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The Lancet: Life expectancy inequalities in England and Wales set to rise over next 15 years

The Lancet

By 2030, life expectancy in England and Wales is expected to reach 85·7 years for men and 87·6 years for women--closing the gap between male and female life expectancy from 6·0 years in 1981 to just 1·9 years by 2030, according to a new study published in The Lancet.

Between 1981 and 2012, national life expectancy in England and Wales increased by 8·2 years in men (to 79·5 years) and 6·0 years in women (to 83·3 years). However, national progress has come at the cost of rising inequalities, and the gap between the top and bottom 1% of life expectancies in local authority districts of England and Wales has increased by around 0·9 of a year for men (from 5·2 to 6·1 years) and 1·1 years for women (from 4·5 to 5·6 years).

Moreover, the research shows that the inequalities (gaps) between the top and bottom 1% of life expectancies of English and Welsh local authority districts are expected to continue to rise steadily, from 6·1 years in 2012 to 8·3 years in 2030 in men, and from 5·6 years to 8·3 years in women (see figure 3, p4).

"Our national forecasts of life expectancy in 2030 are higher than official figures from the Office for National Statistics, by 2·4 years for men and 1·0 years for women, meaning that pensions will have larger pay-outs than planned, and health and social services will have to serve an even older population than currently planned,"* says senior author Professor Majid Ezzati from Imperial College London, UK.

"The discrepancies found between our estimates and earlier figures are likely to be because previous estimates have extrapolated from past trends in death rates, an approach that may underestimate gains in life expectancy."*

Ezzati and colleagues used mortality and population data from the Office for National Statistics for 375 of the 376 local authority districts in England and Wales between 1981 and 2012. Data on the age at death and district of residence were used in advanced statistical methods which analysed current mortality patterns, and then forecast life expectancy to 2030 for each of the districts.

Key findings include:

  • In 2012, life expectancy was lowest in urban northern England (Blackpool in north west England had the lowest male life expectancy for men at 75·2 years, with Manchester and Liverpool next lowest, and Middlesbrough and Manchester had the lowest life expectancy for women at 80·2 years, followed by Blaenau Gwent in southern Wales). The highest life expectancies in 2012 were in southern England and some of London's most affluent districts (the small district of the City of London had the highest life expectancy for both men and women, at 83·4 and 87·3 years, respectively; for men, the next highest life expectancies were found in South Cambridgeshire and East Dorset, and, for women, East Dorset and the London borough of Kensington and Chelsea had the next highest life expectancies).

  • Within London, male and female life expectancies varied by 5 to 6 years, with the lowest life expectancies in Tower Hamlets or Barking and Dagenham, and the highest in the City of London or Kensington and Chelsea.

  • The largest difference in life expectancy between English and Welsh local authority districts in 2012 (8 years for men and 7 years for women) was equivalent to the gap between the average life expectancy in the UK and countries like Sri Lanka, Vietnam, and Nicaragua.

  • Life expectancy is forecast to increase in all 375 local authority districts, reaching or surpassing 81.4 years for men and reaching or surpassing 84·5 years for women in every district by 2030 (see figure 1, p3).

  • Up to 2012, women have had higher life expectancy than men in every district, a pattern which is generally expected to continue. However, in a few districts (Berwick-upon-Tweed, Sevenoaks, and Dartford), male life expectancy is expected to be almost the same as that for women by 2030, as death rates continue to improve more quickly for middle-aged men than women (see figure 5, p6).

According to Professor Ezzati, "The present UK coalition Government has cut public spending on a range of social determinants of health under the rhetoric of austerity. Such policies will, at best, cause the rising inequality trends to continue, and could well worsen them because their adverse effects are particularly large on children and working-age people, and on more disadvantaged social groups and communities, with signs of a rise in poverty already emerging."*

"Moreover, National Health Service reforms, which devolve health and social care responsibilities to local governments, coupled with tight budgets and a large role for the private sector in commissioning and provision of health services, will weaken health systems and worsen inequalities in health care access and quality."*

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NOTES TO EDITORS:

This study was funded by Medical Research Council and Public Health England.

* Quotes direct from author and cannot be found in text of Article.

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