, Roderick J.; Hay, Simon I.; Hemingway, Harry; Larson, Heidi J.; Looker, Katharine J.; Lunevicius, Raimundas; Lyons, Ronan A.; Marcenes, Wagner; Mason-Jones, Amanda J.; Matthews, Fiona E.; Moller, Henrik; Murdoch, Michele E.; Newton, Charles R.; Pearce, Neil; Piel, Frédéric B.; Pope, Daniel; Rahimi, Kazem; Rodriguez, Alina; Scarborough, Peter; Schumacher, Austin E.; Shiue, Ivy; Smeeth, Liam; Tedstone, Alison; Valabhji, Jonathan; Williams, Hywel C.; Wolfe, Charles D.A.; Woolf, Anthony D.; Davis, Adrian C.J.

In: The Lancet, Vol. 386, No. 10010, 05.12.2015, p. 2257-2274.

Research output: Contribution to journalReview article

Newton, JN, Briggs, ADM, Murray, CJL, Dicker, D, Foreman, KJ, Wang, H, Naghavi, M, Forouzanfar, MH, Ohno, SL, Barber, RM, Vos, T, Stanaway, JD, Schmidt, JC, Hughes, AJ, Fay, DFJ, Ecob, R, Gresser, C, McKee, M, Rutter, H, Abubakar, I, Ali, R, Anderson, HR, Banerjee, A, Bennett, DA, Bernabé, E, Bhui, KS, Biryukov, SM, Bourne, RR, Brayne, CEG, Bruce, NG, Brugha, TS, Burch, M, Capewell, S, Casey, D, Chowdhury, R, Coates, MM, Cooper, C, Critchley, JA, Dargan, PI, Dherani, MK, Elliott, P, Ezzati, M, Fenton, KA, Fraser, MS, Fürst, T, Greaves, F, Green, MA, Gunnell, DJ, Hannigan, BM, Hay, RJ, Hay, SI, Hemingway, H, Larson, HJ, Looker, KJ, Lunevicius, R, Lyons, RA, Marcenes, W, Mason-Jones, AJ, Matthews, FE, Moller, H, Murdoch, ME, Newton, CR, Pearce, N, Piel, FB, Pope, D, Rahimi, K, Rodriguez, A, Scarborough, P, Schumacher, AE, Shiue, I, Smeeth, L, Tedstone, A, Valabhji, J, Williams, HC, Wolfe, CDA, Woolf, AD & Davis, ACJ 2015, 'Changes in health in England, with analysis by English regions and areas of deprivation, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013', The Lancet, vol. 386, no. 10010, pp. 2257-2274. https://doi.org/10.1016/S0140-6736(15)00195-6
Newton, John N. ; Briggs, Adam D.M. ; Murray, Christopher J.L. ; Dicker, Daniel ; Foreman, Kyle J. ; Wang, Haidong ; Naghavi, Mohsen ; Forouzanfar, Mohammad H. ; Ohno, Summer Lockett ; Barber, Ryan M. ; Vos, Theo ; Stanaway, Jeffrey D. ; Schmidt, Jürgen C. ; Hughes, Andrew J. ; Fay, Derek F.J. ; Ecob, Russell ; Gresser, Charis ; McKee, Martin ; Rutter, Harry ; Abubakar, Ibrahim ; Ali, Raghib ; Anderson, H. Ross ; Banerjee, Amitava ; Bennett, Derrick A. ; Bernabé, Eduardo ; Bhui, Kamaldeep S. ; Biryukov, Stanley M. ; Bourne, Rupert R. ; Brayne, Carol E.G. ; Bruce, Nigel G. ; Brugha, Traolach S. ; Burch, Michael ; Capewell, Simon ; Casey, Daniel ; Chowdhury, Rajiv ; Coates, Matthew M. ; Cooper, Cyrus ; Critchley, Julia A. ; Dargan, Paul I. ; Dherani, Mukesh K. ; Elliott, Paul ; Ezzati, Majid ; Fenton, Kevin A. ; Fraser, Maya S. ; Fürst, Thomas ; Greaves, Felix ; Green, Mark A. ; Gunnell, David J. ; Hannigan, Bernadette M. ; Hay, Roderick J. ; Hay, Simon I. ; Hemingway, Harry ; Larson, Heidi J. ; Looker, Katharine J. ; Lunevicius, Raimundas ; Lyons, Ronan A. ; Marcenes, Wagner ; Mason-Jones, Amanda J. ; Matthews, Fiona E. ; Moller, Henrik ; Murdoch, Michele E. ; Newton, Charles R. ; Pearce, Neil ; Piel, Frédéric B. ; Pope, Daniel ; Rahimi, Kazem ; Rodriguez, Alina ; Scarborough, Peter ; Schumacher, Austin E. ; Shiue, Ivy ; Smeeth, Liam ; Tedstone, Alison ; Valabhji, Jonathan ; Williams, Hywel C. ; Wolfe, Charles D.A. ; Woolf, Anthony D. ; Davis, Adrian C.J. / Changes in health in England, with analysis by English regions and areas of deprivation, 1990-2013 : A systematic analysis for the Global Burden of Disease Study 2013. In: The Lancet. 2015 ; Vol. 386, No. 10010. pp. 2257-2274.
@article{69d17fa8950a4d8eb61b52b929c8937a,
title = "Changes in health in England, with analysis by English regions and areas of deprivation, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013",
abstract = "Background In the Global Burden of Disease Study 2013 (GBD 2013), knowledge about health and its determinants has been integrated into a comparable framework to inform health policy. Outputs of this analysis are relevant to current policy questions in England and elsewhere, particularly on health inequalities. We use GBD 2013 data on mortality and causes of death, and disease and injury incidence and prevalence to analyse the burden of disease and injury in England as a whole, in English regions, and within each English region by deprivation quintile. We also assess disease and injury burden in England attributable to potentially preventable risk factors. England and the English regions are compared with the remaining constituent countries of the UK and with comparable countries in the European Union (EU) and beyond. Methods We extracted data from the GBD 2013 to compare mortality, causes of death, years of life lost (YLLs), years lived with a disability (YLDs), and disability-adjusted life-years (DALYs) in England, the UK, and 18 other countries (the first 15 EU members [apart from the UK] and Australia, Canada, Norway, and the USA [EU15+]). We extended elements of the analysis to English regions, and subregional areas defined by deprivation quintile (deprivation areas). We used data split by the nine English regions (corresponding to the European boundaries of the Nomenclature for Territorial Statistics level 1 [NUTS 1] regions), and by quintile groups within each English region according to deprivation, thereby making 45 regional deprivation areas. Deprivation quintiles were defined by area of residence ranked at national level by Index of Multiple Deprivation score, 2010. Burden due to various risk factors is described for England using new GBD methodology to estimate independent and overlapping attributable risk for five tiers of behavioural, metabolic, and environmental risk factors. We present results for 306 causes and 2337 sequelae, and 79 risks or risk clusters. Findings Between 1990 and 2013, life expectancy from birth in England increased by 5·4 years (95{\%} uncertainty interval 5·0-5·8) from 75·9 years (75·9-76·0) to 81·3 years (80·9-81·7); gains were greater for men than for women. Rates of age-standardised YLLs reduced by 41·1{\%} (38·3-43·6), whereas DALYs were reduced by 23·8{\%} (20·9-27·1), and YLDs by 1·4{\%} (0·1-2·8). For these measures, England ranked better than the UK and the EU15+ means. Between 1990 and 2013, the range in life expectancy among 45 regional deprivation areas remained 8·2 years for men and decreased from 7·2 years in 1990 to 6·9 years in 2013 for women. In 2013, the leading cause of YLLs was ischaemic heart disease, and the leading cause of DALYs was low back and neck pain. Known risk factors accounted for 39·6{\%} (37·7-41·7) of DALYs; leading behavioural risk factors were suboptimal diet (10·8{\%} [9·1-12·7]) and tobacco (10·7{\%} [9·4-12·0]). Interpretation Health in England is improving although substantial opportunities exist for further reductions in the burden of preventable disease. The gap in mortality rates between men and women has reduced, but marked health inequalities between the least deprived and most deprived areas remain. Declines in mortality have not been matched by similar declines in morbidity, resulting in people living longer with diseases. Health policies must therefore address the causes of ill health as well as those of premature mortality. Systematic action locally and nationally is needed to reduce risk exposures, support healthy behaviours, alleviate the severity of chronic disabling disorders, and mitigate the effects of socioeconomic deprivation. Funding Bill & Melinda Gates Foundation and Public Health England.",
author = "Newton, {John N.} and Briggs, {Adam D.M.} and Murray, {Christopher J.L.} and Daniel Dicker and Foreman, {Kyle J.} and Haidong Wang and Mohsen Naghavi and Forouzanfar, {Mohammad H.} and Ohno, {Summer Lockett} and Barber, {Ryan M.} and Theo Vos and Stanaway, {Jeffrey D.} and Schmidt, {J{\"u}rgen C.} and Hughes, {Andrew J.} and Fay, {Derek F.J.} and Russell Ecob and Charis Gresser and Martin McKee and Harry Rutter and Ibrahim Abubakar and Raghib Ali and Anderson, {H. Ross} and Amitava Banerjee and Bennett, {Derrick A.} and Eduardo Bernab{\'e} and Bhui, {Kamaldeep S.} and Biryukov, {Stanley M.} and Bourne, {Rupert R.} and Brayne, {Carol E.G.} and Bruce, {Nigel G.} and Brugha, {Traolach S.} and Michael Burch and Simon Capewell and Daniel Casey and Rajiv Chowdhury and Coates, {Matthew M.} and Cyrus Cooper and Critchley, {Julia A.} and Dargan, {Paul I.} and Dherani, {Mukesh K.} and Paul Elliott and Majid Ezzati and Fenton, {Kevin A.} and Fraser, {Maya S.} and Thomas F{\"u}rst and Felix Greaves and Green, {Mark A.} and Gunnell, {David J.} and Hannigan, {Bernadette M.} and Hay, {Roderick J.} and Hay, {Simon I.} and Harry Hemingway and Larson, {Heidi J.} and Looker, {Katharine J.} and Raimundas Lunevicius and Lyons, {Ronan A.} and Wagner Marcenes and Mason-Jones, {Amanda J.} and Matthews, {Fiona E.} and Henrik Moller and Murdoch, {Michele E.} and Newton, {Charles R.} and Neil Pearce and Piel, {Fr{\'e}d{\'e}ric B.} and Daniel Pope and Kazem Rahimi and Alina Rodriguez and Peter Scarborough and Schumacher, {Austin E.} and Ivy Shiue and Liam Smeeth and Alison Tedstone and Jonathan Valabhji and Williams, {Hywel C.} and Wolfe, {Charles D.A.} and Woolf, {Anthony D.} and Davis, {Adrian C.J.}",
year = "2015",
month = "12",
day = "5",
doi = "10.1016/S0140-6736(15)00195-6",
language = "English (US)",
volume = "386",
pages = "2257--2274",
journal = "The Lancet",
issn = "0140-6736",
publisher = "Elsevier Limited",
number = "10010",

}

TY - JOUR

T1 - Changes in health in England, with analysis by English regions and areas of deprivation, 1990-2013

T2 - A systematic analysis for the Global Burden of Disease Study 2013

AU - Newton, John N.

AU - Briggs, Adam D.M.

AU - Murray, Christopher J.L.

AU - Dicker, Daniel

AU - Foreman, Kyle J.

AU - Wang, Haidong

AU - Naghavi, Mohsen

AU - Forouzanfar, Mohammad H.

AU - Ohno, Summer Lockett

AU - Barber, Ryan M.

AU - Vos, Theo

AU - Stanaway, Jeffrey D.

AU - Schmidt, Jürgen C.

AU - Hughes, Andrew J.

AU - Fay, Derek F.J.

AU - Ecob, Russell

AU - Gresser, Charis

AU - McKee, Martin

AU - Rutter, Harry

AU - Abubakar, Ibrahim

AU - Ali, Raghib

AU - Anderson, H. Ross

AU - Banerjee, Amitava

AU - Bennett, Derrick A.

AU - Bernabé, Eduardo

AU - Bhui, Kamaldeep S.

AU - Biryukov, Stanley M.

AU - Bourne, Rupert R.

AU - Brayne, Carol E.G.

AU - Bruce, Nigel G.

AU - Brugha, Traolach S.

AU - Burch, Michael

AU - Capewell, Simon

AU - Casey, Daniel

AU - Chowdhury, Rajiv

AU - Coates, Matthew M.

AU - Cooper, Cyrus

AU - Critchley, Julia A.

AU - Dargan, Paul I.

AU - Dherani, Mukesh K.

AU - Elliott, Paul

AU - Ezzati, Majid

AU - Fenton, Kevin A.

AU - Fraser, Maya S.

AU - Fürst, Thomas

AU - Greaves, Felix

AU - Green, Mark A.

AU - Gunnell, David J.

AU - Hannigan, Bernadette M.

AU - Hay, Roderick J.

AU - Hay, Simon I.

AU - Hemingway, Harry

AU - Larson, Heidi J.

AU - Looker, Katharine J.

AU - Lunevicius, Raimundas

AU - Lyons, Ronan A.

AU - Marcenes, Wagner

AU - Mason-Jones, Amanda J.

AU - Matthews, Fiona E.

AU - Moller, Henrik

AU - Murdoch, Michele E.

AU - Newton, Charles R.

AU - Pearce, Neil

AU - Piel, Frédéric B.

AU - Pope, Daniel

AU - Rahimi, Kazem

AU - Rodriguez, Alina

AU - Scarborough, Peter

AU - Schumacher, Austin E.

AU - Shiue, Ivy

AU - Smeeth, Liam

AU - Tedstone, Alison

AU - Valabhji, Jonathan

AU - Williams, Hywel C.

AU - Wolfe, Charles D.A.

AU - Woolf, Anthony D.

AU - Davis, Adrian C.J.

PY - 2015/12/5

Y1 - 2015/12/5

N2 - Background In the Global Burden of Disease Study 2013 (GBD 2013), knowledge about health and its determinants has been integrated into a comparable framework to inform health policy. Outputs of this analysis are relevant to current policy questions in England and elsewhere, particularly on health inequalities. We use GBD 2013 data on mortality and causes of death, and disease and injury incidence and prevalence to analyse the burden of disease and injury in England as a whole, in English regions, and within each English region by deprivation quintile. We also assess disease and injury burden in England attributable to potentially preventable risk factors. England and the English regions are compared with the remaining constituent countries of the UK and with comparable countries in the European Union (EU) and beyond. Methods We extracted data from the GBD 2013 to compare mortality, causes of death, years of life lost (YLLs), years lived with a disability (YLDs), and disability-adjusted life-years (DALYs) in England, the UK, and 18 other countries (the first 15 EU members [apart from the UK] and Australia, Canada, Norway, and the USA [EU15+]). We extended elements of the analysis to English regions, and subregional areas defined by deprivation quintile (deprivation areas). We used data split by the nine English regions (corresponding to the European boundaries of the Nomenclature for Territorial Statistics level 1 [NUTS 1] regions), and by quintile groups within each English region according to deprivation, thereby making 45 regional deprivation areas. Deprivation quintiles were defined by area of residence ranked at national level by Index of Multiple Deprivation score, 2010. Burden due to various risk factors is described for England using new GBD methodology to estimate independent and overlapping attributable risk for five tiers of behavioural, metabolic, and environmental risk factors. We present results for 306 causes and 2337 sequelae, and 79 risks or risk clusters. Findings Between 1990 and 2013, life expectancy from birth in England increased by 5·4 years (95% uncertainty interval 5·0-5·8) from 75·9 years (75·9-76·0) to 81·3 years (80·9-81·7); gains were greater for men than for women. Rates of age-standardised YLLs reduced by 41·1% (38·3-43·6), whereas DALYs were reduced by 23·8% (20·9-27·1), and YLDs by 1·4% (0·1-2·8). For these measures, England ranked better than the UK and the EU15+ means. Between 1990 and 2013, the range in life expectancy among 45 regional deprivation areas remained 8·2 years for men and decreased from 7·2 years in 1990 to 6·9 years in 2013 for women. In 2013, the leading cause of YLLs was ischaemic heart disease, and the leading cause of DALYs was low back and neck pain. Known risk factors accounted for 39·6% (37·7-41·7) of DALYs; leading behavioural risk factors were suboptimal diet (10·8% [9·1-12·7]) and tobacco (10·7% [9·4-12·0]). Interpretation Health in England is improving although substantial opportunities exist for further reductions in the burden of preventable disease. The gap in mortality rates between men and women has reduced, but marked health inequalities between the least deprived and most deprived areas remain. Declines in mortality have not been matched by similar declines in morbidity, resulting in people living longer with diseases. Health policies must therefore address the causes of ill health as well as those of premature mortality. Systematic action locally and nationally is needed to reduce risk exposures, support healthy behaviours, alleviate the severity of chronic disabling disorders, and mitigate the effects of socioeconomic deprivation. Funding Bill & Melinda Gates Foundation and Public Health England.

AB - Background In the Global Burden of Disease Study 2013 (GBD 2013), knowledge about health and its determinants has been integrated into a comparable framework to inform health policy. Outputs of this analysis are relevant to current policy questions in England and elsewhere, particularly on health inequalities. We use GBD 2013 data on mortality and causes of death, and disease and injury incidence and prevalence to analyse the burden of disease and injury in England as a whole, in English regions, and within each English region by deprivation quintile. We also assess disease and injury burden in England attributable to potentially preventable risk factors. England and the English regions are compared with the remaining constituent countries of the UK and with comparable countries in the European Union (EU) and beyond. Methods We extracted data from the GBD 2013 to compare mortality, causes of death, years of life lost (YLLs), years lived with a disability (YLDs), and disability-adjusted life-years (DALYs) in England, the UK, and 18 other countries (the first 15 EU members [apart from the UK] and Australia, Canada, Norway, and the USA [EU15+]). We extended elements of the analysis to English regions, and subregional areas defined by deprivation quintile (deprivation areas). We used data split by the nine English regions (corresponding to the European boundaries of the Nomenclature for Territorial Statistics level 1 [NUTS 1] regions), and by quintile groups within each English region according to deprivation, thereby making 45 regional deprivation areas. Deprivation quintiles were defined by area of residence ranked at national level by Index of Multiple Deprivation score, 2010. Burden due to various risk factors is described for England using new GBD methodology to estimate independent and overlapping attributable risk for five tiers of behavioural, metabolic, and environmental risk factors. We present results for 306 causes and 2337 sequelae, and 79 risks or risk clusters. Findings Between 1990 and 2013, life expectancy from birth in England increased by 5·4 years (95% uncertainty interval 5·0-5·8) from 75·9 years (75·9-76·0) to 81·3 years (80·9-81·7); gains were greater for men than for women. Rates of age-standardised YLLs reduced by 41·1% (38·3-43·6), whereas DALYs were reduced by 23·8% (20·9-27·1), and YLDs by 1·4% (0·1-2·8). For these measures, England ranked better than the UK and the EU15+ means. Between 1990 and 2013, the range in life expectancy among 45 regional deprivation areas remained 8·2 years for men and decreased from 7·2 years in 1990 to 6·9 years in 2013 for women. In 2013, the leading cause of YLLs was ischaemic heart disease, and the leading cause of DALYs was low back and neck pain. Known risk factors accounted for 39·6% (37·7-41·7) of DALYs; leading behavioural risk factors were suboptimal diet (10·8% [9·1-12·7]) and tobacco (10·7% [9·4-12·0]). Interpretation Health in England is improving although substantial opportunities exist for further reductions in the burden of preventable disease. The gap in mortality rates between men and women has reduced, but marked health inequalities between the least deprived and most deprived areas remain. Declines in mortality have not been matched by similar declines in morbidity, resulting in people living longer with diseases. Health policies must therefore address the causes of ill health as well as those of premature mortality. Systematic action locally and nationally is needed to reduce risk exposures, support healthy behaviours, alleviate the severity of chronic disabling disorders, and mitigate the effects of socioeconomic deprivation. Funding Bill & Melinda Gates Foundation and Public Health England.

UR - http://www.scopus.com/inward/record.url?scp=84949529269&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84949529269&partnerID=8YFLogxK

U2 - 10.1016/S0140-6736(15)00195-6

DO - 10.1016/S0140-6736(15)00195-6

M3 - Review article

VL - 386

SP - 2257

EP - 2274

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 10010

ER -