UK's stalling life expectancy: where do we go from here?

Yet another report comes as a reminder, were one needed, that UK’s life expectancy at birth is stalling and falling further behind that of many high-income countries other than the US.

The latest data shows a continuation of the slowdown, with improvements in 2015-17 being the lowest since 1980-82. This follows the steady stream of depressing news about the flat lining of UK’s life expectancy since 2011, and the least improvement in recent years compared with similar countries.  

Early indications are that 2018 could also be a poor year for mortality.  

What’s causing UK’s life expectancy to stall? Public Health England’s report on this, commissioned by the Department for Health and Social Care, is due out shortly. In the interim, we offer some pointers.

These trends are best seen as a story of multiple parts, impacting differently on different age sex groups. Overall, both genders and all age groups are affected by the slowdown in mortality improvements, though older people and women appear to be faring the worst.

Multiple determinants of mortality

Unpacking the impact of the multiple determinants of mortality is nigh on impossible, given also the interactions between them. But there are some components we can be more certain of than others.  

Cardiovascular disease was a big killer but advances in prevention, diagnosis and treatment reduced CVD mortality dramatically from the 1970s, leading to significant increases in UK’s life expectancy.

But improvements in CVD mortality have slowed since 2011, contributing significantly to the stalling of life expectancy. UK is not alone in this – improvements in CVD mortality have slowed in many European countries and the US. What’s causing this is complex to unravel and would benefit from shared international expertise.  

Flu, pneumonia and respiratory disease have caused significant excess mortality in some years, notably 2015, when life expectancy fell in many European countries and beyond. The particular flu virus strain in widespread circulation had low vaccine efficacy and killed older people disproportionately. 

England’s mortality rate for Q1 2018 is the highest for five years, again associated with a prolonged flu season and significant excess deaths, especially among older people. Excess winter mortality in 2017-18 was reported also for Europe, and the US where flu and pneumonia deaths were at or above epidemic threshold level for 16 weeks.

England’s mortality rate for Q1 2018 is the highest for five years, again associated with a prolonged flu season and significant excess deaths, especially among older people

These diseases can in turn trigger or accelerate deaths among frail elderly people with multiple conditions, such as CVD, dementia, COPD  and heart failure. Overall, 2018 could be a bad year for mortality if the bad winter is compounded by excess deaths among older people resulting from the long, hot summer.

Death rates from dementia have increased in recent years (due in part to changes in diagnostic and coding practices) and are now the leading cause of death among women in England.  Although coded as dementia, these deaths are frequently associated with comorbidities that cause or contribute to death, and need further investigation.

But it’s not just older people for whom trends have deteriorated. Mortality rates at ages 15-54 years have increased since 2012, due in part to rises in “external” causes of death, which include accidents (including drug overdoses), self harm and assault.

Other changes

Although the slowdown in overall life expectancy improvements is driven largely by older ages, these adverse trends among younger adults are worrying and illustrate that several factors may be driving current mortality trends.

Other changes going in the wrong direction and which could impact adversely on mortality include, for example, rising levels of obesity and diabetes, and widening geographic and socioeconomic inequalities in mortality.

Life expectancy could differ between different population cohorts, and medical advances in the prevention, diagnosis and treatment of, for example, CVD, could be stalling. And so on. The list of possible explanations is long, and they are not mutually exclusive.  

Austerity measures and the added pressures of an ageing population on healthcare services could have contributed to excess deaths, especially among older people

Some studies suggest post-2008 “austerity” is the cause. Austerity measures and the added pressures of an ageing population on healthcare services could have contributed to excess deaths, especially among older people, coming as they did on top of the chronic underfunding of health and care services in UK relative to other West European countries.  

But it is at odds with European patterns, where life expectancy improvements have in fact been stronger in Greece, Ireland, Spain and Portugal where austerity was most severe, than in countries which had little austerity (eg Germany, Sweden, Netherlands).

Overall, the patterns of mortality change suggest there is unlikely to be a silver bullet that explains why life expectancy has stalled in UK, rather that various factors are at play, some of which could be mediated by austerity.

The many demographic, epidemiological, socioeconomic and service related changes underway simultaneously, and what’s causing them, need further investigation to understand why UK is doing worse than others and to develop appropriate policy and service responses. This will not be quick or easy, and we should pool expertise with international partners where appropriate.