There's been an "alarming growth" in the number of early deaths among 25-44 year olds in the North of England since the mid-1990s--long before the recession of 2008-09-- compounding the country's long established 'North-South' divide, reveals research published online in the Journal of Epidemiology & Community Health.
This disparity comes on top of the known gap in lifespan that has persisted for more than 50 years in the North of the country, adding up to more than 1 million excess deaths before the age of 75 during that time, say the researchers.
Differences in social, economic, and health outcomes between the North and South of England date back to the 11th century, and have persisted despite various government initiatives to narrow the divide, they point out.
They wanted to look at long term trends in premature deaths in northern and southern England, and to find out if the 2008-09 recession, which was much deeper than those of the nineties, eighties, and seventies, had influenced these trends.
They analysed annual figures by age and sex on all registered deaths as well as population estimates from 1965 to 2015 for the whole of England, and by region.
Northern regions comprised the North East; the North West; Yorkshire and the Humber; East Midlands; and West Midlands. Southern regions comprised the East; the South West; London; and the South East.
The analysis showed that between 1965 and 2010, premature deaths--defined as before the age of 75--per 10,000 of the population fell across the entire country, falling from 64 to 28 in the South, and from 72 to 35 in the North. But between 2010 and 2015 this decline stalled in both the North and the South.
The rates of excess early deaths were consistently higher for most age groups in the North than they were in the South throughout the entire 50 years, rising steadily from 17.5% in 1965 to 21.5% of the total in 2015.
Between 1965 and 2008, the chances of dying early were a fifth higher in the North than in the South, despite the country's overall death rate falling by around 50% in men and 40% in women during this period.
And the pattern of excess early deaths in the North was consistent in most age groups: high among the under 5s; falling with increasing age up to the mid-30s, then peaking among 50-74 year olds before falling again.
But a different pattern emerged for 25-34 year olds and 35-44 year olds in recent decades.
Excess deaths among these young and middle-aged people increased sharply between 1995 and 2015, rising from just over 2% to just over 29% of the total among 25-34 year olds, and from just over 3% to nearly 50% of the total among 35-44 year olds.
This was because the rate of premature deaths increased among 25-34 year olds and levelled off among 35-44 year olds in the North, while equivalent rates fell in the South from the mid-1990s onwards, explain the researchers.
Yet the economic climate in the mid-1990s was relatively good, and this period heralded the implementation of a series of government policies designed to reduce health inequalities, they point out.
The researchers acknowledge that they didn't look at the causes of death, so were not able to pinpoint the factors underlying the disparities, nor did they measure the impact of potentially influential factors over time, such as migration, smoking prevalence, and unemployment rates.
Nevertheless, they say, the figures point to "an alarming growth in England's North-South divide in mortality for the population aged 25-44, amid a persistent inequality accounting for 1.2 million northern excess deaths under age 75 over five decades."
And they suggest: "This profound and worsening structural inequality" may require substantial social and economic changes to put right, "including a rebalancing of the economy between North and South England that is proportionate to the scale of the problem."
Journal of Epidemiology & Community Health