Recent cohort effects in suicide in Scotland: a legacy of the 1980s?

Comparing trends in mid-life 'deaths of despair' in the USA, Canada and UK, 2001-2019: is the USA an anomaly?

OBJECTIVES

In recent years, 'deaths of despair' due to drugs, alcohol and suicide have contributed to rising mid-life mortality in the USA. We examine whether despair-related deaths and mid-life mortality trends are also changing in peer countries, the UK and Canada.

DESIGN

Descriptive analysis of population mortality rates.

SETTING

The USA, UK (and constituent nations England and Wales, Northern Ireland and Scotland) and Canada, 2001-2019.

PARTICIPANTS

Full population aged 35-64 years.

OUTCOME MEASURES

We compared all-cause and 'despair'-related mortality trends at mid-life across countries using publicly available mortality data, stratified by three age groups (35-44, 45-54 and 55-64 years) and by sex. We examined trends in all-cause mortality and mortality by causes categorised as (1) suicides, (2) alcohol-specific deaths and (3) drug-related deaths. We employ several descriptive approaches to visually inspect age, period and cohort trends in these causes of death.

RESULTS

The USA and Scotland both saw large relative increases and high absolute levels of drug-related deaths. The rest of the UK and Canada saw relative increases but much lower absolute levels in comparison. Alcohol-specific deaths showed less consistent trends that did not track other 'despair' causes, with older groups in Scotland seeing steep declines over time. Suicide deaths trended slowly upward in most countries.

CONCLUSIONS

In the UK, Scotland has suffered increases in drug-related mortality comparable with the USA, while Canada and other UK constituent nations did not see dramatic increases. Alcohol-specific and suicide mortalities generally follow different patterns to drug-related deaths across countries and over time, questioning the utility of a cohesive 'deaths of despair' narrative.

An age-period-cohort approach to studying long-term trends in obesity and overweight in England (1992-2019)

OBJECTIVE

This study aims to understand long-term trends in obesity and overweight in England by estimating life-course transitions as well as historical and birth cohort trends for both children and adults.

METHODS

Data on individuals aged 5 to 85 years old from the Health Survey for England were used, covering the period 1992 to 2019 and birth cohorts born between 1909 and 2013. Individual BMI values were classified as healthy weight, overweight, or obesity. Trends were compared, and an age-period-cohort model was estimated using logistic regression and categorical age, period, and cohort groups.

RESULTS

There was significant variation in age trajectories by birth cohorts for healthy weight and obesity prevalence. The odds of having obesity compared with a healthy weight increased consistently with age, increased throughout the study period (but faster between 1992 and 2001), and were higher for birth cohorts born between 1989 and 2008. The odds of having overweight showed an inverted U-shape among children, increased through adulthood, have been stable since 2012, and were considerably higher for the youngest birth cohort (2009-2013).

CONCLUSIONS

Younger generations with higher overweight prevalence coupled with increasing obesity prevalence with age suggest that obesity should remain a high priority for public health policy makers in England.

Understanding long-term trends in smoking in England, 1972-2019: an age-period-cohort approach

BACKGROUND AND AIMS

Smoking prevalence has been falling in England for more than 50 years, but remains a prevalent and major public health problem. This study used an age-period-cohort (APC) approach to measure lifecycle, historical and generational patterns of individual smoking behaviour.

DESIGN

APC analysis of repeated cross-sectional smoking prevalence data obtained from three nationally representative surveys.

SETTING

England (1972-2019).

PARTICIPANTS

Individuals aged 18-90 years.

MEASUREMENTS

We studied relative odds of current smoking in relation to age in single years from 18 to 90, 24 groups of 2-year survey periods (1972-73 to 2018-19) and 20 groups of 5-year birth cohorts (1907-11 to 1997-2001). Age and period rates were studied for two groups of birth cohorts: those aged 18-25 years and those aged over 25 years.

FINDINGS

Relative to age 18, the odds of current smoking increased with age until approximately age 25 [odds ratio (OR) = 1.48, 95% confidence interval (CI) = 1.41-1.56] and then decreased progressively to age 90 (OR = 0.06, 95% CI = 0.04-0.08). They also decreased almost linearly with period relative to 1972-73 (for 2018-19: OR = 0.30, 95% CI = 0.26-0.34) and with birth cohort relative to 1902-06, with the largest decreased observed for birth cohort 1992-96 (OR = 0.44, 95% CI = 0.35-0.46) and 1997-2001 (OR = 0.35, 95% CI = 0.74-0.88). Smoking declined in the 18-25 age group by an average of 7% over successive 2-year periods and by an average of 5% in those aged over 25.

CONCLUSIONS

Smoking in England appears to have declined over recent decades mainly as a result of reduced smoking uptake before age 25, and to a lesser extent to smoking cessation after age 25.

Deaths from 'diseases of despair' in Britain: comparing suicide, alcohol-related and drug-related mortality for birth cohorts in Scotland, England and Wales, and selected cities

Background

The contribution of increasing numbers of deaths from suicide, alcohol-related and drug-related causes to changes in overall mortality rates has been highlighted in various countries. In Scotland, particular vulnerable cohorts have been shown to be most at risk; however, it is unclear to what extent this applies elsewhere in Britain. The aim here was to compare mortality rates for different birth cohorts between Scotland and England and Wales (E&W), including key cities.

Methods

Mortality and population data (1981–2017) for Scotland, E&W and 10 cities were obtained from national statistical agencies. Ten-year birth cohorts and cohort-specific mortality rates (by age of death, sex, cause) were derived and compared between countries and cities.

Results

Similarities were observed between countries and cities in terms of peak ages of death, and the cohorts with the highest death rates. However, cohort-specific rates were notably higher in Scotland, particularly for alcohol-related and drug-related deaths. Across countries and cities, those born in 1965–1974 and 1975–1984 had the highest drug-related mortality rates (peak age at death: 30–34 years); the 1965–1974 birth cohort also had the highest male suicide rate (peak age: 40–44 years). For alcohol-related causes, the highest rates were among earlier cohorts (1935–1944, 1945–1954, 1955–1964)—peak age 60–64 years.

Conclusions

The overall similarities suggest common underlying influences across Britain; however, their effects have been greatest in Scotland, confirming greater vulnerability among that population. In addressing the socioeconomic drivers of deaths from these causes, the cohorts identified here as being at greatest risk require particular attention.

Deaths of despair: cause-specific mortality and socioeconomic inequalities in cause-specific mortality among young men in Scotland

Background

Increasing mortality among men from drugs, alcohol and suicides is a growing public health concern in many countries. Collectively known as “deaths of despair”, they are seen to stem from unprecedented economic pressures and a breakdown in social support structures.

Methods

We use high-quality population wide Scottish data to calculate directly age-standardized mortality rates for men aged 15–44 between 1980 and 2018 for 15 leading causes of mortality. Absolute and relative inequalities in mortality by cause are calculated using small-area deprivation and the slope and relative indices of inequality (SII and RII_L) for the years 2001–2018.

Results

Since 1980 there have been only small reductions in mortality among men aged 15–44 in Scotland. In that period drug-related deaths have increased from 1.2 (95% CI 0.7–1.4) to 44.9 (95% CI 42.5–47.4) deaths per 100,000 and are now the leading cause of mortality. Between 2001 and 2018 there have been small reductions in absolute but not in relative inequalities in all-cause mortality. However, absolute inequalities in mortality from drugs have doubled from SII = 66.6 (95% CI 61.5–70.9) in 2001–2003 to SII = 120.0 (95% CI 113.3–126.8) in 2016–2018. Drugs are the main contributor to inequalities in mortality, and together with alcohol harm and suicides make up 65% of absolute inequalities in mortality.

Conclusions

Contrary to the substantial reductions in mortality across all ages in the past decades, deaths among young men are increasing from preventable causes. Attempts to reduce external causes of mortality have focused on a single cause of death and not been effective in reducing mortality or inequalities in mortality from external causes in the long-run. To reduce deaths of despair, action should be taken to address social determinants of health and reduce socioeconomic inequalities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-020-01329-7.

All-cause and cause-specific mortality in Scotland 1981-2011 by age, sex and deprivation: a population-based study

Background

Average life expectancy has stopped increasing for many countries. This has been attributed to causes such as influenza, austerity policies and deaths of despair (drugs, alcohol and suicide). Less is known on the inequality of life expectancy over time using reliable, whole population, data. This work examines all-cause and cause-specific mortality rates in Scotland to assess the patterning of relative and absolute inequalities across three decades.

Methods

Using routinely collected Scottish mortality and population records we calculate directly age-standardized mortality rates by age group, sex and deprivation fifths for all-cause and cause-specific deaths around each census 1981–2011.

Results

All-cause mortality rates in the most deprived areas in 2011 (472 per 100 000 population) remained higher than in the least deprived in 1981 (422 per 100 000 population). For those aged 0–64, deaths from circulatory causes more than halved between 1981 and 2011 and cancer mortality decreased by a third (with greater relative declines in the least deprived areas). Over the same period, alcohol- and drug-related causes and male suicide increased (with greater absolute and relative increases in more deprived areas). There was also a significant increase in deaths from dementia and Alzheimer’s disease for those aged 75+.

Conclusions

Despite reductions in mortality, relative (but not absolute) inequalities widened between 1981 and 2011 for all-cause mortality and for several causes of death. Reducing relative inequalities in Scotland requires faster mortality declines in deprived areas while countering increases in mortality from causes such as drug- and alcohol-related harm and male suicide.

AUDIT Scotland 10 years on: explaining how funding decisions link to increased risk for drug related deaths among the poor

Purpose

In response to Scottish Government assertions that an ageing cohort explained increases in drug-related death (DRD), the previous research by the authors established that socio-economic inequalities were additional risk factors explaining the significant increases in DRD in Scotland. This paper aims to subject the drug policy narratives provided by Scottish Government in relation to the governance of drug and alcohol services to critical scrutiny and reveal the social consequences of the funding formula used to direct funding to services via NHS Scotland Boards, and Alcohol and Drug Partnerships (ADP).

Design/methodology/approach

The paper provides a narrative review in the context of the AUDIT Scotland reports “Drug and Alcohol Services in Scotland” from 2009 and follow-up report published in 2019. The authors refer to the recommendations made in the 2009 report on effectiveness of drug and alcohol services and subject Scottish Government funding processes, and governance of drug and alcohol services to critical scrutiny.

Findings

This analysis provides robust evidence that Scottish Government funding processes and governance of drug and alcohol services increased risk to vulnerable drug users and document evidence that link these risk factors to increased DRD.

Research limitations/implications

The authors have focused on Scottish drug policy and drug services funding. Alcohol services funding is not subject to critical analysis due to limitations of time and resources.

Practical implications

This case study investigates AUDIT Scotland’s recommendations in 2009 to Scottish Government to provide researchers, government policy advisors and media with robust critical analysis that links drug policy decisions to increased DRD.

Social implications

Drug policy governance by the Scottish Government and NHS Scotland since 2009 have disproportionately affected communities of interest and communities of place already experiencing stark inequalities. These budget decisions have resulted in widening inequalities, and increased DRD within communities in Scotland. The authors conclude that in diverging politically and ideologically from Public Health England, and the Westminster Parliament, Scottish Government drug policy and financial governance of drugs services contributes to increased risk factors explaining DRD within deprived communities.

Originality/value

The 2009 AUDIT Scotland recommendations to Scottish Government subject their governance of drug services to critical scrutiny. This analysis provides a counterpoint to the explanations that rising DRD are unconnected to drug policy and drug services governance.

Suicide mortality in Spain (1984-2018): age-period-cohort analysis

OBJECTIVE

To assess the effects of age, period and cohort suicide mortality trend in Spain (1984-2018).

METHODS

Mortality and population data were obtained from the National Institute of Statistics. The analysis of the effect of age, period of death and birth cohort on the evolution of suicide mortality in the period 1984-2018 was performed using a web tool for age-period-cohort analysis provided by the Division of Cancer Epidemiology and Genetics of the National Cancer Institute of the USA.

RESULTS

Rates increase with age (age effect) in both sexes. The period effect shows, in males, an increase over the period 1984-1998 followed by a significant decrease until 2018. In females, rates remain stable over the period 1987-2002, decrease during 2007-2012 (p < 0.05) and eventually stabilise. In both males and females, the risk decreases in each successive birth cohort between 1904 and 1939. Subsequently, the risks increase until the birth cohort of the period 1964-1974 after which the risk decreases for males and remains stable for females.

CONCLUSION

A better understanding of the effects of the birth cohort could open new doors in suicide prevention.

Analysis of age-sex and deprivation stratified trends in assault deaths in Scotland (1974-2015) to identify age, period or cohort effects

OBJECTIVES

Mortality rates in Scotland are higher, and health inequalities are greater, than in the rest of Western and Central Europe. There was a marked divergence during the 1980s and 1990s in the Scottish rates partly due to rises in alcohol-related and drug-related deaths, suicide and deaths by assault. This study examines whether age, period or cohort effects account for the trends in death by assault in Scotland and any sex or deprivation inequalities in these.

DESIGN

We calculated crude and age-standardised mortality rates for deaths by assault for Scottish men and women from 1974 to 2015 for the population overall and for populations stratified by Carstairs area of deprivation. We examined age-sex stratified trends to identify obvious age-period-cohort effects.

SETTING

This study was conducted in Scotland.

PARTICIPANTS

Men and women whose registered death by the International Classification of Diseases was due to assault from 1974 to 2015 (n=3936) were included in this study.

RESULTS

Whereas age-standardised mortality rates from this cause fell gradually for women since 1974, for men they increased in the early 1990s and remained higher until around 2006, before falling. Death by assault was substantially more common among men aged around 15-50 years and in the most deprived areas. There was little change in the age groups most impacted over time, which made cohort effects unlikely. A period effect for the 15 years until 2006, with a consistent age-sex-area deprivation patterning, was evident.

CONCLUSIONS

Mortality due to assault in Scotland is unequally felt, with young men living in the most deprived areas suffering the highest rates. There is a 15-year period effect up until 2006, impacting on young men as an age-period interaction, with no obvious cohort effects. Exploration of the demographics of criminological data may identify age, period or cohort effects among perpetrators of assault.

Recent adverse mortality trends in Scotland: comparison with other high-income countries

OBJECTIVE

Gains in life expectancy have faltered in several high-income countries in recent years. Scotland has consistently had a lower life expectancy than many other high-income countries over the past 70 years. We aim to compare life expectancy trends in Scotland to those seen internationally and to assess the timing and importance of any recent changes in mortality trends for Scotland.

SETTING

Austria, Croatia, Czech Republic, Denmark, England and Wales, Estonia, France, Germany, Hungary, Iceland, Israel, Japan, Korea, Latvia, Lithuania, Netherlands, Northern Ireland, Poland, Scotland, Slovakia, Spain, Sweden, Switzerland and USA.

METHODS

We used life expectancy data from the Human Mortality Database (HMD) to calculate the mean annual life expectancy change for 24 high-income countries over 5-year periods from 1992 to 2016. Linear regression was used to assess the association between life expectancy in 2011 and mean life expectancy change over the subsequent 5 years. One-break and two-break segmented regression models were used to test the timing of mortality rate changes in Scotland between 1990 and 2018.

RESULTS

Mean improvements in life expectancy in 2012-2016 were smallest among women (<2 weeks/year) in Northern Ireland, Iceland, England and Wales, and the USA and among men (<5 weeks/year) in Iceland, USA, England and Wales, and Scotland. Japan, Korea and countries of Eastern Europe had substantial gains in life expectancy over the same period. The best estimate of when mortality rates changed to a slower rate of improvement in Scotland was the year to 2012 quarter 4 for men and the year to 2014 quarter 2 for women.

CONCLUSIONS

Life expectancy improvement has stalled across many, but not all, high-income countries. The recent change in the mortality trend in Scotland occurred within the period 2012-2014. Further research is required to understand these trends, but governments must also take timely action on plausible contributors.

A Durkheimian Theorization of Scottish Suicide Rates, 2011–2017

This article examines recent aggregate statistical data generated by Scottish Government medical bodies concerning suicide rates and the social contexts of those who die by suicide. It compares rates and trends with international studies. Inherent in the data sets explored are indications suggesting that suicide is patterned by variables such as gender, employment, class and marital status. Neoliberalism increases social disparities that influence patterns of suicide, resulting in anomie and alienation, disproportionately impacting the already disenfranchised. Using recent statistical data (2011–2017), the article offers a theorization of suicide through the lens of Emile Durkheim’s social causation model of suicide. Suicide is associated with risk factors inherent in social structures and political processes.

Do age, period or cohort effects explain circulatory disease mortality trends, Scotland 1974-2015?

Objective

We aimed to explore whether age, period or cohort effects explain the trends and inequalities in ischaemic heart disease (IHD) and cerebrovascular disease (CeVD) mortality in Scotland.

Methods

We analysed IHD and CeVD deaths for 1974–2015 by sex, age and area deprivation, visually explored the data using heatmaps and dotplots and built regression models.

Results

CeVD mortality improved steadily over time while IHD mortality improved more rapidly from the late 1980s. Age effects were evident; both outcomes showed an exponential relationship with age for all except males for IHD in the 1980s and 1990s. The mortality profiles by age became older, although improvement was slower for those aged <50 years for IHD, especially for males, and faster for CeVD in females aged <65 years. Rates were higher, and inequalities greater, among males, especially for IHD. For IHD, increased risk for males over females reduced with age (incidence rate ratio for 41–50 year old males=4.28 (95% CI 4.12 to 4.44) and 1.17 (95% CI 1.16 to 1.18) for 71–80 year olds). Inequalities in IHD mortality by area deprivation persisted over time, increasing from around 10% to around 25% higher risk in the most deprived areas between 1974 and 1986 before declining in absolute terms from around 2000. Inequalities for CeVD increased after the late 1980s.

Conclusions

IHD and CeVD mortality in Scotland exhibit age but not recent distinct period or cohort effects. The improvements in mortality rates have been more sustained for CeVD and inequalities greater for IHD.

Suicide: What the General Public and the Individual Should Know

Background

The predominant, current western view is that all suicide is the result of mental disorder. This view is much too narrow and does not admit extensive information regarding the social, economic, and forensic factors (among many others) which may contribute to completed suicide. A consequence of this narrow view is that prevention strategies mainly focus on the detection and treatment of mental disorder. A preferred approach is to place greater emphasis on public health approaches to suicide prevention.

Objective

To develop and suggest a body of information which may be useful in a public health approach to suicide.

Conclusion

It is suggested that the following be available to the general public: i) suicide is a fact of life which should be minimised, ii) suicide has many different triggers, iii) most people who take their lives are able to make decisions, and iv) increased public discussion and understanding of suicide is desirable. Five pieces of information that may be useful to those contemplating suicide include: i) don’t murder the part of you that wants to live, ii) suicide actions may leave you alive but disabled, iii) suicide hurts other people, iv) suicidal impulses do pass if you hold on, and v) suicide is a waste.

Drug-related deaths in Scotland 1979-2013: evidence of a vulnerable cohort of young men living in deprived areas

BACKGROUND

Even after accounting for deprivation, mortality rates are higher in Scotland relative to the rest of Western Europe. Higher mortality from alcohol- and drug-related deaths (DRDs), violence and suicide (particularly in young adults) contribute to this 'excess' mortality. Age-period and cohort effects help explain the trends in alcohol-related deaths and suicide, respectively. This study investigated whether age, period or cohort effects might explain recent trends in DRDs in Scotland and relate to exposure to the changing political context from the 1980s.

METHODS

We analysed data on DRDs from 1979 to 2013 by sex and deprivation using shaded contour plots and intrinsic estimator regression modelling to identify and quantify relative age, period and cohort effects.

RESULTS

The peak age for DRDs fell around 1990, especially for males as rates increased for those aged 18 to 45 years. There was evidence of a cohort effect, especially among males living in the most deprived areas; those born between 1960 and 1980 had an increased risk of DRD, highest for those born 1970 to 1975. The cohort effect started around a decade earlier in the most deprived areas compared to the rest of the population.

CONCLUSION

Age-standardised rates for DRDs among young adults rose during the 1990s in Scotland due to an increased risk of DRD for the cohort born between 1960 and 1980, especially for males living in the most deprived areas. This cohort effect is consistent with the hypothesis that exposure to the changing social, economic and political contexts of the 1980s created a delayed negative health impact.

An analysis of suicide trends in Scotland 1950-2014: comparison with England & Wales

BACKGROUND

Scotland has disproportionately high rates of suicide compared with England. An analysis of trends may help reveal whether rates appear driven more by birth cohort, period or age. A 'birth cohort effect' for England & Wales has been previously reported by Gunnell et al. (B J Psych 182:164-70, 2003). This study replicates this analysis for Scotland, makes comparisons between the countries, and provides information on 'vulnerable' cohorts.

METHODS

Suicide and corresponding general population data were obtained from the National Records of Scotland, 1950 to 2014. Age and gender specific mortality rates were estimated. Age, period and cohort patterns were explored graphically by trend analysis.

RESULTS

A pattern was found whereby successive male birth cohorts born after 1940 experienced higher suicide rates, in increasingly younger age groups, echoing findings reported for England & Wales. Young men (aged 20-39) were found to have a marked and statistically significant increase in suicide between those in the 1960 and 1965 birth cohorts. The 1965 cohort peaked in suicide rate aged 35-39, and the subsequent 1970 cohort peaked even younger, aged 25-29; it is possible that these 1965 and 1970 cohorts are at greater mass vulnerability to suicide than earlier cohorts. This was reflected in data for England & Wales, but to a lesser extent. Suicide rates associated with male birth cohorts subsequent to 1975 were less severe, and not statistically significantly different from earlier cohorts, suggestive of an amelioration of any possible influential 'cohort' effect. Scottish female suicide rates for all age groups converged and stabilised over time. Women have not been as affected as men, with less variation in patterns by different birth cohorts and with a much less convincing corresponding pattern suggestive of a 'cohort' effect.

CONCLUSIONS

Trend analysis is useful in identifying 'vulnerable' cohorts, providing opportunities to develop suicide prevention strategies addressing these cohorts as they age.

How do trends in mortality inequalities by deprivation and education in Scotland and England & Wales compare? A repeat cross-sectional study

OBJECTIVE

To compare the trends in mortality inequalities by educational attainment with trends using area deprivation.

SETTING

Scotland and England & Wales (E&W).

PARTICIPANTS

All people resident in Scotland and E&W between 1981 and 2011 aged 35-79 years.

PRIMARY OUTCOME MEASURES

Absolute inequalities (measured using the Slope Index of Inequality (SII)) and relative inequalities (measured using the Relative Index of Inequality (RII)) in all-cause mortality.

RESULTS

Relative inequalities in mortality by area deprivation have consistently increased for men and women in Scotland and E&W between 1981-1983 and 2010-2012. Absolute inequalities increased for men and women in Scotland, and for women in E&W, between 1981-1983 and 2000-2002 before subsequently falling. For men in E&W, absolute inequalities were more stable until 2000-2002 before a subsequent decline. Both absolute and relative inequalities were consistently higher in men and in Scotland. These trends contrast markedly with the reported declines in mortality inequalities by educational attainment and apparent improvement of Scotland's inequalities with those in E&W.

CONCLUSIONS

Trends in health inequalities differ when assessed using different measures of socioeconomic status, reflecting either genuinely variable trends in relation to different aspects of social stratification or varying error or bias. There are particular issues with the educational attainment data in Great Britain prior to 2001 that make these education-based estimates less certain.

Visualising and quantifying 'excess deaths' in Scotland compared with the rest of the UK and the rest of Western Europe

BACKGROUND

Scotland has higher mortality rates than the rest of Western Europe (rWE), with more cardiovascular disease and cancer among older adults; and alcohol-related and drug-related deaths, suicide and violence among younger adults.

METHODS

We obtained sex, age-specific and year-specific all-cause mortality rates for Scotland and other populations, and explored differences in mortality both visually and numerically.

RESULTS

Scotland's age-specific mortality was higher than the rest of the UK (rUK) since 1950, and has increased. Between the 1950s and 2000s, 'excess deaths' by age 80 per 100 000 population associated with living in Scotland grew from 4341 to 7203 compared with rUK, and from 4132 to 8828 compared with rWE. UK-wide mortality risk compared with rWE also increased, from 240 'excess deaths' in the 1950s to 2320 in the 2000s. Cohorts born in the 1940s and 1950s throughout the UK including Scotland had lower mortality risk than comparable rWE populations, especially for males. Mortality rates were higher in Scotland than rUK and rWE among younger adults from the 1990s onwards suggesting an age-period interaction.

CONCLUSIONS

Worsening mortality among young adults in the past 30 years reversed a relative advantage evident for those born between 1950 and 1960. Compared with rWE, Scotland and rUK have followed similar trends but Scotland has started from a worse position and had worse working age-period effects in the 1990s and 2000s.

The Geography of a rapid rise in elderly mortality in England and Wales, 2014-15

Since at least the early 1900s almost all affluent nations in the world have continually experienced improvements in human longevity. Using ONS mid-year population and deaths estimates for Local Authorities for England and Wales, we show that these improvements have recently reversed. We estimate that in England and Wales there were 39,074 more deaths in the year to July 2015 as compared to the year to July 2014 (32,208 of these were of individuals aged 80+). We demonstrate that these increases occurred almost everywhere geographically; in poor and affluent areas, in rural and urban areas. The implications of our findings are profound given what has come before them, combined with the current political climate of austerity.