Steel N, et al. – Researchers used Global Burden of Disease (GBD) 2016 data on mortality, cause of death, and disability to assess the burden of disease in countries of the United Kingdom and within local authorities in England by deprivation quintile. They found that, particularly with respect to cardiovascular disease and cancer, there was a notable decrease in the improvement of years of life lost (YLLs) and life expectancy after 2010. In order to address the increasing proportion of burden due to morbidity, such as musculoskeletal problems and depression, they authors indicated that a targeted policy response is required. An essential component of this response is the improvement in the quality and completeness of available data on these causes.

Methods

• Data from the GBD 2016 was extracted to estimate YLLs, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and attributable risks from 1990-2016 for England, Scotland, Wales, Northern Ireland, the United Kingdom, and 150 English Upper-Tier Local Authorities.
• Researchers evaluated the burden of disease by cause of death, condition, year, and sex.
• They assessed the correlation between burden of disease and socioeconomic deprivation using the Index of Multiple Deprivation.
• Their findings included results for all 264 GBD causes of death combined and the leading 20 specific causes, and all 84 GBD risks or risk clusters combined and 17 specific risks or risk clusters.

Results

• The leading causes of age-adjusted YLLs in all UK countries in 2016 were ischemic heart disease, lung cancers, cerebrovascular disease, and chronic obstructive pulmonary disease.
• Findings suggested the variation of age-standardized rates of YLLs for all causes by two times between local areas in England according to levels of socioeconomic deprivation (from 14,274 per 100,000 population [95% uncertainty interval: 12,791–15,875] in Blackpool to 6,888 [6,145–7,739] in Wokingham).
• Results demonstrated that, for the level of deprivation, some Upper-Tier Local Authorities, particularly those in London, did better than expected.
• Allowing for differences in age structure, higher attributable YLLs for most major risk factors in the GBD were observed in more deprived Upper-Tier Local Authorities.
• They noted a variation in the population attributable fractions for all-cause YLLs for individual major risk factors across Upper-Tier Local Authorities.
• Compared with 1990–2010, life expectancy and YLLs have improved more slowly since 2010 in all UK countries.
• After 2010, YLLs increased in 9 of 150 Upper-Tier Local Authorities.
• For attributable YLLs, they noted substantial decrease in the rate of improvement for cardiovascular disease and breast, colorectal, and lung cancers, and this demonstrated little change for Alzheimer's disease and other dementias.
• In the United Kingdom, morbidity comprised an increasing contribution to overall burden vs mortality.
• Compared with ischemic heart disease (1,200 [1,155–1,246]) or lung cancer (660 [642–679]), the age-standardized UK DALY rate for low back and neck pain (1,795 [1,258–2,356]) was higher.
• Low back and neck pain, skin and subcutaneous diseases, migraine, depressive disorders, and sense organ disease were the leading causes of ill health (measured through YLDs) in the United Kingdom in 2016.
• Across the United Kingdom, age-standardized YLD rates varied much less than equivalent YLL rates, which reflects the relative scarcity of local data on causes of ill health.