Three years forward, two steps back
Recent longevity trends and their underlying causes
2pm BST
24th May 2019
@ClubVita #longevitytrends
linkedin.com/company/club-vita
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Steven BaxterHead of Research & DevelopmentClub Vita
Erik PickettHead of ContentClub Vita
Doug FullamSenior Manager, Health and Life ModellingAIR Worldwide
Introducing today’s panel
Join the discussion…
LinkedIn: Friends of Club Vita group
Twitter: @ClubVita #longevitytrends
Allan BakerDeputy Head of Population Health AnalysisPublic Health England
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In the news..
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The 2010s slowdownSetting the scene
Steven BaxterHead of Research & DevelopmentClub Vita
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UK longevity
15
16
17
18
19
20
21
22
23
2000 2005 2010 2015 2020
Period life expectancy from age 65
Men Women
Pre 2011 trend Pre 2011 trend
-0.5 0.0 0.5 1.0 1.5 2.0 2.5
1950s
1960s
1970s
1980s
1990s
2000s
2010s
Increases in period life expectancy for
men from age 65 in each decade
Historical improvements 2010-2011 2011-2018
UK longevity is still improving
6
International comparisons
-1
0
1
2
3
4
-1 0 1 2 3 4
Changes in life expectancy from 65 (2001-2011)
-0.5
0
0.5
1
1.5
2
-0.5 0 0.5 1 1.5 2
Changes in life expectancy from 65 (2011-2016)
Slowdown in longevity appears to be happening in much of OECD and Europe
Source: Club Vita calculations based on OECD, EuroStat and HMD data. Charts shows increase in period life expectancy (so no allowance for future improvements) from 65. Each point is a separate OECD or European country (those with period life expectancy for men of 16 years or less are excluded, as such countries generally have high premature mortality). Same countries shown on both charts.
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UK slowdown in context
UK
-1
0
1
2
3
4
-1 0 1 2 3 4
Changes in life expectancy from 65 (2001-2011)
UK
-0.5
0
0.5
1
1.5
2
-0.5 0 0.5 1 1.5 2
Changes in life expectancy from 65 (2011-2016)
Slowdown in UK longevity one of the most dramatic
Source: Club Vita calculations based on OECD, EuroStat and HMD data. Charts shows increase in period life expectancy (so no allowance for future improvements) from 65. Each point is a separate OECD or European country (those with period life expectancy for men of 16 years or less are excluded, as such countries generally have high premature mortality). Same countries shown on both charts.
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UK, USA & Canada
Source: Club Vita calculations based on OECD, EuroStat and HMD data. Charts shows increase in period life expectancy (so no allowance for future improvements) from 65. Each point is a separate OECD or European country (those with period life expectancy for men of 16 years or less are excluded, as such countries generally have high premature mortality). Same countries shown on both charts.
CAN
UK
USA
-1
0
1
2
3
4
-1 0 1 2 3 4
Changes in life expectancy from 65 (2001-2011)
CAN
UKUSA
-0.5
0
0.5
1
1.5
2
-0.5 0 0.5 1 1.5 2
Changes in life expectancy from 65 (2011-2016)
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FRA
GER
NLD
-1
0
1
2
3
4
-1 0 1 2 3 4
Changes in life expectancy from 65 (2001-2011)
FRAGER
NLD
-0.5
0
0.5
1
1.5
2
-0.5 0 0.5 1 1.5 2
Changes in life expectancy from 65 (2011-2016)
Big falls in other “high-income countries”
Slowdown in longevity impacting high income countries
Source: Club Vita calculations based on OECD, EuroStat and HMD data. Charts shows increase in period life expectancy (so no allowance for future improvements) from 65. Each point is a separate OECD or European country (those with period life expectancy for men of 16 years or less are excluded, as such countries generally have high premature mortality). Same countries shown on both charts.
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More than austerity: Mediterranean Europe
GRE
ITA
ESP
-1
0
1
2
3
4
-1 0 1 2 3 4
Changes in life expectancy from 65 (2001-2011)
GRE
ITA
ESP
-0.5
0
0.5
1
1.5
2
-0.5 0 0.5 1 1.5 2
Changes in life expectancy from 65 (2011-2016)
Slowdown in longevity not happened in austerity hit Mediterranean Europe
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JAP
-1
0
1
2
3
4
-1 0 1 2 3 4
Changes in life expectancy from 65 (2001-2011)
JAP
-0.5
0
0.5
1
1.5
2
-0.5 0 0.5 1 1.5 2
Changes in life expectancy from 65 (2011-2016)
..and some countries are having a good decade
Source: Club Vita calculations based on OECD, EuroStat and HMD data. Charts shows increase in period life expectancy (so no allowance for future improvements) from 65. Each point is a separate OECD or European country (those with period life expectancy for men of 16 years or less are excluded, as such countries generally have high premature mortality). Same countries shown on both charts.
Japanese longevity is increasing faster this decade than last
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Socio-economic trendsOffice for National Statistics data
Longevity gap widened by
3 months
6 monthsChange in life expectancy
between 2012-2014
and 2015-2017
Source: BBC News version (https://www.bbc.co.uk/news/health-47721167) of ONS data analysis published on 27 March 2019 https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthinequalities/bulletins/healthstatelifeexpectanciesbyindexofmultipledeprivationimd/2015to2017
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Socio-economic trendsLatest Club Vita analysis
Improvements for pension plan members in UK continue to differ by socio-economics
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Recent longevity trendsAllan BakerDeputy Head of Population Health AnalysisPublic Health England
A review of recent trends in
mortality in England
Allan Baker
Deputy Head of Population Health Analysis
Public Health England
Context and aims of the review
Reports of:
• A recent increase in the number of deaths in England, particularly in some
winter periods from 2014/15 through to 2017/18.
• A reduction in the rate of improvement (slowdown in improvement) in life
expectancy and age-standardised mortality rates in recent years, particularly
since 2011.
Aims
1. Review recent trends in numbers of deaths, mortality rates and life
expectancy in England. Focus on differences in trends by specific groups of
the population and specific causes of death.
2. Using official data, consider available evidence for potential explanatory
factors which may have influenced any changes in mortality rates or
affected patterns of winter deaths, and make suggestions for further work
that is required.
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Mortality rates from heart disease, stroke and ‘other’ causes have
fallen but the level of improvement has decreased. More people are
living with dementia and other conditions that may make them
particularly vulnerable to the effects of flu and other winter risk factors.
17
Source: PHE analysis of ONS data
Trends for cardiovascular disease for England
and 22 peer countries, 1990 to 2016
18
Age-standardised rate per 100,000 population
Source: Global Burden of Disease, 2016
1990 2000 2010
100
200
300
400
As heart disease and stroke are leading causes of death, the
slowdown in improvement from these causes has had a large
impact on the trend in overall mortality and life expectancy.
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Males Females
Source: PHE analysis of ONS data
Contribution of 10 leading causes of death to changes in life expectancy, England
Contribution of 5 leading causes of death to changes in life expectancy, aged 20-44, England
20
Males Females
The cause of death that had the most noticeable impact on
the slowdown at younger ages was accidental poisoning,
with a large proportion due to drug misuse.
Source: PHE analysis of ONS data
The size and frequency of recent winter peaks in mortality which is
determined by the type of flu circulating, vaccine effectiveness, and is
sometimes exacerbated by cold weather, has contributed to the
slowdown in improvement in life expectancy.
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61% 34% 52% 40% 15%
Source: PHE flu annual report: 2017 to 2018 (Figure 33)
Weekly observed and expected number of all-age all-cause deaths, with the dominant circulating strain
type(s), and percentage vaccine effectiveness, England, 2013/14 to 2017/18
22
However improvement in mortality rates for the non-winter
months has also slowed in recent years.
Trend in age-standardised mortality rate for winter and non-winter months for males and females
Source: PHE analysis of ONS data
Males Winter
MalesNon-winter
FemalesNon-winter
600
800
1000
1200
1400
1600
1800
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
Directly age standardised mortality rate per 100,000
Females Winter
Year
The causes of the slowdown in improvement are having
the greatest impact in the most deprived areas.
70
72
74
76
78
80
82
84
862
001
-20
03
20
02-2
004
20
03-2
005
20
04-2
006
20
05-2
007
20
06-2
008
20
07-2
009
20
08-2
010
20
09-2
011
20
10-2
012
20
11-2
013
20
12-2
014
20
13-2
015
20
14-2
016
Life Expectancy at Birth (years)
Least deprived decile
All other deciles
Most deprived decile
IMD 2010 IMD 2015
76
78
80
82
84
86
88
20
01-2
003
20
02-2
004
20
03-2
005
20
04-2
006
20
05-2
007
20
06-2
008
20
07-2
009
20
08-2
010
20
09-2
011
20
10-2
012
20
11-2
013
20
12-2
014
20
13-2
015
20
14-2
016
Life Expectancy at Birth (years)
Least deprived decile
All other deciles
Most deprived decile
IMD 2010 IMD 2015
76
78
80
82
84
86
88
20
01
-20
03
20
02
-20
04
20
03
-20
05
20
04
-20
06
20
05
-20
07
20
06
-20
08
20
07
-20
09
20
08
-20
10
20
09
-20
11
20
10
-20
12
20
11
-20
13
20
12
-20
14
20
13
-20
15
20
14
-20
16
Life Expectancy at Birth (years)
Least deprived decile
All other deciles
Most deprived decile
IMD 2010 IMD 2015
Source: PHE analysis of ONS data
Males Females
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The slowdown in improvement in the UK has also been
seen in other countries across Europe
Source: PHE analysis of data from Eurostat database
Trends in life expectancy at birth, by sex, large EU countries, 2001 up to 2016
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Conclusions
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• It is not possible to attribute the recent slowdown in improvement to any
single cause and it is likely due to a number of factors, operating
simultaneously across a wide range of age groups, geographies and
causes of death.
• This slowdown in improvement has been seen in other large EU countries,
but of these, the UK has had the slowest rate of improvement since 2011.
• The causes of the slowdown in improvement are having the greatest impact
in the more deprived areas.
• Our ageing population means there are likely to be more people living with
dementia and other long-term conditions, who are particularly vulnerable to
effects of flu and other winter risk factors, and who may be particularly
reliant on health and social care services.
• Recent winter peaks in mortality, determined by the intensity and dominant
type of influenza circulating, flu vaccine uptake and effectiveness, and
sometimes exacerbated by cold weather, have contributed to fluctuations in
annual age-standardised rates and the slowdown in improvement.
Further work
• A slowdown in improvement in mortality rates from heart disease and stroke
has had a large impact on the trend in life expectancy. In young people,
accidental poisoning deaths had the biggest negative impact on the trend.
Further research focused on these causes, could aid understanding of the
trends seen.
• Other authors have reported an association between trends in mortality and
changes in public spending, and health and social care provision. Further
work would be required to understand any potential causal mechanisms which
may be operating between changes in health and social care provision and
trends in mortality within England and across different countries.
• There is a need to support the most vulnerable in society, particularly older
people, to minimise the impact of poverty and extremes of temperature, and
diseases such as dementia and influenza. Additional research could focus on
understanding the interactions between these factors and suggest actions to
address widening health inequality.
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LinksA review of recent trends in mortality in England
Report and data packs:
https://www.gov.uk/government/publications/recent-trends-in-mortality-in-
england-review-and-data-packs
Why have increases in life expectancy slowed down in England?
https://publichealthmatters.blog.gov.uk/2018/12/11/why-have-increases-in-life-
expectancy-slowed-down-in-england/
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Recent longevity trendsDoug FullamSenior Manager, Life and Health ModellingAIR Worldwide
29©2019 AIR Worldwide 29
Years of Life Expectancy at Birth, 1900-2014
30
40
50
60
70
80
90
1900 2014
Both sexes Female Male
30©2019 AIR Worldwide 30
• While it is impossible to predict future trends with complete accuracy, we can significantly reduce the uncertainty
• Simple deviations relative to the best estimate (current data) have proven insufficient
Capturing Future Life Expectancy Trends
Year Life Expectancy
2014 78.84
2015 78.69
2016 78.69
2017 78.60
31©2019 AIR Worldwide 31
Mortality Trends Are Not One Size Fits All
0
10
20
30
40
50
60
70
80
Injuries
175
180
185
190
195
200
0
50
100
150
200
250
300
350
400
CVD All cancers
De
ath
s P
er
10
0,0
00
Pe
op
le
32©2019 AIR Worldwide 32
US CVD Slow-up
33©2019 AIR Worldwide 33
Mortality Trends By Cause
2000-09 2009-15
3.95% 1.45%
Median annualized improvement:
Heart Disease
2000-09 2009-15
1.90% 0.76%
Median annualized improvement:
Overall
2000-09 2009-15
1.66% 2.21%
Median annualized improvement:
Cancer
34©2019 AIR Worldwide 34
UK vs. US in Mortality Improvement in the 21st Century
35©2019 AIR Worldwide 35
Life Expectancy Change by Income
Source: The Association Between Income and Life Expectancy in the United States, 2001–2014
36©2019 AIR Worldwide 36
• Income is related to mortality, but income is also
correlated with other factors:
• Breaking down biomedical information and using a
multi-variable dynamic model provides a better
view of risk
Mortality Improvements Are Not Simply a Function of Income
37©2019 AIR Worldwide 37
The Role of Lifestyle in Mortality Trends
…
38©2019 AIR Worldwide 38
• We often like to think top line numbers of life expectancy can be applied ubiquitously or with conditional statements of “in general”. These metrics can obscure and often mislead the impact to specific population sets
• We need to rethink how mortality is changing for each group, what are they are risk for, and what technology has come online or may come online which will affect their risk
• When comparing life expectancy across countries, there are societal, cultural, and medical variables that may not be immediately apparent in data (e.g. definition of life, health regulations)
Conclusion
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Steven BaxterHead of Research & DevelopmentClub Vita
Erik PickettHead of ContentClub Vita
Doug FullamSenior Manager, Health and Life ModellingAIR Worldwide
Questions?
Join the discussion…
LinkedIn: Friends of Club Vita group
Twitter: @ClubVita #longevitytrends
Allan BakerDeputy Head of Population Health AnalysisPublic Health England
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Thank you
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