Tuesday March 5 2013
Smoking remains the leading risk factor for disease
“The UK is lagging behind progress by similar countries on many indicators for ill-health” BBC News reports, based on a study that generated a wide range of media coverage.
The study, published in The Lancet, had three main aims:
- to look at the leading causes of disease and disability in the UK
- to assess the leading preventable risks (such as lifestyle behaviours) that cause some of these patterns
- to compare these 2010 results with similar results taken in the UK during 1990, and also to compare these UK health outcomes with other western countries, such as other EU member states, Australia, and the US
A key finding, widely reported by the media, was that while there have been improvements across the board in terms of health outcomes over the past 30 years in the UK, these improvements have been outstripped by other countries.
Another concerning trend is that out of the 10 leading causes of premature death in the UK during 2010, many of them (such as heart disease, lung cancer and stroke) are, at least to some extent, preventable.
This would suggest that there is a great deal more that can be done in the fields of public health and preventive medicine.
In response to the study’s findings, Jeremy Hunt, the health secretary, is reported as saying ‘despite real progress in cutting deaths we remain a poor relative to our global cousins on many measures of health’.
The Department of Health has published a document, ‘Living Well for Longer: A call to action to reduce avoidable premature mortality’ (PDF, 687.4Kb), inviting consultation on questions such as:
- How can early diagnosis and prevention of chronic disease be improved?
- Are there more effective or additional ways anti-tobacco, safe drinking and healthy eating messages can be promoted to the public?
The authors of the study note its limitations, including the fact that there are differences in how countries record health information and a lack of information on some diseases and injuries.
Overall, however, this study provides useful information on the greatest burden of disease in the UK and where efforts could be focused to improve and protect people’s health in the future.
Who compiled the report?
This report was compiled by numerous researchers from the University of Washington in the US, as well as researchers from various universities in the UK, including the Universities of Manchester, Liverpool, Cambridge, and Oxford. It was funded by the Bill and Melinda Gates Foundation.
The report was published in the peer-reviewed journal, The Lancet.
What sources of data did the researchers look at?
The researchers used data from the Global Burden of Diseases, Injuries and Risk Factor study carried out in 2010, which compared information collected in 1990 to information collected in 2010. This data was then used to examine:
- the patterns of ‘health loss’ in the UK
- the leading preventable risks that explain some of the patterns of health
- how UK health outcomes (such as death due to disease) compare with other western countries including Australia, Canada, Norway, and the US
Data from the UK came from sources such as disease registers, hospital discharge data and the Health Survey for England.
The study looked at 291 diseases (including cardiovascular diseases and various cancers) and injuries (including road injuries, falls and self-harm), 67 risk factors (such as smoking) or groups of risk factors, and 24 outcomes of each disease or injury (such as death).
The researchers then calculated ‘health loss’ by looking at the following health indicators:
- number of deaths from each disease or injury
- years of human life lost due to early (premature) death from each disease or injury – which the researchers described as years of life lost due to premature morality (YLLs)
- the number of years a person has lived with a disability – years lived with a disability (YLDs)
- healthy life expectancy
- disability adjusted life years – that is the number of years ‘lost’ from healthy expectancy due to disability or death (calculated as the sum of YLLs and YLDs)
The researchers then compared the leading causes of health loss for 259 diseases relevant to the UK to the average from other comparable western countries in 1990 and 2010 to determine trends and patterns.
What were the main results?
The main results of this report were:
- overall, life expectancy in the UK has increased by 4.2 years from 1990 to 2010. But compared to other European countries, from 1990 to 2010 the UK position on death rates, years of premature life lost and life expectancy had worsened.
- for premature death, worsening ranks in the UK compared to other European Union countries from 1990 to 2010 were most notable among men and women aged 20 to 54 years
- across all age groups, Alzheimer’s disease, liver disease (cirrhosis) and drug use disorder contributed to premature death more in 2010 than in 1990
- compared to other western countries (including EU nations, Australia, Canada and the US), the UK had significantly higher rates for heart disease, certain lung diseases (including chronic obstructive pulmonary disease [COPD] and pneumonia) and breast cancer
- the major causes of years living with a disability in 2010 were mental and behavioural disorders (including substance use disorder) and musculoskeletal disorders
- the leading risk factor for disease was tobacco (11.8%), followed by high blood pressure (9.0%), and high body mass index (8.6%)
- diet and physical inactivity accounted for 14.3% of disability adjusted life years in the UK in 2010
The researchers conclude that premature death in the UK is below the average compared to other western countries (including Australia, Canada and the US) and that focused attention is required to address this problem.
Was there any ‘good news’?
Reading coverage of this study would convince you that, as the Daily Mirror put it, the UK is the ‘sick man of Europe’.
And while most of the study does make for alarming reading, there are a number of shafts of light breaking through the doom and gloom.
For example, the UK has lower rates of years of life lost due to road injury, diabetes, liver cancer and chronic kidney disease compared to the western average.
The study also highlights the fact that the UK now has some of the most stringent anti-tobacco legislation in Europe. And while tobacco-related diseases were the highest cause of death, this could be the result of historical trends rather than current failings in UK healthcare.
As the study noted, the use of tobacco peaked after the second world war and did not begin to drop significantly until after the 1970s.
So, the high number of deaths we are seeing now could be the result of the smoking habits of teenagers during the 1970s, who went on to be life-long smokers, taking their toll. Hopefully, tobacco-related deaths should begin to significantly fall in the years to come.
Alzheimer’s is a disease of ageing, so as life expectancies increase due to improvement in public health, so would rates of Alzheimer’s be expected to increase.
What explanations were given for the UK discrepancy compared to other developed countries?
The researchers note that in 1990, health outcomes in the UK were significantly below average compared with other comparable western countries. This provides some explanation; despite achieving improvements in life expectancy (an increase of 4.2 years), this was still not enough to ‘catch up’ to the average of other western countries by 2010.
Some of the reporting on the study, such as the Metro's, claimed that ‘drink and drug abuse’ was ‘pushing Britain down world death table’. The current study did find that mental and behavioural conditions including substance misuse were a major cause of YLD (years lived with disability) in the UK in 2010, but the study did not specifically look at differences between different countries in rates of alcohol and drug misuse.
The researchers note there may be differences in how each country classifies the causes of a death and how a country collects health data, which could have affected the results. They also say that a lack of data for some diseases or injuries in particular countries (such as sensory conditions) is a limitation of the study.
How accurate was the media coverage of the report?
This study was covered widely in the media, and the newspapers took several angles in reporting the study’s findings. The Daily Mirror had a headline relating to heart disease and cancer, The Guardian focused on life expectancy, The Independent focused on dementia and the Daily Mail reported on Alzheimer’s disease.
The Daily Telegraph chose to focus its headlines around NHS spending and argued that this has failed to ‘stop rot’ in the NHS.
There were some important points raised by the study that arguably did not generate the coverage they deserved.
For example, the study found that accidental falls are now the second most common cause of long-term disability in adults. Despite this, the researchers say that though there are preventative strategies, these have to be widely implemented.
Self-harming or suicidal behaviour remain the second leading causes of years of life lost in adults aged 20-54 years (after ischaemic heart disease). Alongside the study’s finding that mental and behavioural disorders are a major cause of disability in the UK, this again highlights the continued need for effective mental health care.
How has the report been received?
Jeremy Hunt, the health secretary, was quoted in several newspapers as saying ‘For too long we have been lagging behind and I want the reformed health system to take up this challenge and turn this shocking underperformance around …’
In a related commentary in The Lancet, one of the study’s co-authors, Professor Edmund Jessop called for new (and controversial) public health legislation, saying: ‘There is still plenty of room for bold action by politicians and the body politic [such as] plain packaging for cigarettes, minimum pricing for alcohol, banning of trans fats, improved control of hypertension attention to psychiatric disorders.'
While focusing on the rise of Alzheimer’s disease as a cause of death, Andrew Chidgey, director of external affairs at the Alzheimer’s Society, called for an increase in funding for Alzheimer’s and dementia research, saying: 'As well as the untold human cost, dementia costs the economy £23billion a year. Despite these statistics, and the fact one in three people over the age of 65 will develop it, funding for dementia research lags far behind other conditions like cancer.’
This study provides some estimates of how the UK compares to other western countries such as Australia, Canada and the US in terms of ‘health loss’ due to leading causes of disease and injury.
There are some limitations to this study, some of which have already been described above, such as differences in how countries collect health information and areas where there is a lack of data (such as on sensory conditions).
In their conclusion, the researchers say that progress in combatting premature death from diseases such as cardiovascular disease and cancers will require improved prevention, early intervention and treatment activities, and overall improved public health efforts. They also note a growing burden of disability from mental disorders, substance use, musculoskeletal disorders and falls, all of which require strategic attention.
They say that efforts to improve and protect people’s health must be tailored to address the risks and causes that are associated with greatest impact of poor health.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.