Future inequalities in life expectancy in England and Wales

www.thelancet.com Vol 386 July 11, 2015 115 Recent international trends in life expectancy tell a remarkable story of improvement. In England, life expectancy from birth has doubled since 1840 and, from 1982 to 2012, has increased by about 8 years for men (from 71·3 years to 79·2 years) and 6 years for women (from 77·3 years to 83.0 years). This most recent change equates to more than 6 h of life expectancy gained per day survived for men, and more than 4 h for women. Historically, improvements in life expectancy were achieved through reductions in infant and child mortality, whereas, from 1981 to 2012, life expectancy at 65 years improved by 41% for men and 24% for women in England; and even at 85 years, by 34% for men and 27% for women. For men, 39% of deaths in the UK now occur at ages older than 85 years, and 52% occur at these ages in women, increased from 14% for men and 31% for women in 1981. In low-mortality countries such as England, summary mortality statistics therefore mainly track changes in the common pathologies of old age. Life tables have been used since the 1840s to describe geographical inequalities in health. These life tables generally correlate strongly with area deprivation, although migration has an eff ect. Unfortunately, improvement in overall life expectancy has not led to commensurate reductions in levels of inequality. The range of life expectancy at birth in England across its districts increased for males, from 8·3 years in 2008 to 8·7 years in 2012, although it did fall for women from 7·3 years to 6·4 years. At a regional level, inequalities have reduced for men, for whom the range between regions fell from 2·7 to 2·4 years, but no change occurred for women, for whom the equivalent range remained at 2·4 years. On a positive note, the gap between men and women at a national level has progressively narrowed from 5·9 years in 1982 to 3·8 years in 2012. Statistics on period life expectancy combine agespecifi c mortality data into a single summary statistic that is meaningful to almost any audience. Pitfalls exist, however. No one actually experiences period life expectancy. Just as the satellite navigation system in your car tells you how long the journey to an airport would take with present traffi c conditions, but not with the ones that you will actually encounter, period life expectancy is a notional construct based on present age-specifi c mortality patterns. In reality, people contribute to death statistics as members of birth cohorts living through diff erent periods at diff erent ages. Period life expectancy statistics therefore tell us a lot about present mortality experience, but rather little about future expectations. Life expectancy at birth has been projected to 2062 for England, but the uncertainty range is huge. At best, the life expectancy of men could be 92·6 years and 95·1 years for women, but, at worst, it could be 81·9 years for men and 85·5 years for women. The main estimate is in the middle and represents substantial fl attening of present rates of improvement. In The Lancet, James Bennett and colleagues have used elaborate Bayesian models to analyse present mortality patterns in England and Wales. They then forecasted life expectancy to 2030 for 375 districts. Their models take separate account of age, cohort, period, and geography; the one that performed best emphasised the eff ect of cohort. One of the many benefi ts of this approach is that it makes few, if any, assumptions about trends in mortality. It allows for non-linear trends of the sort that might be expected to follow known patterns of, for example, smoking in past decades. The model output is more optimistic than offi cial fi gures. By 2030, life expectancy is predicted to reach 85·7 years (95% credible interval 84·2–87·4) for men Future inequalities in life expectancy in England and Wales 4 Poulin F, Khairy P, Roy D, et al. Atrial fi brillation and congestive heart failure: a cost analysis of rhythm-control vs rate-control strategies. Can J Cardiol 2013; 29: 1256–62. 5 Schnabel RB, Yin X, Gona P, et al. 50 year trends in atrial fi brillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet 2015; published online May 8. http://dx.doi. org/S0140-6736(14)61774-8. 6 Moran PS, Flattery MJ, Teljeur C, Ryan M, Smith SM. Eff ectiveness of systematic screening for the detection of atrial fi brillation. Cochrane Database Syst Rev 2013; 4: CD009586. 7 Madoc-Sutton H, Pearson E, Upton J. Pulse check as a screen for atrial fi brillation. Practice Nursing 2009; 20: 310–13. 8 Ghasemzadeh N, Maziar Zafari A. A brief journey into the history of the arterial pulse. Cardiol Res Pract 2011; 2011: 164832. 9 Cooke G, Doust J, Sanders S. Is pulse palpation helpful in detecting atrial fi brillation? A systematic review. J Fam Pract 2006; 55: 130–34.