Quantifying the contribution of leading causes of death to mortality decline among older people in England, 1991–2005

Abstract

This paper quantifies the contribution of leading causes of death to mortality change between 1991 and 2005 for people aged 50 years and over in England. Between 1971 and 2005 the life expectancy of men aged 50 years increased by more than in the whole of the rest of the 20(th) century. The ageing population has not only had an important impact on health and social services, but was responsible for sparking the pensions crisis affecting both the public and commercial sector. A cross-sectional analysis was used to quantify trends in cause-specific mortality in terms of absolute and relative change between 1991 and 2005 in the population aged 50 and over. Absolute change is quantified in terms of the numbers of deaths prevented or postponed (or conversely, increased or brought-forward) in a year compared to deaths in the baseline year. The percentage change in age-standardised rates was used to identify relative change in causes of death. Between 1991 and 2005 there was a continuous decline in overall all-cause death rates for people aged 50 and over. Age-standardised mortality declined by 30 per cent for men, from 3,216 per 100,000 men to 2,267 per 100,000. This resulted in 86,477 fewer male deaths in 2005 than would have occurred had 1991 rates persisted. For women the age-standardised mortality rate declined by 20 per cent from 2,032 per 100,000 to 1,626 per 100,000, resulting in 48,406 deaths postponed (or fewer deaths) in 2005.Of the total numbers of deaths postponed in 2005, ischaemic heart disease contributed the largest share for both men (45,244 deaths - 52.3 per cent) and women (33,601 - 69.4 per cent).The greatest decline in the mortality rate was observed for influenza, for which age-standardised rates fell by 89 per cent for men and 93 per cent for women. However the proportion of deaths in which influenza was the underlying cause was extremely small and so did not contribute a large proportion in terms of the total fall in numbers of deaths.Mortality rates from some conditions increased. Liver disease rates demonstrated some of the largest increases for both men and women aged 50 and over. For men the age-standardised mortality rate from liver disease increased by 104 per cent, resulting in 1,434 more deaths in 2005 than in 1991. The trends of decreasing mortality rates from ischaemic heart disease and stroke have continued into the 21(st) century, however both causes continue to be the biggest killers in England. They are projected to remain so, and consequently, to contribute significantly to the burden of disease in the population.The steady increase in liver disease mortality identified highlights the importance of tackling alcohol misuse as a public health priority.