Life Expectancy and Deaths in Buckinghamshire Written by: Piers Simey, Consultant in Public Health, Buckinghamshire County Council Healthy life expectancy With people living longer, it is important to reduce the number of years people spend living in poor health or disability. Healthy life expectancy at birth will be a specific measure within the public health outcomes framework, but data is not yet available to report in the JSNA. Healthy life expectancy at 16 can be used as an interim measure. The number of years people at the age of 16 can expect to live free from disability in Buckinghamshire was 54.1 years, compared to 49.6 years in England (27-9). Long term limiting illness 13.4% of Buckinghamshire residents reported having a long term limiting illness at the time of the census 211. This was lower than the national average (17.6%), but was a slight increase on the percentage reported in Buckinghamshire in 21 (12.8%). Life expectancy at birth Life expectancy in Buckinghamshire is above the national and regional average (Table 1). A baby boy born in the county now can expect to live until he is 8.5 (compared to 78.6 years in England) while a baby girl can expect to live until she is 84. (compared to 82.6 years in England). Male life expectancy is statistically significantly higher than the national rate in all four district councils. For men, life expectancy is highest in South Bucks (81.4 years) and lowest in Aylesbury Vale (8.1 years). Female life expectancy is statistically significantly higher than the national average in three of the four district councils. For women, Aylesbury Vale has the lowest life expectancy at 83. years and this is not significantly different to the national average. Table 1: Life expectancy at birth, 28-1, in Buckinghamshire by local authority Male life expectancy England 78.6 82.6 South East 79.7 83.5 Buckinghamshire 8.5 84. By district: Aylesbury Vale 8.1 83. Chiltern 8.7 85. South Bucks 81.4 84. Wycombe 8.4 84.7 Source: NHS Information Centre for Health & Social Care Female life expectancy 1
Life expectancy, years Life expectancy in Buckinghamshire increased by 2.5 years for males and 2.1 years for females between 21-3 and 28-1. This is in line with national improvements. Male life expectancy has been higher than the national average for the county and across Buckinghamshire districts since 21-3 (figures 1 & 2). Female life expectancy has been higher than the national average for the county and districts throughout this period, although female life expectancy in Aylesbury Vale has been lower than the regional average throughout (figures 3 & 4). Figure 1: Male life expectancy at birth in Buckinghamshire, 21-3 to 28-1 Please note that y-axis is not zeroed 83 Life Expectancy at Birth, 21-3 to 28-1 - Males 81 79 77 75 73 71 21-3 22-4 23-5 24-6 25-7 26-8 27-9 28-1 ENGLAND SOUTH EAST Buckinghamshire CC Source: NHS Information Centre for Health & Social Care 2
Life expectancy, years Life expectancy, years Figure 2: Male life expectancy at birth in Buckinghamshire, 21-3 to 28-1, by district Please note that y-axis is not zeroed 83 Life Expectancy at Birth, 21-3 to 28-1 - Males 82 81 8 79 78 77 76 75 74 21-3 22-4 23-5 24-6 25-7 26-8 27-9 28-1 Aylesbury Vale CD Chiltern CD South Bucks CD Wycombe CD Buckinghamshire CC Source: NHS Information Centre for Health & Social Care Figure 3: Female life expectancy at birth in Buckinghamshire, 21-3 to 28-1 Please note that y-axis is not zeroed 86 Life Expectancy at Birth, 21-3 to 28-1 - Females 85 84 83 82 81 8 79 78 21-3 22-4 23-5 24-6 25-7 26-8 27-9 28-1 ENGLAND SOUTH EAST Buckinghamshire CC Source: NHS Information Centre for Health & Social Care 3
Life expectancy, years Figure 4: Female life expectancy at birth in Buckinghamshire, 21-3 to 28-1, by district Please note that y-axis is not zeroed 86 Life Expectancy at Birth, 21-3 to 28-1 - Females 85 84 83 82 81 8 79 21-3 22-4 23-5 24-6 25-7 26-8 27-9 28-1 Aylesbury Vale CD Chiltern CD South Bucks CD Wycombe CD Buckinghamshire CC Source: NHS Information Centre for Health & Social Care Health status, death rates and life expectancy vary across Buckinghamshire. Analysis using the English index of multiple deprivation (covering indicators such as education and skills, income, crime, the living environment, health and disability) has been used to divide Buckinghamshire population into fifths, called quintiles. The fifth of the population living in the least deprived areas is quintile 1, while the most deprived fifth is quintile 5. Each fifth contains around 98, people. The map below (figure 5) shows the geographic areas in each deprivation quintile. 4
Figure 5: Deprivation quintiles in Buckinghamshire, using the index of multiple deprivation (21) Life expectancy is lowest for those living in the most deprived areas of Buckinghamshire. Figure 6 shows that male life expectancy is more than seven 5
Life Expectancy (years) Life Expectancy (years) years lower in the most deprived areas compared to the least deprived. For women, the gap is narrower at just over four years (figure 7). Figure 6: Difference in male life expectancy at birth in Buckinghamshire by deprivation quintile, 27-11 9 Male Life Expectancy at birth, 27-211, by Deprivation Quintile within Buckinghamshire County 8 7 6 5 4 3 2 1 DQ1 (Least Deprived) DQ2 DQ3 DQ4 DQ5 (Most Deprived) Life Expectancy Source: SEPHO Life Expectancy calculator BCC Average Figure 7: Difference in female life expectancy at birth in Buckinghamshire by deprivation quintile, 27-11 1 9 8 7 Female Life Expectancy at birth, 27-211, by Deprivation Quintile within Buckinghamshire County 6 5 4 3 2 1 DQ1 (Least Deprived) DQ2 DQ3 DQ4 DQ5 (Most Deprived) Life Expectancy Source: SEPHO Life Expectancy calculator BCC Average 6
One of the indicators in the Public Health Outcomes Framework is to reduce differences in life expectancy between communities. The Slope Index of Inequality is a national report on the life expectancy gap between the most and least deprived residents within every local authority in the country. It is developed by analysing life expectancy for population deciles (tenths of the population). An advantage of using this method is that results can be benchmarked with other areas. The higher the value of the Slope Index of Inequality, the greater the difference in life expectancy within the local authority. In Buckinghamshire, the Slope Index of Inequality was 7.9 for males in 26-1 (Figure 8). This indicates that the life expectancy gap between the most and least deprived males living in Buckinghamshire was almost 8 years. This compared to a median value of 8.9 for the 15 upper and single tier local authorities. The index has increased for males in Buckinghamshire from 6.5 in 21-5. Figure 8: Slope Index of Inequality for Males in Buckinghamshire, 21-5 to 26-1 Source: Public Health Observatories of England The life expectancy gap between the most and least deprived females living in Buckinghamshire was 5.4 years in 26-1, compared to the median value of 5.9 (Figure 9). The index for females has increased from 4.9 in 21-5. The national Slope Index of Inequality has increased for both males and females over this period. 7
Figure 9: Slope Index of Inequality for Females in Buckinghamshire, 21-5 to 26-1 Source: Public Health Observatories of England Differences in life expectancy at electoral ward level are shown in Figure 1. A baby born in Southcourt in Aylesbury can expect to live 14 years less than a baby born in Lacey Green, Speen and the Hampdens. Figure 11 shows the ten wards with the shortest life expectancy and the ten wards with the longest life expectancy in Buckinghamshire. The wards with the lowest life expectancy are within the urban areas of Aylesbury (four), Chesham (two) and Wycombe (two). 8
Figure 1: Life Expectancy by District Ward within Buckinghamshire, 27-11 9
Figure 11: Difference in life expectancy at birth in Buckinghamshire by District electoral ward, 27-11 Difference in Life Expectancy (persons) 27-211, by ward within Buckinghamshire County County Average = 82.41 years Lacey Green, Speen and the Hampdens Chesham Bois and Weedon Hill Gerrards Cross East and Denham South West Gerrards Cross South Stewkley Weedon Hambleden Valley Seer Green Greater Marlow Chalfont St Giles Abbey Quarrendon Elmhurst and Watermead Booker and Cressex Ridgeway Vale Gatehouse Southcourt -8-6 -4-2 2 4 6 8 1 (Years shorter) Difference from County average (Years longer) Source: SEPHO Life Expectancy calculator 1
DASR per 1, population Deaths There were 3,793 deaths in Buckinghamshire in 211, with almost a third of these deaths (32%) among people aged under 75 (known as premature deaths). In Buckinghamshire, the all age death rate during 28-21 was 15% lower than the national average, while the premature death rate was 21% lower. People living in Chiltern, Wycombe, South Bucks and Aylesbury Vale districts have all age death rates that are 18%, 16%, 17% and 1% lower than the average for England. Two of the districts (South Bucks & Wycombe) had similar death rates to the prospering southern England comparator, whereas the death rate was statistically higher in Aylesbury Vale and statistically lower in Chiltern (figure 12). The prospering southern England comparator averages the results of areas with similar population characteristics. Figure 12: Death rates from all causes and all ages by local council district, 28-1 6 All Cause Mortality, all ages, 28-21 (Combined) 5 4 3 2 1 Aylesbury Vale Chiltern South Bucks Wycombe Buckinghamshire County DASR Prospering Southern England DASR England DASR Source: ONS Annual District Deaths Extract In Buckinghamshire the all age all cause death rate fell by 19% between 21-3 and 28-1 which was slightly more than the fall in the national rate (17%). Premature death rates fell by 14% between 23-5 and 28-1 which was also greater than the fall in the national rate (12%). No data is available nationally for premature death rates before 23-5. People living in the most deprived quintile in Buckinghamshire have a significantly higher death rate compared to other areas in Buckinghamshire. The all age death rate for the most deprived quintile was 62% higher than for the least deprived quintile (Figure 13). Premature death rates in the most deprived quintile were more than double (216%) the rate in the least deprived quintile in 29-11. 11
Figure 13: Death rates from all causes and all ages by deprivation quintile, 29-11 Source: ONS Annual Deaths Extract; ONS Small Area Population Estimates (SAPE) Mid 21 to Mid 21 LSOA Experimental Quinary Population Estimate; Deprivation Quintiles: IMD 21 Death rates are falling faster in the least deprived quintile compared to the most deprived quintile (Figure 14). Between 21-3 and 29-11, the all age death rate fell by 14% in the most deprived quintile and by more than a fifth (22%) in the least deprived quintile. For premature deaths over the same period, the rate fell by 12% in the most deprived quintile and by a quarter (25%) in the least deprived quintile (Figure 15). For men living in the most deprived quintile of Buckinghamshire, all age death rates were 9% higher and premature death rates more than double (237%) compared to those in the least deprived quintile in 29-11. Death rates for men living in the most deprived quintile are also falling more slowly. Between 21-3 and 29-11, the all age death rate for men living in the most deprived quintile fell by 11% compared to a fall of 3% for men living in the least deprived quintile. There was a similar pattern in premature death rates for men, with a 9% reduction in the most deprived quintile and a 29% reduction in the least deprived quintile. For women living in the most deprived quintile of Buckinghamshire, all age death rates were more than a third higher (38%) and premature death rates 89% higher compared to those in the least deprived quintile in 29-11. All age death rates fell further for women living in the most deprived quintile (18%) compared to the least (15%) between 21-3 and 29-11. 12
DASR per 1, population DASR per 1, population Figure 14: Trend in death rates for all causes and all ages in Buckinghamshire by deprivation quintile, 21-3 to 29-11 All Cause Mortality, all ages, 21-211 by Deprivation Quintile within Buckinghamshire County 8 7 6 5 4 3 2 1 21-3 22-4 23-5 24-6 25-7 26-8 27-9 28-1 29-11 Year DQ1 DQ5 Buckinghamshire County England Source: ONS Annual Deaths Extract; ONS Small Area Population Estimates Mid 21 to Mid 21 LSOA Experimental Quinary Population Estimate; Deprivation Quintiles: IMD 21 Figure 15: Trend in premature death rates for all causes in Buckinghamshire by deprivation quintile, 21-3 to 29-11 All Cause Mortality, under 75s, 21-211 by Deprivation Quintile within Buckinghamshire County 45 4 35 3 25 2 15 1 5 21-3 22-4 23-5 24-6 25-7 26-8 27-9 28-1 29-11 Year DQ1 DQ5 Buckinghamshire County England Source: ONS Annual Deaths Extract; ONS Small Area Population Estimates Mid 21 to Mid 21 LSOA Experimental Quinary Population Estimate; Deprivation Quintiles: IMD 21 13
Main causes of deaths The main causes of death for Buckinghamshire in 211 are shown in Table 2. The most common causes of death were diseases of the circulatory system (31%), which include heart attacks and strokes, and cancers (3%). Respiratory diseases caused 13% of deaths. A third (33%) of male deaths were due to cancers, compared to 27% of female deaths. There was a similar proportion of deaths from circulatory disease for both genders (31% for males and 3% for females). For premature deaths, cancers caused 44% of deaths and circulatory disease caused 23% of deaths. Gender differences were more marked for premature deaths. Almost half (49%) of all premature female deaths were due to cancers, compared to 4% of male deaths. 17% of premature female deaths were due to circulatory disease compared to 28% of male deaths. Table 2: Main causes of deaths for all ages in Buckinghamshire, 211 Cause of Death Deaths Percentage Diseases of the Circulatory System 1166 31% Cancers 1139 3% Diseases of the Respiratory System 51 13% Mental & Behavioural Disorders 228 6% Diseases of the Digestive System 195 5% Diseases of the Nervous System 166 4% External Causes of Morbidity & Mortality 139 4% Other 1 3% Diseases of the Genitourinary System 73 2% Endocrine, Nutritional & Metabolic Diseases 41 1% Certain Infectious and Parasitic Diseases 36 1% TOTAL 3793 Source: ONS Annual Deaths Extract Figure 16 shows that that death rates from most causes are higher among people living in the most deprived quintile of Buckinghamshire. Approaching a third (31%) of the difference in all age death rates between the most and least deprived quintile is due to circulatory disease, and more than a fifth (22%) of the difference is due to cancers. Respiratory deaths make up a further 15% of the difference. 14
Directly age-standardised rates per 1, population Figure 16: differences in death rates for major causes of death between most and least deprived quintiles for Buckinghamshire County, 27-11 All persons, all ages, cause specific mortality profile (27-11 combined) for Buckinghamshire County 7 6 44. 3.9 5 25.1 34.2 Other causes Infectious & parasitic diseases 4 3 17.6 15. 18.5 16.4 43.8 79.7 186. External causes Genitourinary system diseases Nervous system diseases Mental and behavioral disorders Digestive diseases Respiratory diseases Cancers 2 132. Circulatory diseases 1 189.1 112.8 Buckinghamshire CC top quintile Buckinghamshire CC bottom quintile Other causes 17.6 44. Infectious & parasitic diseases 4. 8.3 External causes 15. 3.9 Genitourinary system diseases 6.8 12.9 Nervous system diseases 18.5 25.1 Mental and behavioral disorders 15. 17.3 Digestive diseases 16.4 34.2 Respiratory diseases 43.8 79.7 Cancers 132. 186. Circulatory diseases 112.8 189.1 Source: South East England health inequalities gap measurement tool Deaths from circulatory disease Death rates from circulatory disease have decreased considerably in Buckinghamshire between 21-3 and 29-11, although downward trends have recently slowed for the most and least deprived quintiles (figures 17 and 18). The all age death rate from circulatory disease for Buckinghamshire fell by 39% over this period and the premature death rate fell by a similar proportion. Death rates fell slightly faster in Buckinghamshire (36% lower) compared to nationally (32% lower) for all ages in the period up to 28-1. The premature death rate in 29-11 was more than three times higher in the most deprived quintile compared to the least deprived quintile (figure 18). In contrast, the all age death rate was 71% higher in the most deprived quintile compared to the least deprived quintile (figure 17). The cardiovascular disease section of the JSNA provides further information on needs and related services. 15
DASR per 1, population DASR per 1, population Figure 17: Trend in all age death rates for circulatory disease by deprivation quintile, 21-3 to 29/11 Mortality from Circulatory Disease, all ages, 21-211 by Deprivation Quintile within Buckinghamshire County 3 25 2 15 1 5 21-3 22-4 23-5 24-6 25-7 26-8 27-9 28-1 29-11 Year DQ1 DQ5 Buckinghamshire County England Source: ONS Annual Deaths Extract; ONS Small Area Population Estimates Mid 21 to Mid 21 LSOA Experimental Quinary Population Estimate; Deprivation Quintiles: IMD 21 Figure 18: Trend in premature death rates for circulatory disease by deprivation quintile, 21-3 to 29/11 Mortality from Circulatory Disease, under 75s, 21-211 by Deprivation Quintile within Buckinghamshire County 14 12 1 8 6 4 2 21-3 22-4 23-5 24-6 25-7 26-8 27-9 28-1 29-11 Year DQ1 DQ5 Buckinghamshire County England Source: ONS Annual Deaths Extract; ONS Small Area Population Estimates Mid 21 to Mid 21 LSOA Experimental Quinary Population Estimate; Deprivation Quintiles: IMD 21 16
DASR per 1, population Deaths from Cancer The death rate from cancer fell between 21-3 and 29-11 in Buckinghamshire, although reductions have been considerably less than those noted for circulatory disease. The all age death rate for Buckinghamshire fell by a tenth (1%) over this period and the premature death rate fell by 13%. The all age death rate in 29-11 was 36% higher in the most deprived quintile compared to the least deprived quintile (Figure 19). The premature death rate was 47% higher in the most deprived quintile compared to the least (Figure 2). The cancer section of the JSNA provides further information on needs and related services. Figure 19: Trend in all age death rates for cancer by deprivation quintile, 21-3 to 29/11 Mortality from All Cancers, all ages, 21-211 by Deprivation Quintile within Buckinghamshire County 25 2 15 1 5 21-3 22-4 23-5 24-6 25-7 26-8 27-9 28-1 29-11 Year DQ1 DQ5 Buckinghamshire County England Source: ONS Annual Deaths Extract; ONS Small Area Population Estimates (SAPE) Mid 21 to Mid 21 LSOA Experimental Quinary Population Estimate; Deprivation Quintiles: IMD 21 17
DASR per 1, population Figure 2: Trend in premature death rates for cancer by deprivation quintile, 21-3 to 29/11 Mortality from All Cancers, under 75s, 21-211 by Deprivation Quintile within Buckinghamshire County 14 12 1 8 6 4 2 21-3 22-4 23-5 24-6 25-7 26-8 27-9 28-1 29-11 Year DQ1 DQ5 Buckinghamshire County England Source: ONS Annual Deaths Extract; ONS Small Area Population Estimates (SAPE) Mid 21 to Mid 21 LSOA Experimental Quinary Population Estimate; Deprivation Quintiles: IMD 21 18