Geographic inequalities in premature mortality

Key points

There are significant differences in how likely people are to die early (before the age of 75) between different parts of England and Wales. After accounting for age and sex, people are almost twice as likely to die early in the 10% of local authority areas with the highest rates of premature mortality as those in the 10% of local authority areas with the lowest rates.

Premature mortality rates are highest in local authorities in the North East, the North West and Yorkshire and the Humber, and lowest in London.

Our research explores why premature mortality is more common in some areas than others. We look at the role of socioeconomic factors as well as ethnicity and being born outside the UK. We also look at how much inequality is left unexplained, pointing to other potential factors at play.

Our analysis finds:

Socioeconomic factors, ethnicity and being born outside the UK account for 61% of the variation in premature mortality rates. On their own, ethnicity and being born outside the UK account for 7% of the variation.

This means socioeconomic factors (highest qualification achieved, occupation and area-level deprivation) play a major role in geographic inequalities in premature mortality rates.

The remainder – almost 40% – is unexplained by the factors we looked at, but could result from differences in environmental exposures, other socioeconomic factors and building blocks of health (such as social connection) and access to quality health and care services.

The analysis also looks at four of the leading causes of death – cancer, cardiovascular disease, diabetes and respiratory conditions. The gap in premature mortality rates is widest for deaths associated with diabetes and deaths due to respiratory conditions.

Addressing the scale of health inequalities will require long-term action for economic recovery in areas with longstanding industrial decline; a strong focus on prevention; investment in public health services; and action to address risk factors, such as smoking, alcohol and poor diet. These actions should be brought together in a clear strategy for tackling health inequalities.

Our analysis also shows that the impact of accounting for ethnicity, being born outside the UK and socioeconomic factors on premature mortality rates differs across local authorities. For example, in Blackpool, these factors almost entirely explain its higher premature mortality rate. This points to the urgent need for action to address the socioeconomic factors behind this. However, in Wrexham, these factors do not entirely explain higher premature mortality rates, highlighting the need for further understanding of other drivers of these disparities.