2020 JSNA

Mortality & Healthy Life Expectancy trends

December 2019

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CONTENTS

• Key Summary3

• Introduction5

• Life expectancy6

• Healthy life expectancy15

• All cause mortality rates19

• Major causes of death21

• Preventable causes of death29

• Infant and childhood mortality33

• Excess winder deaths36

• Palliative Care37

• Appendix38

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Life expectancy• Early mortality is largely preventable.• Life expectancy at birth, age 65 and 85 has increased for both men and women between the

periods 1981-83 and 2015-17, though the rate of increase has slowed since 2011.• Males in Stockport are now expected to live to 79.9 years and females to 83.3 years, rates

similar to the national average.• The gap in life expectancy between the genders has narrowed as male life expectancy has grown

more quickly than female life expectancy .• It is not known whether the slower rate of improvement experienced since 2011, which is a local,

national and international trend, will continue, or whether previous trends will resume.

Inequalities• There are clear deprivation profiles in life expectancy with males in the least deprived areas

expected to live 8.8 years longer, and females 8.5 years longer, than their counterparts in the most deprived areas. At a ward level these gaps widen to 11 and 10 years respectively.

• Trends fluctuate, but the inequality gap in male life expectancy has narrowed slightly between 2002-04 and 2015-17, while it has increased for females.

• The main causes of death responsible for the inequality in life expectancy are currently circulatory, cancer and respiratory causes for males and cancer, mental and behavioural, and respiratory causes for females.

• The main contributing age group to life expectancy inequality is those dying between the ages of 60 and 79.

• Inequalities in infant mortality are no longer evident, in part due to the significant reduction in numbers during the 1980 and 1990s.

Key Summary

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Healthy Life expectancy• Around 22% of a typical Stockport resident’s life will be spent in not good health• Males typically live 18.2 years past health life expectancy, and females 18.6 years past healthy life

expectancy.• National data analysis shows that while healthy life expectancy is increasing, it is not increasing as

much as life expectancy, meaning that people are spending more years in fair and poor health.• People in deprived areas of Stockport spend 7 more years in fair or poor health compared to

those in other areas.

Causes of death

• Cancer is the biggest causes of death amongst Stockport residents in all ages and aged under 75, followed by circulatory disease

• Although cancer mortality rates are falling, circulatory disease mortality rates have fallen more rapidly meaning that cancer is now the largest cause of premature death.

• Dementia is increasingly becoming a major cause of death for older people. This is in part due to a change in coding leading to better identification of dementia

• In under 35s, external causes are a large proportional cause of death; deaths in these younger age groups are primarily due to accidents or self-harm.

• Stockport tends to have similar mortality rates to the national average but better than those in the North West an exception is for under 75 liver diseases where rates are higher than national averages, 90% of these deaths are preventable

• There are inequalities in all causes of death between the most deprived and least deprived areas.• Cancer is the largest cause of preventable death in Stockport residents. Rates are similar to the

England average

Key Summary

• Preservation of life and avoiding unnecessary deaths are key objectives for all involved

in the health and care of Stockport residents

• Mortality rates give an effective assessment of the overall health of the population

– giving an insight into whether the population is getting healthier

– demonstrating if interventions are having the desired effect

– indicating the particular diseases and health issues which are effecting our

population

• Mortality rates are easily defined and universal, meaning that comparison with other

areas is straightforward

• By standardising for gender and age, rates can be compared across areas and causes

• Mortality rates can also be used to compare areas within Stockport to consider if

inequalities in health are present

• The main mortality rates will be analysed in this document looking at overall rates, how

they are influenced by gender and age and finally whether there are inequalities in

outcomes within Stockport

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Introduction

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• Analysis from the Global Burden of Disease Study 2017 for Stockport shows the preventable underlying risk factors for deaths in Stockport

• Both unhealthy eating and smoking are significant behavioural risk factors, particularly for deaths from cancer and heart disease

• Dietary risks also contribute to many of the metabolic risk factors including blood pressure, obesity and blood sugar levels.

Underlying risk factors for death in Stockport

Note there can be a number of contributory causes to a death, and these shouldn’t therefore be added together

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• Life expectancy has risen from 71.0 to 79.9 years for males and from 77.0 to 83.3 years for females since the early 80’s• The gap between male and female life expectancy has narrowed to 3.4 years, as life expectancy has risen faster in males

(12%) than females (8%)• Stockport residents have experienced similar levels and similar changes in life expectancy as the England and Wales average• Since 2011 there has been a slow down in the rate of improvement in life expectancy, this has happened in Stockport,

England and internationally.

Life expectancy at birth

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Life expectancy at ages 65 & 85

• At age 65 Stockport males are now expected to live 48% longer than they would have in 1981-83 whereas females are expected to live 27% longer, life expectancy at 65 is now for a further 19.1 years for men and 21.2 years for women.

• At age 85 the increase in life expectancy has been 33% and 34% for male and female residents respectively, life expectancy at 85 is now for a further 6.1 years for men and 7.1 years for women.

• Stockport residents at 65 and 85 have experienced the same trends as the England and Wales average• The rate of increase in life expectancy at these older ages has also slowed since 2011

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Changes in underlying trend since 2011

The long term trend for mortality rates in England

has been a steady fall over time; however since 2011

the rate of decline (the improvement) has

significantly slowed and life expectancy

improvements have therefore stalled. The Office for

National Statistics (ONS) has concluded that a

“statistically significant slowdown in the long-term

improvement in age-standardised mortality rates for

England and Wales took place around early 2010s”.

Local mortality rates in Stockport have followed this

pattern, until 2010/12 the rate of decline for both

males and females was consistent and followed a

linear trend, since then rates have stopped falling

and have instead held steady.

These trends are being driven particularly by deaths

for older people, and especially for those over 90,

although mortality improvements are slowing down

for younger age groups too. The changes are also

being felt most significantly in the deprived areas,

particularly for females under 75 years, reinforcing

existing inequalities. These patterns are seen both

locally and nationally.

There are many suggestions about the possible causes of this change, including

flu infections, cold weather, the impact of austerity and cohort effects; and it is

possible that a number of these factors are contributing to the trend. As yet

there is no national consensus and it is being debated hotly.

We cannot yet say what will happen to the trend in the mortality rate in the

future, as there is not enough evidence to help predict whether it will return to

its earlier trends or continue with current worsening patterns, although early

data for 2018 suggest that the deterioration is continuing.

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Life expectancy by deprivation

Males• All areas of Stockport have seen around a 4% rise

in life expectancy since 1990-92.• The gap between the most and least deprived

quintile areas is around 9 years.• The gap between the most deprived and

Stockport average has decreased from 6.2 years in 2002-04 to 5.5 years, but this is not a statistically significant change.

• Males in the least deprived areas are expected to live three years longer than the Stockport average

• Similar trends are present in age 65+ males; rates have risen in all areas but slightly more in the most deprived quintile

Females• Female life expectancy has risen but at a slower

rate than male life expectancy.• The gap between the most and least deprived

areas has increased from 6.9 to 8.5 years.• The gap has also increased between the most

deprived area and the Stockport average from 4.2 to 5.9 years.

• Females in the least deprived areas are expected to live 2 years longer than the Stockport average.

• Similar trends are present in age 65+ females; rates have risen, albeit slower than males, and the increase has been slower in the more deprived areas.

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Life Expectancy by Ward

• For men, life expectancy has risen in all wards over the last 10 years.

• For women, the trend is less consistent, with smaller gains and occasional decreases.

• Inequality gaps persist however: around 11 years for

males between highest and lowest wards.

around 10 years for females between highest and lowest wards.

WardsMale Life Expectancy

at birth (2015-2017)

Female Life Expectancy

at birth (2015-2017)

Bramhall North 83.6 85.0

Bramhall South & Woodford 85.9 87.4

Bredbury & Woodley 80.3 80.6

Bredbury Green & Romiley 81.8 83.1

Brinnington & Central 74.8 77.2

Cheadle & Gatley 82.2 83.7

Cheadle Hulme North 82.2 82.3

Cheadle Hulme South 84.0 86.5

Davenport & Cale Green 77.7 79.3

Edgeley & Cheadle Heath 78.6 80.0

Hazel Grove 84.0 85.4

Heald Green 82.7 86.1

Heatons North 81.8 83.1

Heatons South 82.0 83.3

Manor 81.7 83.8

Marple North 83.5 84.7

Marple South 81.7 83.1

Offerton 82.0 83.3

Reddish North 81.3 82.9

Reddish South 80.9 82.4

Stepping Hill 81.8 85.4

STOCKPORT 81.6 83.3

Gap between highest and lowest 11.1 10.2

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Causes of death driving inequalities in life expectancy

• In 2015-17 the main drivers of male life expectancy inequality were circulatory, cancer and respiratory causes. Of those leading causes only external causes is currently showing an increase.

• For females it was primarily cancer, mental and behavioural, and respiratory causes contributing to life expectancy inequalities.

• Data for inequalities in life expectancy is from Public Health England’s Segment Tool

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• People dying between the ages of 60 and 79 is the main contributor to life expectancy inequalities in both genders.• For men, those dying between ages 40 and 59 are also a large contributor; for women, those dying aged 80 and over are the

second largest contributor.• Data for inequalities in life expectancy is from Public Health England’s Segment Tool

Age groups driving inequalities in life expectancy

• Life expectancy at birth, age 65 and 85 has increased between the periods 1981-83 and 2015-17, though the rate of increase has slowed since 2011.

• Males in Stockport are now expected to live to 79.9 years and females to 83.3 years.

• The gap between the genders has narrowed as male life expectancy has grown more quickly than female life expectancy .

• Life expectancy for males and females in Stockport is similar to the national average.

• It is not known whether the slower rate of improvement will continue, or whether previous trends will resume.

• There are clear deprivation profiles in life expectancy with males in the least deprived areas expected to live 8.8 years longer, and females 8.5 years longer, than their counterparts in the most deprived areas. At a ward level these gaps widen to 11 and 10 years respectively.

• Trends fluctuate, but the inequality gap in male life expectancy has narrowed slightly between 2002-04 and 2015-17, while it has increased for females.

• The main causes of death responsible for the inequality in life expectancy are currently circulatory, cancer and respiratory causes for males and cancer, mental and behavioural, and respiratory causes for females.

• The main contributing age group to life expectancy inequality is those dying between the ages of 60 and 79.

• Early mortality is largely preventable.14

Summary - life expectancy

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• Males and females typically spend around 77% of their life in good health from birth• Females typically live 18.6 years past healthy life expectancy, and males 18.2 years past healthy life expectancy – in other

words these are the number of years spent in fair or poor rather than good health towards the end of life.

Life expectancy versus healthy life expectancy at birth, 2015-17

Difference 18.6

Difference 18.2

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• At age 65 Stockport residents will live a similar amount of their remaining life in good health as they do in not good health• Females and males will typically spend around 11 of their remaining years of life in good health• Females will then spend around 10.1 years not in good health and males around 8.3 years not in good health

Life expectancy versus healthy life expectancy at age 65+, 2015-17

Difference 10.1

Difference 8.3

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Life expectancy versus healthy life expectancy by deprivation

• Males in the most deprived areas live in good health 16.5 years less than those in the least deprived areas, and live 19 years in fair and not good health compared to 12 years in the least deprived areas

• Females in the least deprived areas will spend around 15 years longer in good health than those in the most deprived, and 7.5 years less in fair and poor health

• Females in all areas of Stockport will live longer in good and fair health than males. Males will live longer in poor health than females in all areas.

• Both males and females living in the least deprived areas will spend around 85% of their lives in good health

• This is in contrast to the most deprived areas where males and females typically spend around 74% of their lives in good health.

• Although females in all areas spend more years in good health than males it is males who spend a larger proportion of their life in good health.

• However males in all areas also spend a larger proportion of their life in poor health than females

• Around 22% of a typical Stockport resident’s life will be spent in not good health

• Males typically live 18.2 years past health life expectancy, and females 18.6 years past healthy life expectancy

• At age 65, 44% of a typical male and 48% or a typical female Stockport resident’s remaining life will be spent in not good health

• Males will then spend around 8.3 years not in good health and females around 10.1 years not in good health

• The healthy life expectancy models do not support trend analysis for local authorities

• National data analysis shows that while healthy life expectancy is increasing, it is not increasing as much as life expectancy

• Therefore, people are typically living longer in not good health, both in years and as a percentage of their life

• Data for internal inequalities is only available from the Census, and therefore the gaps described are the same as in 2015.

• People in deprived of Stockport areas spend 7 more years in fair or poor health compared to those in other areas.

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Summary – healthy life expectancy

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Benchmarking mortality rates

• Stockport has similar all age all cause mortality rates to England but is consistently better than the North West• Stockport rates are 12% lower than the North West• Rates have fallen in all areas at around the same pace; mortality rates in Stockport have decreased by 13% since 2008• Rates for under 65 mortality have shown similar trends

• Like life expectancy, all age all cause mortality rates have been improving though the improvement has slowed since 2011.

• Between 2002 and 2017 male mortality rates fell by 27%, quicker than female rate that fell by 17%, leading to overall rates falling by 21%. The total number of deaths fell by 4%.

• Mortality rates for those aged under 75 have fallen more sharply and more consistently than those for all ages.

• As with for all ages the male pace of reduction in under 75 rates (29%) has exceeded the pace of reduction in female rates (23%). Deaths fell by 14%.

• In all areas the all age male rate has fallen at generally the same pace and the most deprived rate has remained double the least deprived rate.

• The female all age rate has fallen less evenly in all areas and the inequality gap has widened slightly with the most deprived rate now double the least deprived rate.

• In under 75 males the rates have fallen at generally the same pace and the most deprived rates is three times the least deprived rate.

• Under 75 female rates have fallen less evenly in all areas and the inequality gap has widened slightly with the most deprived rate now three times the least deprived rate.

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All cause mortality rates summary

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All age causes of death in Stockport 2017

• Cancer, heart disease and lung disease are the most significant causes of death in Stockport at all ages• Dementia and Alzheimer’s also cause large numbers of deaths in the older age groups

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Under 75 causes of death in Stockport 2017

• Cancer and heart disease are the most significant causes of death in Stockport for early deaths.• Cancer accounts for a far bigger share of early deaths than deaths overall; the portion of deaths from external causes is also

higher

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Causes of death by age group

• The main causes of death change through the life course, with heart disease increasing as people get older.• External causes (accidents and suicides) causes a larger proportion of deaths in younger ages• Though cancer and heart disease cause similar numbers of deaths overall, cancer causes double the amount of deaths in

those aged 50 to 79 and causes a lower proportion for those aged over 80 years.

% of deaths in age groups

80+ 57%

65-79 29%

50-64 10%

35-49 3%

20-34 1%

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Circulatory and cancer mortality trends

All Ages• Since 2012 cancer has been the biggest cause of

death for all ages.• Circulatory mortality has decreased rapidly (by

51%) since 2002, whereas cancer has fallen by 14% in the same period.

• Stockport’s all age mortality from cancer is statistically similar to England’s rates for 2013-17

• Stockport’s all age mortality from circulatory causes is statistically similar to England’s rates for 2013-17

Under 75• Cancer has continued as the biggest cause of

death for those under 75, but circulatory is still roughly double any other cause of death

• Circulatory mortality has fallen by 53% and cancer by 18% since 2002

• Stockport’s under 75s mortality from cancer is statistically similar to England’s rates for 2013-17

• Stockport’s under 75s mortality from circulatory causes is statistically better than England’s rates for 2013-17

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Cancer and circulatory mortality trends by deprivation

Cancer• There is a clear deprivation profile in cancer

mortality rates.• The least deprived rate is 37% lower than the most

deprived rate.• For under 75s the deprivation profile is slightly

steeper, as the least deprived rate is 47% lower than the most deprived.

• Rates have decreased in all areas of Stockport and, whilst this is good, it means the deprivation profile has not narrowed.

Circulatory• There is a clear deprivation profile in circulatory

mortality rates.• For all ages, the least deprived rate is 42% lower

than the most deprived rate.• For under 75s the deprivation profile is more stark

as the least deprived rate is 68% lower than the most deprived.

• For all ages, the most deprived rate has improved slightly quicker than the least deprived rate, making the gap narrower.

• For under 75s, the most deprived rate has improved more slowly, meaning the gap has widened.

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Mortality trends of Stockport’s other major killers

All ages• Respiratory disease, the third biggest killer of

Stockport residents, has fallen by a fifth since 2002• Mental disorders have seen a dramatic rise as the

rate has tripled. This is due to a recent change in coding deaths identifying more dementia, the major cause of these deaths

• External causes have risen by almost 50% and liver disease has increased by over 20%

• Death from external causes are predominantly accidental falls and self-harm

• Digestive disease mortality has remained stable over the last 15 years

Under 75• Because of earlier falls in respiratory disease in the

under 75s, respiratory, digestive and external causes now have similar mortality rates for this age group

• Mental disorders are not a major cause of death in under 75s. This is due to dementia typically being a disease of those over 75

• Mortality from liver disease in the under 75s has had an identical trend to that in all ages

• External cause mortality has risen by a third, which is slower than for all ages

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Focus on early liver disease mortality

Liver disease mortality is one of the few causes of death that has risen over the last 20 years and is also one of the few causes where rates in Stockport are significantly higher than the national average.

Trend analysis shows that this rise occurred in the middle of the last decade – when the number of annual deaths increased from 40 up to 60.

Since then rates have levelled out, but have maintained the gap to the national average.

The majority of these deaths occur for people aged 40-69 and there is a close link to alcohol.

90% of these deaths are defined as preventable.

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Summary of the major causes of death in Stockport

• Cancer and circulatory disease are the biggest causes of death amongst Stockport residents in all ages and aged

under 75

• Although cancer mortality is falling, circulatory disease is falling more rapidly meaning that cancer is now the

biggest single cause of death Stockport overall. In under 75s cancer and circulatory mortality rates were once

similar but now cancer is clearly the largest cause of premature death.

• Dementia is increasingly becoming a major cause of death for older people. This is in part due to a change in

coding leading to better identification of dementia

• In under 50s, external causes and digestive disease are a larger cause of death than for all ages. External causes

are a significant cause of death under 35 years and are primarily either accidental death and self-harm; whilst

digestive disease is mainly chronic liver disease

• Respiratory disease is a sizable cause of death in all ages and under 75s. However the rates are falling in both age

categorisations

• Stockport tends to have similar mortality rates to the national average but better than those in the North West for

the major causes of death mentioned

• An exception is for under 75 liver diseases where rates are higher than national averages, 90% of these deaths are

preventable

• There are inequalities in all causes of death between the most deprived and least deprived areas. These

inequalities are either not changing or widening

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Preventable causes of death benchmarked with England

A death is preventable if, in the light of understanding of the determinants of health at time of death, all or most deaths from that cause, subject to age limits, could be avoided by health interventions or public health prevention in the broadest sense.

Currently in Stockport, 555 people per year die from preventable causes, giving a directly standardized ratio of 190.9, statistically significantly higher than the value for England.

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Main preventable causes mortality rates

The main causes of preventable mortality are certain cancers, cardiovascular diseases and respiratory diseases, if they cause death before the age of 75.

For all of these causes, Stockport has followed the national trends and in recent years has been statistically similar to England.

Preventable cancer is the largest cause of preventable mortality in Stockport, but rates are continuing to decline for both men and women, with men improving slightly more.

The improvements in preventable cardiovascular disease mortality seems to have bottomed out in 2011, with rates remaining broadly the same since then.

Preventable mortality from respiratory disease has been slowly increasing since 2010, in line with trends nationally.

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Unlike other preventable causes of death where Stockport’s rates have usually been similar to national rates, Stockport’s rate of mortality from preventable liver disease has usually been higher than the England rate. Currently, there are around 55 deaths from preventable liver disease in Stockport each year.

Though in past years the higher rate of preventable liver mortality in men has been the main driver of Stockport’s rates, in recent years there has been an increase in the women’s rates. Generally, two thirds of the preventable liver disease deaths have been men and one third women. However in the 2016-18 period, 60% of the deaths were men and 40% women.

Alcohol consumption and obesity are key risk factors associated with liver disease. Alcoholic liver disease is the cause of 60% of the preventable liver disease deaths in Stockport. Liver cancer is the cause of around a quarter of the deaths; hepatitis and other cirrhosis of the liver make up the remainder of the causes.

Preventable liver disease mortality rates

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Summary of preventable mortality

• Stockport has higher preventable mortality rates than the England average

• Cancer is the largest cause of preventable death in Stockport residents. Rates are continuing to decline and are

statistically similar to the England average

• The decline in mortality rates from preventable cardiovascular disease seems to have ended, with rates similar to

the England average

• Preventable mortality from respiratory causes is slowly rising, a trend that is similar to England

• Stockport has higher rates of preventable liver disease than England

• Preventable mortality from liver disease in men in Stockport has usually been higher than the England rate; in

recent years the rate for women in Stockport has also been higher than the England rate

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• Infant mortality rates fell to 4.6 per 1,000 live births in 2004-06, and continued at a lower rate through to 2013-15.• However in recent years rates have been higher, though not as high as in 2003-05 and not a statically significant change.• All infant deaths are investigated by the multi-disciplinary Child Overview Death Panel, as part of the safeguarding duties of

local areas, to understand how and why children in Stockport die and to identify whether there are any factors which could have been modified to prevent or reduce the chances of a similar death in future.

Infant mortality

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Infant mortality by deprivation

• In the past, there was a clear deprivation profile in infant mortality, with the 40% most deprived areas were significantly higher than all other areas and the least deprived areas were significantly lower than all others

• Currently, rates in all areas are similar to the Stockport average. The most deprived areas have improved greatly; however over the same time period the rates in the least deprived and second least deprived areas have worsened slightly.

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• Childhood mortality since 1998-02 has seen a decline in the directly standardised rate per 100,000• However the rate of decline has not been consistent and seems to have slowed in recent years• As the actual number of deaths is relatively small even when combining 5 and 10 year periods there is little value in doing

a sub-Stockport breakdown• All childhood deaths are investigated by the multi-disciplinary Child Overview Death Panel, as part of the safeguarding

duties of local areas, to understand how and why children in Stockport die and to identify whether there are any factors which could have been modified to prevent or reduce the chances of a similar death in future.

Childhood mortality

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• Excess winter deaths have shown a fairly consistent trend since 1996-97• There is an almost cyclical trend as periods of low numbers are followed by periods of peaks with a regression to the mean• Stockport follows the England and Wales index relatively closely• Excess winter deaths do not seem to conform to the deprivation profile that has been present in other analysis

Excess winter deaths

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• An aim of palliative and end of life care is that where it is realistically possible people should be allowed to die in their own home

• From 2004-05 there has been an upward trend in people dying at their usual address• In recent years, the trend has been erratic but always above 40%

Palliative care

2019 JSNA

Mortality & Healthy Life Expectancy Appendix (additional analysis)

38

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Stockport’s infant mortality rate and most life expectancy measures are similar to the England average. However healthy life expectancy at 65 for males is better than the national average; and mortality from causes considered preventable is worse.

KeyCompared with England:

Quintiles:

England Value

Selected mortality indicators from the Public Health Profiles presenting Stockport compared to England. Data extracted November 2019.

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Stockport has comparable mortality rates of under 75 cardiovascular disease and also cancer with those experienced in England. Under 75 mortality from cardiovascular disease and cancer that is considered preventable is also similar to the national rates.

41

Stockport’s under 75 mortality rate from liver disease and liver disease considered preventable is worse than the England average. This is driven by the rates for females, but the male rate is also slightly below the England average.

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The under 75 mortality rate from respiratory disease for males in Stockport is better than the England average. However, the rate for females is not, so the overall rate is similar to England.Suicide rates in Stockport are similar to the England average.