Why has mortality in England andWales been increasing? An iterative demographic analysis
Why has mortality in England andWales been increasing? An iterative demographic analysis
复制标题
DOI：
10.1177/0141076817693599
复制
发表时间：
2017-04-01
影响因子：
17.3
通讯作者：
McKee, Martin
中科院分区：
文献类型：
--
作者：
Hiam, Lucinda;Dorling, Danny;McKee, Martin
目标：了解 2015 年英格兰和威尔士死亡率上升的原因。设计：迭代人口分析。背景：英格兰和威尔士参与者：英格兰和威尔士人口。主要结果指标：导致 2013 年至 2015 年预期寿命变化的原因和死亡年龄。结果：英格兰和威尔士年龄标准化死亡率的长期下降趋势在 2011 年得到逆转。尽管2013年和2014年，2015年是战后时期死亡人数增幅最大的一年之一。尽管如此，2015年的死亡率高于2008年以来的任何一年。2013年至2015年间出生时预期寿命的小幅下降并不显着，但60岁以上的预期寿命下降却很显着。观察到的预期寿命变化的最大贡献者是 85 岁以上的人群，其中痴呆症对男女的贡献最大。然而，编码实践和痴呆症诊断的变化要求谨慎解释这一发现。结论：英格兰和威尔士死亡率的长期下降趋势已经逆转，与 2006 年至 2014 年平均年龄特定死亡率持续下去的预期相比，死亡人数大约增加 30,000 人。这些超额死亡主要发生在老年人口，他们最依赖健康和社会护理。根据报告的死亡原因，主要原因是痴呆症，但在这种解释中建议谨慎。随附的论文探讨了卫生和社会保健系统的作用。
Objectives: To understand why mortality increased in England and Wales in 2015.Design: Iterative demographic analysis.Setting: England and WalesParticipants: Population of England and Wales.Main outcome measures: Causes and ages at death contributing to life expectancy changes between 2013 and 2015.Results: The long-term decline in age-standardised mortality in England and Wales was reversed in 2011. Although there was a small fall in mortality rates between 2013 and 2014, in 2015 we then saw one of the largest increases in deaths in the post-war period. Nonetheless, mortality in 2015 was higher than in any year since 2008. A small decline in life expectancy at birth between 2013 and 2015 was not significant but declines in life expectancy at ages over 60 were. The largest contributors to the observed changes in life expectancy were in those aged over 85 years, with dementias making the greatest contributions in both sexes. However, changes in coding practices and diagnosis of dementia demands caution in interpreting this finding.Conclusions: The long-term decline in mortality in England and Wales has reversed, with approximately 30,000 extra deaths compared to what would be expected if the average age-specific death rates in 2006- 2014 had continued. These excess deaths are largely in the older population, who are most dependent on health and social care. The major contributor, based on reported causes of death, was dementia but caution was advised in this interpretation. The role of the health and social care system is explored in an accompanying paper.