Excess winter mortality and stalling international improvements in life expectancy and mortality rates

2020 ◽  
Vol 26 (12) ◽  
pp. 1-8
Author(s):  
Rodney P Jones
Keyword(s):  
Health Service ◽  
Life Expectancy ◽  
Confounding Factor ◽  
Mortality Rates ◽  
Winter Mortality ◽  
Potential Confounding Factor ◽  
The Uk ◽  
Year 2000 ◽  
Service Perspective ◽  
Health Service Perspective

In the UK, government austerity has been suggested as a major reason for the stalling of life expectancy improvements and age-standardised mortality rates. However, these trends have also been observed in many other countries. Influenza has been suggested as a potential confounding factor, as this condition contributes significantly to excess winter mortality (EWM) rates each year. This study uses calculated EWM rates in 64 countries with more than 12 000 deaths per annum to show that the decade before the financial crash was characterised by lower than average rates of EWM. The observed international stalling in life expectancy may therefore have been happening as early as the year 2000 but may have been partly masked by a decade of lower than usual winter deaths. From a health service perspective, EWM is also a source of winter bed pressures because of the associated medical admissions. The coincidental decade of low EWM rates may have also created a false picture of low winter demand, to which managers will have responded by trimming resources. This will, in part, have contributed to current winter pressures as EWM rates have returned to more ‘normal’ levels.

scholarly journals Cost-effectiveness of a domestic violence and abuse training and support programme in primary care in the real world: updated modelling based on an MRC phase IV observational pragmatic implementation study

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e021256 ◽  
Author(s):  
Estela Capelas Barbosa ◽  
Talitha Irene Verhoef ◽  
Steve Morris ◽  
Francesca Solmi ◽  
Medina Johnson ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health Service ◽  
Cost Effective ◽  
Uncertainty Interval ◽  
The Uk ◽  
The Cost ◽  
Training And Support ◽  
Domestic Violence And Abuse ◽  
Service Perspective ◽  
Health Service Perspective

ObjectivesTo evaluate the cost-effectiveness of the implementation of the Identification and Referral to Improve Safety (IRIS) programme using up-to-date real-world information on costs and effectiveness from routine clinical practice. A Markov model was constructed to estimate mean costs and quality-adjusted life-years (QALYs) of IRIS versus usual care per woman registered at a general practice from a societal and health service perspective with a 10-year time horizon.Design and settingCost–utility analysis in UK general practices, including data from six sites which have been running IRIS for at least 2 years across England.ParticipantsBased on the Markov model, which uses health states to represent possible outcomes of the intervention, we stipulated a hypothetical cohort of 10 000 women aged 16 years or older.InterventionsThe IRIS trial was a randomised controlled trial that tested the effectiveness of a primary care training and support intervention to improve the response to women experiencing domestic violence and abuse, and found it to be cost-effective. As a result, the IRIS programme has been implemented across the UK, generating data on costs and effectiveness outside a trial context.ResultsThe IRIS programme saved £14 per woman aged 16 years or older registered in general practice (95% uncertainty interval −£151 to £37) and produced QALY gains of 0.001 per woman (95% uncertainty interval −0.005 to 0.006). The incremental net monetary benefit was positive both from a societal and National Health Service perspective (£42 and £22, respectively) and the IRIS programme was cost-effective in 61% of simulations using real-life data when the cost-effectiveness threshold was £20 000 per QALY gained as advised by National Institute for Health and Care Excellence.ConclusionThe IRIS programme is likely to be cost-effective and cost-saving from a societal perspective in the UK and cost-effective from a health service perspective, although there is considerable uncertainty surrounding these results, reflected in the large uncertainty intervals.

scholarly journals A large decrease in the magnitude of seasonal fluctuations in mortality among elderly explains part of the increase in longevity in Sweden during 20th century

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Anders Ledberg
Keyword(s):  
Life Expectancy ◽  
20Th Century ◽  
Winter Season ◽  
Total Mortality ◽  
Mortality Rates ◽  
Relative Increase ◽  
Winter Mortality ◽  
Birth Cohorts ◽  
Seasonal Fluctuations ◽  
Time Period

Abstract Background Mortality rates are known to depend on the seasons and, in temperate climates, rates are highest during winter. The magnitude of these seasonal fluctuations in mortality has decreased substantially in many countries during the 20th century, but the extent to which this decrease has contributed to the concurrent increase in life expectancy is not known. Here, I describe how the seasonality of all-cause mortality among people ages 60 years or more has changed in Sweden between 1860 and 1995, and investigate how this change has contributed to the increase in life expectancy observed during the same time period. Methods Yearly sex-specific birth cohorts consisting of all people born in Sweden between 1800 and 1901 who reached at least 59 years of age were obtained from a genealogical database. The mortality rates for each cohort were modeled by an exponential function of age modulated by a sinusoidal function of time of year. The potential impact of seasonal fluctuations on life expectancy was investigated by a novel decomposition of the total mortality rate into a seasonal part and a part independent of the seasons. Cohort life expectancy at age 60 was used to quantify changes in lifespan during the time period. Results The magnitude of seasonal fluctuations in mortality rates decreased substantially between 1860 and 1995. For cohorts born in 1800, the risk of dying during the winter season was almost twice that of dying during summer. For cohorts born in 1900, the relative increase in winter mortality was 10%. Cohort life expectancy at age 60 increased by 4.3 years for men and 6.8 years for women, and the decrease in seasonal mortality fluctuations accounted for approximately 40% of this increase in average lifespan. Conclusion By following a large number of extinct cohorts, it was possible to show how the decrease in seasonal fluctuations in mortality has contributed to an increase in life expectancy. The decomposition of total mortality introduced here might be useful to better understand the processes and mechanisms underlying the marked improvements in life expectancy seen over the last 150 years.

scholarly journals Scaling COVID-19 against inequalities: should the policy response consistently match the mortality challenge?

2020 ◽  
pp. jech-2020-214373
Author(s):  
Gerry McCartney ◽  
Alastair Leyland ◽  
David Walsh ◽  
Dundas Ruth
Keyword(s):  
Life Expectancy ◽  
Socioeconomic Inequality ◽  
Negative Impact ◽  
Disease Model ◽  
Mortality Rates ◽  
Economic Policies ◽  
Drug Poisoning ◽  
Infectious Disease Model ◽  
The Public ◽  
The Uk

BackgroundThe mortality impact of COVID-19 has thus far been described in terms of crude death counts. We aimed to calibrate the scale of the modelled mortality impact of COVID-19 using age-standardised mortality rates and life expectancy contribution against other, socially determined, causes of death in order to inform governments and the public.MethodsWe compared mortality attributable to suicide, drug poisoning and socioeconomic inequality with estimates of mortality from an infectious disease model of COVID-19. We calculated age-standardised mortality rates and life expectancy contributions for the UK and its constituent nations.ResultsMortality from a fully unmitigated COVID-19 pandemic is estimated to be responsible for a negative life expectancy contribution of −5.96 years for the UK. This is reduced to −0.33 years in the fully mitigated scenario. The equivalent annual life expectancy contributions of suicide, drug poisoning and socioeconomic inequality-related deaths are −0.25, −0.20 and −3.51 years, respectively. The negative impact of fully unmitigated COVID-19 on life expectancy is therefore equivalent to 24 years of suicide deaths, 30 years of drug poisoning deaths and 1.7 years of inequality-related deaths for the UK.ConclusionFully mitigating COVID-19 is estimated to prevent a loss of 5.63 years of life expectancy for the UK. Over 10 years, there is a greater negative life expectancy contribution from inequality than around six unmitigated COVID-19 pandemics. To achieve long-term population health improvements it is therefore important to take this opportunity to introduce post-pandemic economic policies to ‘build back better’.

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