Mortality rates look at the number of people who die relative to the size and age of the population at any one time, and give a general measure of the health of that population. One variant is to look at the subset of deaths ‘amenable to healthcare’ which is based on premature deaths (under age 75) for a list of diseases where it is believed that effective and timely health care can reduce the chances of somebody dying. In both cases, it has been recognised for a long time that people who live in more affluent areas, or more affluent social groups, have better health and this can be seen in terms of the lower mortality rates in more affluent areas.
There is a strong association (R2 greater than 0.7) between measures of deprivation for local authority areas and the age-standardised mortality rates in the local population. Higher mortality rates in the most deprived parts of the country were observed at both time points even though mortality rates overall had fallen. The reasons behind these differences are complex.
These studies provide a compelling case for monitoring inequalities in life expectancy with a view to narrowing the gap between different areas. As noted by Marmot (2010), reducing health inequalities would benefit society in many ways. There would be economic benefits in reducing losses from illness associated with health inequalities. These currently account for productivity losses, reduced tax revenue, higher welfare payments and increased treatment costs.
The mortality rate from all causes has been falling steadily since 2000-02 and is one indication that as a society we are generally living longer. In fact, this is part of a much longer term secular trend for reductions in mortality. Male mortality rates are consistently higher than those for females, although male rates have reduced more between 2000 and 2011 (22% reduction are compared with 18% for females).
Similar to all age all cause mortality, the rate of death for causes amenable to healthcare has been falling steadily for some time. We also see consistent differences between male and female rates. For all cause mortality male rates are 1.4 times the female rate, whereas for mortality amenable to health care it is 1.5 times the female rate. Mortality amenable to health care has fallen more swiftly and evenly than all cause mortality between 2001 and 2010, with a 36% reduction for females and a 37% reduction for males.
There is also a strong association between age-standardised rates of mortality amenable to healthcare and deprivation at local authority level, with mortality rates in the most deprived areas of the country being notably higher than those in the most affluent. The slope between deprivation and mortality rates is an indication of the degree of health inequality between local authority areas. In this case it seem that, unlike all age all cause mortality, the slope has reduced between 2001 and 2010. This suggests that rates of mortality amenable to healthcare have fallen more quickly in more deprived areas, and the distribution of rates has become more equitable. However, mortality rates for the more deprived areas remain substantially higher than those for more affluent areas.
Amenable mortality rates can be used to compare health care access and quality across countries. They represent deaths that could have been avoided in the presence of optimal quality health care. Risk- and age-adjusted amenable mortality rates have been decreasing over time in all of the comparator countries. Although the UK does well by global standards (in 2015 the global average was 228 deaths per 100,000), it performs poorly compared with the other developed countries in our comparison group. In 2015, the UK's amenable mortality rate was 69.7 per 100,000, which is higher than 12 of the comparator countries. Spain had the lowest amenable mortality rate in 2015 at 50.8 per 100,000, while the United States had the highest at 99 per 100,000.
About this data
Data are based on latest revisions of Office for National Statistics (ONS) population estimates for the respective years. Numerators are the total number of deaths in specific age groups, or number of deaths judged to be amenable to health care, as appropriate (HSCIC 2013). Amenability to health care is based on the original underlying cause of death, and being aged under 75. Denominators are 2011 census based mid-year population estimates for the respective calendar years. Mortality amenable to health care only considers populations aged 0 to 74.