Stalling life expectancy in the UK
BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k4050 (Published 27 September 2018) Cite this as: BMJ 2018;362:k4050
All rapid responses
Like many other I am disquieted by the austerity theory due to the simplistic implication that the restoration in funding will reverse the increase in deaths. I agree that austerity has caused hardship but the extent of its effect on deaths is questionable.
To this end I have recently published three studies investigating if other factors are involved. It is hoped that these studies can help to craft the research questions needed to establish the actual causes for the increase in deaths [1-3]. Periods of higher deaths have occurred in the past but their significance may have been overlooked [4].
May I also support the notion that linkage with hospital admission is a vastly important part of this process [5-7].
I hope that these studies are of benefit in this endeavour.
References
1. Jones R (2017) Did austerity cause the rise in deaths seen in England and Wales in 2015? British Journal of healthcare Management 23(9): 418-424.
2. Jones R (2017) Role of social group and gender in outbreaks of a novel agent leading to increased deaths, with insights into higher international deaths in 2015. Fractal Geometry and Nonlinear Analysis in Medicine and Biology 3(1): in press. https://www.oatext.com/role-of-social-group-and-gender-in-outbreaks-of-a...
3. Jones R (2017) Different patterns of male and female deaths in 2015 in English and Welsh local authorities question the role of austerity as the primary force behind higher deaths. Fractal Geometry and Nonlinear Analysis in Medicine and Biology 3(1): in press. https://www.oatext.com/different-patterns-of-male-and-female-deaths-in-2...
4.Jones R (2018) Periods of unexplained higher deaths and medical admissions have occurred previously – but were apparently ignored, misinterpreted or not investigated. European Journal of Internal Medicine 40: e18-e20. https://doi.org/10.1016/j.ejim.2017.11.004
5. Jones R (2017) A reduction in acute thrombotic admissions during a period of unexplained increased deaths and medical admissions in the UK. European Journal of Internal Medicine 46: e31-e33 doi: http://dx.doi.org/10.1016/j.ejim.2017.09.007
6. Jones R (2017) Age-specific and year of birth changes in hospital admissions during a period of unexplained higher deaths in England. European Journal of Internal Medicine 45: 2-4. doi: http://dx.doi.org/10.1016/j.ejim.2017.09.039
7. Jones R (2018) Admissions for certain conditions show explosive growth in England following a sudden and unexpected increase in deaths. European Journal of Internal Medicine. 2018; 54: e33-e35. doi: https://doi.org/10.1016/j.ejim.2018.03.005
Competing interests: No competing interests
We are not immortal. In order to study the slowing down of the rate of increase in life expectancy one should first try to understand the reason for this increase, and attempt to estimate the achievable mean expectancy.
Life expectancy at 60 did not start to increase until the mid twentieth century. It occurred in almost all advanced societies, despite different health and social systems and disparate experience during the war years. Although modern medicine has contributed to this increase, it is not the prime cause, improvements often preceding rather than following the medical advances -- for example, the reduction in cardiovascular mortality was apparent by the end of the seventies, whilst interventions aimed at increasing survival were developed in the eighties and nineties.
Furthermore, the simultaneous increase in height seen in the same populations is certainly not due to medical interventions, nor can my observation supported by a sock retailer that my grand-children's feet are disproportionately even larger than those of my friends at the same age. All two or three are likely to have the same as yet undetermined cause. Elucidation of this is likely to achieve more than blaming lack of resources as the prime reason.
Successful social and medical interventions aimed at improving the lot of the deprived should have the desirable effect of improving average performance and the lot of many deprived. However, the few who do not benefit may have less potential, so, albeit the number of deprived being less, the outcome for the remaining deprived may get worse and the gap with the more fortunate is likely to increase.
Competing interests: No competing interests
Migrant effect
Migration can affect life expectancy. The “healthy migrant” effect had a beneficial effect upon life expectancy in Australia.[1]. Over the last two decades, there has been significant migration especially from Eastern European Countries to UK.[2]. Life expectancy in Eastern European as well as in African and Asian countries is significantly lower than UK .[3]. Could the stalling life expectancy in UK be explained by migration from countries with poor life expectancy rather than austerity.[4]. [5]
References
1 WHO | Global comparative assessments of life expectancy: the impact of migration with reference to Australia. WHO. http://www.who.int/bulletin/volumes/85/6/06-036202/en/ (accessed 1 Oct 2018).
2 International migration - Office for National Statistics. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigrati... (accessed 1 Oct 2018).
3 List of countries by life expectancy. Wikipedia. 2018.https://en.wikipedia.org/w/index.php?title=List_of_countries_by_life_exp... (accessed 1 Oct 2018).
4 Raleigh VS. Stalling life expectancy in the UK. BMJ 2018;362:k4050. doi:10.1136/bmj.k4050
5 Cao B, Bray F, Beltrán-Sánchez H, et al. Benchmarking life expectancy and cancer mortality: global comparison with cardiovascular disease 1981-2010. BMJ 2017;357:j2765. doi:10.1136/bmj.j2765
Competing interests: No competing interests
Further to Professor Dorllng's query, I'd like to clarify that my reference to "periodic bad winters" refers to periodic bad winter mortality and does not refer to winter temperatures ie it needs to be interpreted in the context of the rest of the sentence which refers to "the general deceleration in mortality improvements". This is also explained earlier in para 3 of the paper. More generally, the aim of the article was to illustrate why we need a better epidemiological understanding, including in the international context, of what's causing UK's life expectancy to stall, and make some practical suggestions for how this can be facilitated. This could aid the development of appropriate, targeted policy responses.
As Dr Colvin notes for Scotland, drug-related deaths have been rising also in England. The recent ONS report[1] shows that mortality rates at ages 15-54 in UK have increased since 2012, with deaths from external causes (including drug-related deaths) being a significant contributor. These trends illustrate the differences in age-sex patterns in current mortality trends and the need for close monitoring across the board.
Veena Raleigh
1. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarri...
Competing interests: No competing interests
The contribution of opioids to falling life expectancy is not unique to the USA. The number of drug related deaths in Scotland has doubled since 2007, contributing significantly to our falling life expectancy according the nrscotland report.
Competing interests: No competing interests
The author claims that: "In summary, the general deceleration in mortality improvements in many high income countries since 2010 has been compounded by periodic bad winters."
ONS have reported the deceleration to be greater in the UK than all other 20 affluent countries they compared, with the sole exception of the USA. In many of those countries there was no deceleration and, in some, an actual acceleration of previous improvements. The Conservative MP Robert Court and others responded to this news by suggesting a natural plateauing was occurring and that there are many complex factors at play including cold winter weather since 2010 (1).
In the winter of 2011/12 UK "temperatures in the UK were 0.9 °C above the 1971-2000 average" (2).
In the winter of 2012/13 UK temperatures were "0.4 °C below the 1981-2010 average." (3). However, note that the baseline had change, and the largest rise in excess deaths had not yet begun.
In the winter of 2013/2014 UK temperatures were "0.5 °C above the 1981-2010 average." (4).
In the winter of 2014/2015 UK temperatures were "0.2 °C above the 1981-2010 average." (5).
In the winter of 2015/2016 UK temperatures were "1.8 °C above the 1981-2010 average" (6)!
In the winter of 2016/2017 UK temperatures were "1.3 °C above the 1981-2010 average." (7)!
In the winter of 2017/2018 UK temperatures were "0.2 °C below the 1981-2010 average". However, in the December of that winter, when that year's rapid rise in deaths began: "temperatures 0.4 °C above average" (8).
So, when was this series of "periodic bad winters"?
I am a professor of Geography. I understand how to measure the weather.
I sincerely hope my colleagues from epidemiology, social statistics, public health, social policy and virology will help explain what else in this article needs to be questioned. But for a start, please let us know when this series of periodic bad winters in the UK began and when it ended during the 2011-2018 period?
Danny Dorling
School of Geography and the Environment
Oxford University Centre for the Environment
South Parks Road
Oxford, UK.
(1) Hiam, L. and Dorling, D. Improving life expectancy used to be the UK’s forte – now it’s falling behind, The Conversation, August 16th 2018, https://theconversation.com/improving-life-expectancy-used-to-be-the-uks...
(2) https://www.metoffice.gov.uk/climate/uk/summaries/2012/winter
(3) https://www.metoffice.gov.uk/climate/uk/summaries/2013/winter
(4) https://www.metoffice.gov.uk/climate/uk/summaries/2014/winter
(5) https://www.metoffice.gov.uk/climate/uk/summaries/2015/winter
(6) https://www.metoffice.gov.uk/climate/uk/summaries/2016/winter
(7) https://www.metoffice.gov.uk/climate/uk/summaries/2017/winter
(8) https://www.metoffice.gov.uk/climate/uk/summaries/2018/winter
Competing interests: No competing interests
Re: Stalling life expectancy in the UK
In response to this excellent editorial by Veena Raleigh I have summarised a number of research questions which need to be answered before the austerity theory can be accepted as proven. This has been lodged as a short paper 'Unanswered questions for the austerity theory' in Research Gate with the doi: 10.13140/RG.2.2.20357.60643
I hope that these questions will stimulate further research.
Competing interests: No competing interests