Annex C: data on the distribution, determinants and burden of non-communicable diseases in England
Updated 9 December 2021
Applies to England
© Crown copyright 2021
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1. Summary
This report is an annex to ‘Preventing illness and improving health for all: a review of the NHS Health Check programme and recommendations’. It summarises data published up until 30 June 2021 in order to describe the distribution, determinants and burden (mortality and morbidity) of non-communicable diseases and the underlying risk factors of smoking, body mass index, alcohol and physical activity, by age, sex, socio economic status and ethnicity. This data was considered as part of the NHS Health Check review process and used to inform review issue 2: the potential inclusion of physical or mental health conditions.
On 1 October 2021, responsibility for national oversight of the NHS Health Check programme and for publishing the findings of the review transitioned from Public Health England (PHE) to the Office for Health Improvement and Disparities (OHID).
The main findings considered were:
- in 2017 the most common cause of death in males in England was heart disease (13.6%), in females it was dementia and Alzheimer’s disease (16.6%) [footnote 1]. These were the top 2 causes of death for both sexes [footnote 1]
- between 2014 and 2016, as a cause of death, heart disease was the biggest contributor (1.49 years) to the difference in male life expectancy between the most and least affluent, followed by lung cancer (0.93 years) and chronic lower respiratory diseases (0.92 years) [footnote 2]
- between 2014 and 2016, as a cause of death among the most deprived females, chronic lower respiratory disease was the biggest contributor (1.04 years) to the difference in life expectancy, followed by lung cancer (0.86 years) and heart disease (0.82 years) [footnote 2]
- in 2020 it was estimated that 6.4 million people in England were living with cardiovascular conditions (self-reported or doctor-diagnosed heart attack, angina, heart murmur, abnormal heart rhythm or stroke) [footnote 3]
- between 2015 and 2017 people from the most deprived decile were nearly 4 times more likely to die prematurely from cardiovascular disease (CVD), and more than twice as likely to die from cancer than the least deprived [footnote 2]
- in 2017 musculoskeletal disorders were a leading cause of morbidity among adults in England, accounting for 20.3% of years lived with disability (YLD) in people over 15 years old [footnote 4]
- in 2017 mental health disorders were the second highest broad cause of morbidity among adults in England, accounting for 10.1% of YLD in people over 15 years old [footnote 4]
- in 2020 self-reported morbidity from non-communicable disease varied between ethnicities, with high blood pressure the most common among any Black, Black African, Black Caribbean ethnic groups, and any Asian ethnic groups [footnote 5]
- in 2017 the top 3 risk factors for YLD were high body mass index, smoking and high fasting plasma glucose. These were unevenly distributed across England, by age, sex, socio economic status, and ethnicity [footnote 6]
2. Background
NHS Health Checks are an important component of locally led public health prevention services. They are offered to people without pre-existing disease aged between 40 and 74, free of charge, every 5 years. The results are used to raise awareness and support individuals to make behaviour changes and, where appropriate, access clinical management to help them reduce their risk of a heart attack, diabetes, stroke, respiratory disease and some forms of dementia and cancer in the next 10 years.
The government’s prevention green paper ‘Advancing our Health: Prevention in the 2020s’ [footnote 7] recognised that the NHS Health Check programme, originally introduced in April 2009, has achieved a lot and continues to do so. A national evaluation of the programme estimates that at current statin prescribing levels, over 5 years, 2,500 people will have avoided a major cardiovascular event, such as heart attack or stroke [footnote 8].
In their current form, checks also underpin important ‘NHS Long Term Plan’ [footnote 9] commitments to prevent 150,000 heart attacks, strokes and cases of dementia, and are the major conduit for recruitment to the Diabetes Prevention Programme.
However, the green paper also recognised significant variation in uptake and follow-up of health risks identified by the programme, along with the potential that people could benefit from a more tailored service or a particular focus at pivotal changes in the life course. The government therefore announced its intention, building on the gains made over the past 10 years, to consider whether changes to the NHS Health Check programme could help it deliver even greater benefits.
To achieve this, the Department of Health and Social Care (DHSC) commissioned PHE to undertake an evidence-based review of how NHS Health Checks can evolve in the next decade to maximise the future benefits of the programme. Professor John Deanfield, was appointed to chair the PHE review of the programme.
On 1 October 2021, responsibility for national oversight of the NHS Health Check programme and for publishing the findings of the review transitioned from PHE to the Office for Health Improvement and Disparities (OHID).
This report is an annex to ‘Preventing illness and improving health for all: a review of the NHS Health Check programme and recommendations’. It summarises data published up until 30 June 2021 in order to describe the distribution, determinants and burden (mortality and morbidity) of non-communicable diseases and the underlying risk factors of smoking, body mass index, alcohol and physical activity, by age, sex, socio economic status and ethnicity. This data was considered as part of the NHS Health Check review process and used to inform review issue 2: the potential inclusion of physical or mental health conditions.
3. Method
Existing sources of data, published up until the 30 June 2021, on non-communicable disease in adults (over 15 years) in England were used. Where multiple sources of data existed, the most current published data with the largest sample sizes were used to describe the following health outcomes: mortality (death), life expectancy (estimated years before death, from birth), morbidity (years lived with disability), and healthy life expectancy (estimated years of life at birth, without morbidity).
The prevalence of the top 20 causes of these health outcomes were identified, from which the top 5 or significantly prevalent conditions were explored in more detail. Specific risks factors were selected based upon their prevalence across England and their relevance for the existing NHS Health Check programme.
Where possible, socio economic status was explored either by deprivation deciles or National Statistics Socio-economic (NS-SEC) groups. This depended on the format used by the selected data.
Ethnicity data is also presented, where available, and grouped using the structure applied by the original data source. This ranges between using 18 distinct ethnic groups, to 3 limited groupings of: any White; Pakistani, Indian, Bangladeshi, other Asian; or Black African, Black Caribbean, other Black.
Although data by age, sex, ethnicity and socio-economic status was sought, its availability was very limited. Furthermore, some data sources had not been updated since the start of the coronavirus (COVID-19) pandemic, while those that were updated in 2020 are likely to have been impacted by the COVID-19 pandemic.
4. Life expectancy
From 2016 to 2018 life expectancy at birth was an estimated 79.6 years for males and 83.2 years for females in England [footnote 10].
Between 2017 and 2019 life expectancy for:
- males was 83.5 years for the least deprived decile and 74.1 years for the most deprived decile [footnote 12]
- females was 86.4 years for the least deprived decile and 78.7 years for the most deprived decile [footnote 12]
The variation in estimated life expectancy at birth with deprivation can be understood in more detail by examining the conditions shortening people’s lives. Figure 1 illustrates the contribution to the difference in life expectancy between the most deprived (decile 1) and least deprived (decile 10) by the cause of death in England. It shows that between 2014 and 2016 among the most deprived:
- males, heart disease was the biggest contributor (1.49 years) to the difference in life expectancy, followed by lung cancer and chronic lower respiratory diseases [footnote 2]
- females, chronic lower respiratory disease was the biggest (1.04 years) contributor to the difference in life expectancy, followed by lung cancer (0.86 years) and heart disease (0.82 years) [footnote 2]
Figure 1: contribution to the difference in life expectancy at birth between the most (decile 1) and least deprived (decile 10) by causes of death, by sex, in England, 2014 to 2016 [footnote 2]
| Cause of death | Male | Female |
|---|---|---|
| Heart disease | 1.49 | 0.82 |
| Dementia and Alzheimer’s disease | 0.32 | 0.45 |
| Lung cancer | 0.93 | 0.86 |
| Chronic lower respiratory diseases | 0.92 | 1.04 |
| Stroke | 0.36 | 0.34 |
| Prostate (male) or breast cancer (female) | 0.04 | 0.08 |
| Colorectal cancer | 0.12 | 0.07 |
| Leukaemia and lymphomas | 0.05 | 0.04 |
| Cirrhosis and other liver disease | 0.57 | No data |
| Urinary disease | No data | 0.13 |
5. Healthy life expectancy
While poor health can lead to an earlier death, it also impacts people’s quality of life. This can be explored through healthy life expectancy. Between 2017 and 2019 healthy life expectancy at birth in England was an estimated 63.2 years for males and 63.5 years for females [footnote 11].
Figure 2 combines a bar graph and line graph. The x-axis shows the deprivation decile and for each decile (1 to 10) data is presented separately for males and females. The bars represent the proportion of life in good health and the line illustrates the healthy life expectancy.
The graph shows that healthy life expectancy and the proportion of life in good health from birth varies significantly in England by level of deprivation. More specifically, the graph shows that from 2017 to 2019:
- healthy life expectancy decreased as deprivation increased in males and females [footnote 12]
- healthy life expectancy among the least deprived decile was more than a third higher compared to the most deprived decile, accounting for a difference of 18.4 years for males and 19.8 years for females [footnote 12]
- among males and females, compared to the least deprived the most deprived spent a smaller portion of their life in good health, dropping from 85% to 71% among males and from 82% to 65% among females [footnote 12]
Figure 2: healthy life expectancy and proportion in good health (%) at birth by national decile of area deprivation in England, 2017 to 2019 [footnote 12]
| Decile | Healthy life expectancy: male | Healthy life expectancy: female | Proportion of life in good health: male (%) | Proportion of life in good health: female (%) |
|---|---|---|---|---|
| 1 | 52.26 | 51.4 | 70.6% | 65.3% |
| 2 | 55.74 | 56.1 | 73.1% | 69.6% |
| 3 | 58.21 | 59.2 | 74.8% | 72.3% |
| 4 | 61.71 | 61.9 | 78.2% | 74.9% |
| 5 | 63.87 | 64.5 | 79.8% | 77.3% |
| 6 | 64.51 | 64.9 | 79.9% | 77.2% |
| 7 | 66.34 | 67.0 | 81.6% | 79.3% |
| 8 | 66.9 | 67.4 | 81.7% | 79.4% |
| 9 | 68.84 | 68.2 | 83.6% | 79.9% |
| 10 | 70.69 | 71.2 | 84.7% | 82.3% |
6. The burden of non-communicable disease
Non-communicable diseases (NCD) are diseases that cannot be directly transmitted between people. They can often be chronic diseases that affect people for the rest of their lives.
NCDs are a significant cause of death, playing a large role in the burden of mortality across the population. In 2019, 88.8% of deaths in England were attributable to NCDs [footnote 4].
6.1 Mortality
Figure 3 and Figure 4 show the leading causes of death in 2017 for males and females, respectively. The first column of each table divides the gender by age. The following columns indicate the first, second, third, fourth and fifth largest causes of death for each age group. Each cell also indicates the broad category each cause of death sits in: external causes, cancer, circulatory, respiratory and other.
The data for 2017, represented in Figure 3 and Figure 4, shows that:
- the most common cause of death in males in England was heart disease (13.6%); in females it was dementia and Alzheimer’s disease (16.6%) [footnote 1] – these were the top 2 causes of death for both sexes [footnote 1]
- across both sexes, heart disease, cancers and respiratory diseases were the leading causes of mortality in people between 50 and 79 years of age (figures 4 and 5); stroke is among the 5 most common causes of mortality for the over 65s, and dementia and Alzheimer’s disease the leading cause of death for the over 80s (see figures 3 and 4) [footnote 1]
- among the younger adult population, suicide is the leading causes of mortality in females aged 20 to 34 and males aged 20 to 49 (see figures 3 and 4) [footnote 1]
- for the majority of working age adults (20 to 64), liver disease was among the 5 most common causes of death in both sexes (see figures 3 and 4) [footnote 1]
Figure 3: leading causes of death by age group for males in England, 2017 [footnote 1]
| Age | First | Second | Third | Fourth | Fifth |
|---|---|---|---|---|---|
| 20 to 34 | Suicide and injury or poisoning of undetermined intent (external) | Accidental poisoning (external) | Transport accidents (external) | Homicide (external) | Cirrhosis and other diseases of liver (other) |
| 35 to 49 | Suicide and injury or poisoning of undetermined intent (external) | Accidental poisoning (external) | Heart disease (circulatory) | Cirrhosis and other diseases of liver (other) | Stroke (circulatory) |
| 50 to 64 | Heart disease (circulatory) | Lung cancer (cancer) | Cirrhosis and other diseases of liver (other) | Chronic lower respiratory diseases (respiratory) | Colorectal and anal cancer (cancer) |
| 65 to 79 | Heart disease (circulatory) | Lung cancer (cancer) | Chronic lower respiratory diseases (respiratory) | Stroke (circulatory) | Dementia and Alzheimer’s disease (other) |
| 80+ | Dementia and Alzheimer’s disease (other) | Heart disease (circulatory) | Influenza and pneumonia (respiratory) | Stroke (circulatory) | Chronic lower respiratory diseases (respiratory) |
Figure 4: leading causes of death by age group for females in England, 2017 [footnote 1]
| Age | First | Second | Third | Fourth | Fifth |
|---|---|---|---|---|---|
| 20 to 34 | Suicide and injury or poisoning of undetermined intent (external) | Accidental poisoning (external) | Cirrhosis and other diseases of liver (other) | Breast cancer (cancer) | Transport accidents (external) |
| 35 to 49 | Breast cancer (cancer) | Cirrhosis and other diseases of liver (other) | Accidental poisoning (external) | Suicide and injury or poisoning of undermined intent (external) | Colorectal and anal cancer (cancer) |
| 50 to 64 | Breast cancer (cancer) | Lung cancer (cancer) | Heart disease (circulatory) | Chronic lower respiratory diseases (respiratory) | Cirrhosis and other diseases of liver (other) |
| 65 to 79 | Lung cancer (cancer) | Chronic lower respiratory diseases (respiratory) | Heart disease (circulatory) | Dementia and Alzheimer’s disease (other) | Stroke (circulatory) |
| 80+ | Dementia and Alzheimer’s disease (other) | Heart disease (circulatory) | Stroke (circulatory) | Influenza and pneumonia (respiratory) | Chronic lower respiratory diseases (respiratory) |
6.2 Morbidity
Morbidity can be understood as the impact of a disease or medical condition on a person’s quality of life. Years lived with disability (YLD) is a measure of morbidity that combines the prevalence of each disease with a rating of the severity of its symptoms to give an overall measure of the loss of quality of life. In 2017:
-
low back pain represented the largest burden, accounting for 1,339 YLD per 100,000 population (age-standardised) for male and 1,540 YLD for female. Overall, musculoskeletal disorders increased with age from 774 YLD per 100,000 in persons 15 to 19 years old reaching the highest rate of 5,6512 YLD in those aged 70 to 74 [footnote 6]
-
depressive disorders accounted for the third highest burden with 501 YLD in male per 100,000 population and 744 YLD per 100,000 in female. Overall, mental disorder morbidity increased with age in younger adults, peaking at 35 to 39 years, where they accounted for 2,567 YLD per 100,000 population [footnote 6]
-
Alzheimer’s disease and other dementias accounted for 1,147 YLD per 100,000 for male aged 70 or over. Overall neurological disorders burden increased with age to 1,500 YLD per 100,000 in people reaching the age of 40; rates increased again in population aged over 74 to reach 6,000 YLD per 100,000 in those aged 95 or more [footnote 6]. Age-related and other hearing loss represented the second largest burden for male (2,324 YLD per 100,000) and female (2,271 YLD per 100,000) aged 70 and over. Age-related and other hearing loss was ranked in the top 5 leading causes of morbidity for males over the age of 50 and females over the age of 70 [footnote 6]; it also ranked higher as the cause of death or injury among males (rank ninth) than females (rank 14th). Overall, sense organ diseases burden increased with age reaching 4,023 YLD per 100,000 in persons aged 80 to 84 and 6,600 YLD in those aged 90 to 94 [footnote 6]
-
Among males over the age of 50 diabetes ranked in the top 3 causes of morbidity and in the top 5 causes for females aged 70 and over [footnote 6]
Figure 5 shows the age-standardised morbidity rate for the top 15, level 3 leading causes of morbidity in males aged 15 or more in 1990 compared to 2017. The graph shows that low back pain, headache disorders and depressive disorders were the top 3 ranking causes of age-standardised morbidity. Compared to 1990, age-standardised morbidity rates from diabetes, falls and drug use disorders among males were higher.
Figure 5: age-standardised leading causes of morbidity (level 3 disease group), for males aged over 15, England, 1990 and 2017 [footnote 6]
| Cause of death or injury | 1990 | 2017 |
|---|---|---|
| Low back pain | 1,314 | 1,339 |
| Headache disorders | 567 | 565 |
| Depressive disorders | 539 | 501 |
| Falls | 367 | 435 |
| Diabetes mellitus | 239 | 430 |
| Drug use disorders | 319 | 416 |
| Neck pain | 348 | 412 |
| Neonatal disorders | 315 | 365 |
| Age-related and other hearing loss | 326 | 338 |
| Asthma | 391 | 308 |
| Anxiety disorders | 294 | 295 |
| Dermatitis | 283 | 280 |
| Chronic obstructive pulmonary disease | 283 | 274 |
| Other musculoskeletal disorders | 256 | 232 |
| Alcohol use disorders | 181 | 222 |
Figure 6 shows the age-standardised morbidity rate for the top 15, level 3 leading causes of morbidity in females aged 15 or more in 1990 compared to 2017. The graph shows that low back pain, headache disorders and depressive disorders were the top 3 ranking causes of age-standardised morbidity. Compared to 1990, age-standardised morbidity rates from lower back pain, neck pain and chronic obstructive pulmonary disease among females were higher.
Figure 6: age-standardised leading causes of morbidity (level 3 disease group), for females aged over 15, England, 1990 and 2017 [footnote 6]
| Cause of death or injury | 1990 | 2017 |
|---|---|---|
| Low back pain | 1,360 | 1,540 |
| Headache disorders | 1116 | 1112 |
| Depressive disorders | 786 | 744 |
| Neck pain | 478 | 564 |
| Anxiety disorders | 494 | 496 |
| Falls | 318 | 371 |
| Dermatitis | 361 | 360 |
| Diabetes mellitus | 200 | 356 |
| Gynaecological diseases | 350 | 353 |
| Asthma | 417 | 351 |
| Neonatal disorders | 307 | 349 |
| Chronic obstructive pulmonary disease | 309 | 332 |
| Other musculoskeletal disorders | 317 | 310 |
| Age-related and other hearing loss | 284 | 292 |
| Oral disorders | 335 | 269 |
Across England in 2020:
- diabetes was more commonly self-reported by people from any Asian or any Black, Black African, Black Caribbean ethnic group than people from other ethnic groups[footnote 5] – this was highest within Bangladeshi (14.6%) and Black Caribbean (13.6%) ethnic groups [footnote 5]
- high blood pressure was more commonly self-reported by people from Black, Black African, and Black Caribbean ethnic groups compared to any people from other broad ethnic groupings [footnote 5] – this was higher for certain ethnic groups, with 27.4% of those from Black Caribbean groups. 21.6% of those from Irish and gypsy or Irish traveller groups had high blood pressure [footnote 5]
- gypsy or Irish travellers more commonly self-reported experiencing a mental health condition than other ethnic groups [footnote 5]
6.3 Risk factors behind the burden of NCD morbidity
The Global Burden of Disease study provides information on how far the burden of morbidity, as measured with YLD, is attributable to different risk factors for ill-health [footnote 4]. This allows the identification of the common risk factors driving many conditions, as the underlying causes of morbidity.
Figure 7 uses a bar chart to show the rate of years lived with disability per 100,000 people for the top 20 risk factors in 1990 compared to 2017. The risk factors have been categorised using the following abbreviations in brackets: (B) stands for behavioural, (E) stands for environmental and (M) stands for metabolic.
The figure shows that, across all ages in England:
- in 2017 the top 3 risk factors for YLD were high body mass index (M), smoking (B) and high fasting plasma glucose (M) [footnote 6]
- from 1990 to 2017, while remaining among the major contributors to the existing burden of NCD morbidity, smoking (B), high blood pressure (M), and high cholesterol (M) showed considerable reductions; YLD arising from body mass index (M), high fasting plasma glucose (M), alcohol (B) and drug use (B) went up [footnote 6]
Figure 7: morbidity rate (YLD per 100,000) attributed to top 20 behavioural (B), environmental (E) and metabolic (M) risk factors, England, 1990 and 2017 [footnote 6]
| Risk factor | 1990 | 2017 |
|---|---|---|
| High body mass index (M) | 422.9 | 622.2 |
| Smoking (B) | 778.9 | 508.2 |
| High fasting plasma glucose (M) | 302.0 | 489.7 |
| Drug use (B) | 240.7 | 313.9 |
| Alcohol use (B) | 250.8 | 285.4 |
| Occupational ergonomic factors (E) | 219.3 | 260.7 |
| High systolic blood pressure (M) | 300.9 | 183.4 |
| Short gestation for birth weight (B) | 135.4 | 153.4 |
| Low birth weight for gestation (B) | 135.4 | 153.4 |
| Diet low in whole grains (B) | 106.0 | 131.8 |
| Iron deficiency (B) | 214.0 | 129.6 |
| Ambient particulate matter pollution (E) | 101.7 | 126.3 |
| Impaired kidney function (M) | 87.1 | 75.8 |
| Low bone mineral density (M) | 65.2 | 75.5 |
| Diet low in fruits (B) | 57.3 | 67.1 |
| High LDL cholesterol (M) | 86.1 | 54.7 |
| Diet low in nuts and seeds (B) | 43.2 | 52.3 |
| Secondhand smoke (B) | 44.6 | 43.5 |
| Childhood sexual abuse (B) | 42.2 | 42.9 |
| Occupational noise (E) | 34.0 | 35.9 |
7. The current burden of CVD
CVD remains one of the most significant drivers of mortality and population morbidity. In 2020 an estimated 6.4 million people in England were living with cardiovascular conditions (self-report of doctor-diagnosed heart attack, angina, heart murmur, abnormal heart rhythm or stroke) [footnote 3]. In 2019, CVD accounted for almost 1 in 4 (24%) deaths in England across all ages [footnote 13].
Diseases of the circulatory system are a significant driver of mortality among males and females, accounting for 26.4% of deaths in males and 23.1% in females over 40 in England [footnote 13].
Figure 8 shows the deaths caused by diseases of the circulatory system by sex in England. The data is presented in 10-year age groups, starting with 40 to 49. Bars are used to illustrate the number of deaths and a line graph denotes the percentage of deaths caused by diseases of the circulatory system. The graph shows that while the proportion of deaths in 2019 was higher among males in younger age groups, the impact of CVD on mortality across the sexes converged with age. The peak absolute number of deaths occurred for males and females in their 80s [footnote 13].
Figure 8: deaths caused by diseases of the circulatory system by sex in England, 2019 [footnote 13]
| Age range | Male deaths number | Female deaths number | Male deaths (%) | Female deaths (%) |
|---|---|---|---|---|
| 40 to 49 | 1,651 | 645 | 22.5% | 13.6% |
| 50 to 59 | 4,746 | 1,769 | 27.4% | 15.3% |
| 60 to 69 | 8,503 | 3,908 | 26.4% | 17.7% |
| 70 to 79 | 16,253 | 9,850 | 26.1% | 20.5% |
| 80 to 89 | 22,246 | 21,912 | 26.6% | 25.1% |
| 90+ | 9,907 | 18,279 | 26.7% | 26.0% |
Diseases of the circulatory system are defined as acute rheumatic fever, chronic rheumatic heart diseases, hypertensive diseases, ischaemic heart diseases, other heart diseases, cerebrovascular diseases, diseases of arteries, arterioles and capillaries, diseases of veins lymphatic vessels and lymph nodes not elsewhere classified, other and unspecified disorders of the circulatory system.
Figure 9 shows the regional variations in age-standardised mortality rates per 100,000 population caused by diseases of the circulatory system in 2019. The highest rates were in Yorkshire and the Humber and the lowest in the South East of England [footnote 14].
Figure 9: all age age-standardised mortality rates, per 100,000 population caused by diseases of the circulatory system by region in England, 2019 [footnote 14]
| Region | Age-standardised mortality rate per 100,000 |
|---|---|
| North East | 241.86 |
| North West | 245.39 |
| Yorkshire and The Humber | 246.55 |
| East Midlands | 232.41 |
| West Midlands | 229.64 |
| East | 210.47 |
| London | 211.44 |
| South East | 204.29 |
| South West | 208.97 |
For males in 2014 to 2016, heart disease accounted for 16% of the life expectancy gap between the most and least deprived deciles. For females, heart disease accounted for 11% of the gap [footnote 2].
In 2015 to 2017:
- people living in the most deprived areas were almost 4 times more likely to die prematurely from CVD than the least deprived [footnote 2]
- the most deprived were more than twice as likely to die prematurely from CVD than those living in average levels of deprivation (fifth and sixth population deciles) [footnote 2]
8. Conclusion
The burden of non-communicable diseases reduces both the life expectancy and healthy life expectancy of adults across England, disproportionally affecting people by age, gender, ethnicity and socio-economic status. This is driven in part by the high and unequal prevalence of morbidity and underlying risk factors among the population.
In 2017 heart disease remained one of the leading causes of death and is one of the top contributors to the difference in life expectancy between the most and least deprived. Inequality within CVD is high, with people from the most deprived communities 4 times as likely to die from CVD as those in the least deprived.
Musculoskeletal and mental health conditions, are leading causes of years lived with disability across England. While drug use disorders and hearing loss also place a significant burden on the nation’s health these conditions account for fewer years lived with disability.
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