Abstract
We systematically reviewed the evidence on secular trends in main chronic conditions, disability and self-assessed general health among adults in the United Kingdom, as reported in primary/secondary care databases and population-based surveys. Searches were conducted separately for: (1) trends in age-standardised or age-specific prevalence of major non-communicable diseases, disability, and self-reported general health; (2) trends in health expectancy. The databases searched were MEDLINE, EMBASE/EMBASE Classic and Web of Science (all from 1946/7). The evidence was synthesised narratively. There were 39 studies reporting trends in prevalence of health conditions and 15 studies in health expectancy. We did not find evidence for improvement in the age-standardised or age-specific prevalence of any of the studied major chronic conditions over the last few decades, apart from Alzheimer's disease and other dementias. Both increasing or stable prevalence rates with simultaneous rising life expectancy support the expansion of morbidity theory, meaning that people are expected to spend a greater number of years with chronic condition(s). The evidence on disability—expressed as prevalence or health expectancy—was mixed, but also appeared to support the expansion of morbidity among those aged 65 or over. The evidence on trends in disability for younger age is lacking. Across the studied period (1946–2017), the UK population endured more years with chronic morbidity and disability, which may place a serious strain on the health care system, the economy and the society.
Highlights
The period following World War II saw dramatically increasing life expectancy at birth in the United Kingdom, from 66.3 years in 1946 to 82.0 in 2015.[1]
The review focused on major contributors to chronic morbidity, included conditions must have accounted for at least 1 per cent of disability-adjusted years of life (DALYs) in the UK from non-communicable diseases according to the Global Burden of Diseases Study 2010 (GBD).[17]
The evidence consistently points towards expansion in limiting longstanding morbidity, self-reported general health at birth and among older people for the period of 1970s-1990s, and of more severe disability between early 1980s and mid-1990s
Summary
The period following World War II saw dramatically increasing life expectancy at birth in the United Kingdom, from 66.3 years in 1946 to 82.0 in 2015.[1]. Post-war (1946-2017) population health change in the UK with increasing life expectancy, for example, whether these additional years of life have been spent in good health. The most optimistic theory—compression of morbidity—states that health expectancy is rising faster than total life expectancy; meaning that age-specific prevalence of morbidity is declining over time.[4] The third theory, dynamic equilibrium, proposes that there is an overall increase in prevalence and years of morbidity, which, has a mildly disabling effect.[5] Dynamic equilibrium would occur when morbidity neither expands nor compresses as both mortality and morbidity are postponed by an equal number of years (see Table 1).[5] Interpreting evidence from the perspective of these theories helps to emphasise the necessity to improve population health to compensate the consequences of increasing lifespan. Only reduction in morbidity over time can be considered as a positive scenario for public health
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