1 November 2017
Inequalities in Life Expectancy across Wakefield District
Shane Mullen
Public Health Intelligence Manager
Summary
· Deaths in females aged under 75 in the most deprived 5 deciles are increasing.
· Wakefield residents die younger compared with the national averages.
· Wakefield residents experience significantly more disability in their shorter life spans.
· Women live longer compared to men, but with more disability and the inequality is worsening.
· Men die far sooner, however the trend in inequality has been improving.
Background
Public Health England produce a raft of inequalities indictors for the nation. In the latest update to these, Wakefield District measures show a widening of the gap between the most deprived and the least deprived populations in the district.
The measures look at premature mortality, those that die aged 74 or less. They go on further to calculate Life Expectancy in the most deprived and the least deprived 10% of each area, based on IMD 2015 local deciles. The size of the gap is then calculated between the least deprived and most deprived decile. It is the gap in life expectancy that for Wakefield shows a widening trend for women, in particular over the last 3 years.
Inequality
Overall life expectancy for men and women in the district is falling or stagnating. For men the latest available shows a decrease in life expectancy between the most recent and the previous period. For women the value has seen little change in the same time frame.
In parallel to this the same information is used to calculate the gap between the most deprived 10% of each Local Authority and the least deprived 10%. For women in Wakefield district, in recent periods the trend in the gap appears to be an increasing one. With the value in the most recent time period being 7.8 years. For men the most recent value is 8.5 years, though in magnitude terms men have a bigger gap, the gap has been reducing.
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Figure 1: Slope index of inequality in life expectancy at birth within English local authorities, based on local deprivation deciles within each area (Female)
Figure 2: Slope index of inequality in life expectancy at birth within English local authorities, based on local deprivation deciles within each area (Male)
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For men the absolute gap is consistently greater than for women, peaking at over 10 years between the most and least deprived. For men the gap in recent time periods has begun to narrow.
Figure 3: Gap between the most deprived IMD 2015 local decile and least deprived decile in Wakefield District (Persons)
Source: Primary Care Mortality Database
The trajectory in the Life expectancy is pretty consistent between the most and least deprived deciles, which in turn means that the gap is static in the areas.
It this gap that Public Health England calculate for all local authorities and present in the Public Outcomes Framework. Due to the lag in the production and release of mortality information, the above is a locally created early indication of what the 2013-15 figure is likely to be for Wakefield. The actual figure may differ slightly, however it would be expected that the trend will remain, indicating a further decrease in this measure for Wakefield.
Disability Free Life Expectancy
Disability Free Life Expectancy is a measure calculated for Local Authority areas, indicating how many years an individual is likely to be disability free in their lifetime. It is the combination of this figure, Healthy Life expectancy and Life expectancy that are to be considered when looking into inequalities.
The compounding issues faced by residents in Wakefield, is that not only are residents not likely to live as long as the national average, they are more likely to face longer periods of ill health and disability in that shorter life span.
Figure 4: Males Disability Free Life Expectancy Trend
Worryingly for Wakefield, the male disability free life expectancy is significantly below the Yorkshire and Humber average, which in turn is significantly below the national average. In the most recent figures shown, men in Wakefield are expected to have 56.7 years of disability free life, compared with Yorkshire and Humber of 61.4 and England of 63.3
Figure 5: Females Disability Free Life Expectancy Trend
Still worryingly for Wakefield, the female disability free life expectancy is significantly below the Yorkshire and Humber average, which in turn is significantly below the national average. In the most recent time periods the female value is on a declining trend, particularly since 2010. England and Yorkshire are also on a declining pattern, however the rate of decline is greater in Wakefield.
In the most recent figures shown, women in Wakefield are expected to have 56.7 years of disability free life, compared with Yorkshire and Humber of 61.6 and England of 63.2
Wakefield Mortality
There is inequality in life expectancy across the district, the gap for women is growing and for men decreasing, however the overall life expectancy is falling for men. This present’s different problems for the genders. The inequality issue is largely in women, suggesting that the focus should lie on the most deprived populations. For men the issues should still weight toward the deprived but simultaneously focus on improving the overall life expectancy for men. Understanding what is killing the residents of the district will shed further light on this issue.
Cardiovascular Disease (CVD) are diseases which affect the heart or the blood vessels of the body; CVD mortality rates have been calculated both locally and nationally. Mortality in women under 75 has been on an improving trend across Wakefield, until the latest period available where it has significantly deteriorated. For men the trend shows a similar pattern, however with a recent increase in the rate of CVD deaths.
Respiratory diseases, include obstructive pulmonary conditions and lung cancer. Deaths from these diseases have a similar pattern in Wakefield District. For women the pattern has been consistently significantly worse for the district in the available information period, when compared to the national average. The trend however has been a decreasing one, until the latest available period where we have seen an increase in the rate of deaths from respiratory disease. For men the story is a little different, in recent times the rate of deaths has decreased to similar levels as the national average. Three out of the last five years have not been significantly higher than the national average. The two rates preceding the most recent were not significantly different, however the most recent was significantly higher, demonstrating the deterioration in the district.
The district has just over 3,000 deaths per year; around a fifth of these are premature deaths.
Cancer and Circulatory diseases make up over 50% of all age deaths in the district. Respiratory and Dementia diseases account for over 25%, with the remainder falling between other causes (20%) and liver and renal diseases (1%). The under 75s is slightly different, with cancer dominating at over a third of deaths, followed by other causes (around 25%) and then Cardiovascular diseases (around 25%).
Disease Grouping / Age / 2009 / 2010 / 2011 / 2012 / 2013 / 2014 / 2015Cancer / All / 28.6% / 27.9% / 30.4% / 29.2% / 29.1% / 28.7% / 28.1%
Cancer / Under 75 / 38.7% / 37.0% / 40.7% / 38.1% / 41.3% / 36.8% / 36.3%
Circulatory / All / 31.8% / 31.1% / 26.8% / 27.3% / 26.3% / 26.6% / 25.5%
Circulatory / Under 75 / 28.8% / 28.0% / 23.8% / 23.4% / 22.1% / 23.1% / 24.6%
Dementia / All / 5.8% / 6.3% / 9.7% / 9.8% / 10.2% / 11.1% / 11.0%
Dementia / Under 75 / 0.6% / 1.5% / 1.6% / 1.5% / 2.8% / 2.8% / 2.2%
Liver / All / 0.3% / 0.4% / 0.3% / 0.6% / 0.3% / 0.5% / 0.4%
Liver / Under 75 / 0.4% / 0.8% / 0.5% / 0.6% / 0.1% / 0.7% / 0.8%
Renal / All / 0.1% / 0.2% / 0.1% / 0.0% / 0.0% / 0.0% / 0.0%
Renal / Under 75 / 0.0% / 0.0% / 0.1% / 0.0% / 0.0% / 0.0% / 0.0%
Respiratory / All / 14.9% / 14.4% / 13.8% / 14.3% / 15.2% / 13.2% / 15.4%
Respiratory / Under 75 / 9.3% / 8.7% / 9.3% / 10.4% / 7.8% / 9.0% / 10.0%
Other / All / 18.5% / 19.7% / 18.8% / 18.7% / 18.9% / 19.9% / 19.6%
Other / Under 75 / 22.2% / 24.0% / 23.9% / 26.0% / 25.8% / 27.7% / 26.1%
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Figure 6: Wakefield CVD deaths for those Females aged under 75
Figure 7: Wakefield CVD deaths for those Males aged under 75
Figure 8: Wakefield respiratory deaths for those Females aged under 75
Figure 9: Wakefield respiratory deaths for those Males aged under 75
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Figure 10: All age Disease deaths split by gender and IMD 2015 decile for Wakefield District change between 2009 and 2015
All aged deaths
Disease Grouping / Gender / D1 Most Deprived / D2 / D3 / D4 / D5 / D6 / D7 / D8 / D9 / D10 Least DeprivedCancer / Females / X / X
Males / X / X / X
Persons / X / X
Circulatory / Females / X / X / X / X / X / X / X / X / X / X
Males / X / X / X / X / X / X / X / X / X / X
Persons / X / X / X / X / X / X / X / X / X / X
Dementia / Females / X / X / X / X / X / X / X
Males / X / X / X / X
Persons / X / X / X / X / X
Liver / Females / X / X
Males / X / X / X / X
Persons / X / X / X / X / X
Respiratory / Females / X / X / X / X / X
Males / X / X / X / X / X / X
Persons / X / X / X / X / X / X / X / X
Other / Females / X / X / X / X
Males / X / X / X / X
Persons / X / X / X / X / X / X
Source Primary Care Mortality Database 2016
* X indicates a decile showing an increasing trend for deaths from the condition.
The above table demonstrates the deciles that have an increased number of deaths from the major conditions, where the gradient in deaths for that decile over the last 6 years shows an upward trend. The table is all age deaths grouped by gender and IMD2015 decile.
· Cancer related deaths are currently increasing mainly in the more affluent deciles for males and females.
· Unsurprisingly given the district trend for under 75 CVD mortality, for all age deaths across the deciles circulatory deaths are increasing across all deciles.
· Dementia in females is increasing in the more deprived deciles in the main. In males the pattern is not consistent with females with increases being shown in the least deprived deciles in the main.
· Liver deaths are on the increase in the more deprived parts of the district for both males and females in the main, though there are some increases in the less deprived deciles in men.
· Respiratory deaths are increasing for males and females in the most deprived deciles in the main, with the combined person measure showing an increase from decile 1 to decile 8
· Other (Around 20% of all deaths) is everything else, consistently increasing in the most deprived decile and the mid-range deciles between the genders.
Figure 11: Those aged under 75 disease deaths split by gender and IMD 2015 decile for Wakefield District change between 2009 and 2015
Under 75 aged deaths
Disease Grouping / Gender / D1 Most Deprived / D2 / D3 / D4 / D5 / D6 / D7 / D8 / D9 / D10 Least DeprivedCancer / Females / X / X / X
Cancer / Males / X / X / X / X
Cancer / Persons / X / X
Circulatory / Females / X / X / X / X / X / X / X
Circulatory / Males / X / X / X / X / X / X
Circulatory / Persons / X / X / X / X / X / X / X / X / X
Respiratory / Females / X / X
Respiratory / Males / X / X / X / X / X
Respiratory / Persons / X / X / X / X / X
Other / Females / X / X / X / X / X
Other / Males / X / X / X / X / X / X / X
Other / Persons / X / X / X / X / X / X / X / X
Source Primary Care Mortality Database 2016
* X indicates a decile showing an increasing trend for deaths from the condition.
Those aged under 75 that die are considered premature deaths. Wakefield district has a higher rate of deaths aged under 75 as a whole when compared to the national average. Looking at this table, it’s clear that the bulk of the deaths occur toward the left. The left being the more deprived parts of the district.
The range of broad disease groupings are fewer in the premature deaths, indicating that there are fewer conditions affecting those under 75. The most consistent of these is circulatory disease, which is a constant for females in the most deprived 5 deciles in the district. In men 3 out of 5 of the most deprived deciles are seeing an increase.
· Cancer related deaths, where increasing trends are present in the under 75’s, occur in the more deprived parts of the district for females and males.