Trends in disease incidence and survival and their effect on mortality in Scotland: nationwide cohort study of linked hospital admission and death records 2001–2016
Objectives Identify causes and future trends underpinning Scottish mortality improvements and quantify the relative contributions of disease incidence and survival.Design Population-based study.Setting Linked secondary care and mortality records across Scotland.Participants 1 967 130 individuals bor...
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BMJ Publishing Group
2020-03-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/3/e034299.full |
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| author | Jon Minton Harry Campbell Paul R H J Timmers Joannes J Kerssens Ian Grant James F Wilson Colin M Fischbacher Peter K Joshi |
| author_facet | Jon Minton Harry Campbell Paul R H J Timmers Joannes J Kerssens Ian Grant James F Wilson Colin M Fischbacher Peter K Joshi |
| author_sort | Jon Minton |
| collection | DOAJ |
| description | Objectives Identify causes and future trends underpinning Scottish mortality improvements and quantify the relative contributions of disease incidence and survival.Design Population-based study.Setting Linked secondary care and mortality records across Scotland.Participants 1 967 130 individuals born between 1905 and 1965 and resident in Scotland from 2001 to 2016.Main outcome measures Hospital admission rates and survival within 5 years postadmission for 28 diseases, stratified by sex and socioeconomic status.Results ‘Influenza and pneumonia’, ‘Symptoms and signs involving circulatory and respiratory systems’ and ‘Malignant neoplasm of respiratory and intrathoracic organs’ were the hospital diagnosis groupings associated with most excess deaths, being both common and linked to high postadmission mortality. Using disease trends, we modelled a mean mortality HR of 0.737 (95% CI 0.730 to 0.745) from one decade of birth to the next, equivalent to a life extension of ~3 years per decade. This improvement was 61% (30%–93%) accounted for by improved disease survival after hospitalisation (principally cancer) with the remainder accounted for by lowered hospitalisation incidence (principally heart disease and cancer). In contrast, deteriorations in infectious disease incidence and survival increased mortality by 9% (~3.3 months per decade). Disease-driven mortality improvements were slightly greater for men than women (due to greater falls in disease incidence), and generally similar across socioeconomic deciles. We project mortality improvements will continue over the next decade but slow by 21% because much progress in disease survival has already been achieved.Conclusion Morbidity improvements broadly explain observed mortality improvements, with progress on prevention and treatment of heart disease and cancer contributing the most. The male–female health gaps are closing, but those between socioeconomic groups are not. Slowing improvements in morbidity may explain recent stalling in improvements of UK period life expectancies. However, these could be offset if we accelerate improvements in the diseases accounting for most deaths and counteract recent deteriorations in infectious disease. |
| format | Article |
| id | doaj-art-783022ed77ec40cfa09967fd4004aa2e |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-783022ed77ec40cfa09967fd4004aa2e2024-12-06T03:20:07ZengBMJ Publishing GroupBMJ Open2044-60552020-03-0110310.1136/bmjopen-2019-034299Trends in disease incidence and survival and their effect on mortality in Scotland: nationwide cohort study of linked hospital admission and death records 2001–2016Jon Minton0Harry Campbell1Paul R H J Timmers2Joannes J Kerssens3Ian Grant4James F Wilson5Colin M Fischbacher6Peter K Joshi7Place and Wellbeing Directorate, Public Health Scotland, Glasgow, UKCentre for Global Health Research, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UKCentre for Global Health Research, The University of Edinburgh Usher Institute, Edinburgh, UKInformation Services Division, NHS National Services Scotland, Edinburgh, UKPublic Health Scotland, Edinburgh, UKCentre for Global Health Research, The University of Edinburgh Usher Institute, Edinburgh, UKInformation Services Division, NHS National Services Scotland, Edinburgh, UKCentre for Global Health Research, The University of Edinburgh Usher Institute, Edinburgh, UKObjectives Identify causes and future trends underpinning Scottish mortality improvements and quantify the relative contributions of disease incidence and survival.Design Population-based study.Setting Linked secondary care and mortality records across Scotland.Participants 1 967 130 individuals born between 1905 and 1965 and resident in Scotland from 2001 to 2016.Main outcome measures Hospital admission rates and survival within 5 years postadmission for 28 diseases, stratified by sex and socioeconomic status.Results ‘Influenza and pneumonia’, ‘Symptoms and signs involving circulatory and respiratory systems’ and ‘Malignant neoplasm of respiratory and intrathoracic organs’ were the hospital diagnosis groupings associated with most excess deaths, being both common and linked to high postadmission mortality. Using disease trends, we modelled a mean mortality HR of 0.737 (95% CI 0.730 to 0.745) from one decade of birth to the next, equivalent to a life extension of ~3 years per decade. This improvement was 61% (30%–93%) accounted for by improved disease survival after hospitalisation (principally cancer) with the remainder accounted for by lowered hospitalisation incidence (principally heart disease and cancer). In contrast, deteriorations in infectious disease incidence and survival increased mortality by 9% (~3.3 months per decade). Disease-driven mortality improvements were slightly greater for men than women (due to greater falls in disease incidence), and generally similar across socioeconomic deciles. We project mortality improvements will continue over the next decade but slow by 21% because much progress in disease survival has already been achieved.Conclusion Morbidity improvements broadly explain observed mortality improvements, with progress on prevention and treatment of heart disease and cancer contributing the most. The male–female health gaps are closing, but those between socioeconomic groups are not. Slowing improvements in morbidity may explain recent stalling in improvements of UK period life expectancies. However, these could be offset if we accelerate improvements in the diseases accounting for most deaths and counteract recent deteriorations in infectious disease.https://bmjopen.bmj.com/content/10/3/e034299.full |
| spellingShingle | Jon Minton Harry Campbell Paul R H J Timmers Joannes J Kerssens Ian Grant James F Wilson Colin M Fischbacher Peter K Joshi Trends in disease incidence and survival and their effect on mortality in Scotland: nationwide cohort study of linked hospital admission and death records 2001–2016 BMJ Open |
| title | Trends in disease incidence and survival and their effect on mortality in Scotland: nationwide cohort study of linked hospital admission and death records 2001–2016 |
| title_full | Trends in disease incidence and survival and their effect on mortality in Scotland: nationwide cohort study of linked hospital admission and death records 2001–2016 |
| title_fullStr | Trends in disease incidence and survival and their effect on mortality in Scotland: nationwide cohort study of linked hospital admission and death records 2001–2016 |
| title_full_unstemmed | Trends in disease incidence and survival and their effect on mortality in Scotland: nationwide cohort study of linked hospital admission and death records 2001–2016 |
| title_short | Trends in disease incidence and survival and their effect on mortality in Scotland: nationwide cohort study of linked hospital admission and death records 2001–2016 |
| title_sort | trends in disease incidence and survival and their effect on mortality in scotland nationwide cohort study of linked hospital admission and death records 2001 2016 |
| url | https://bmjopen.bmj.com/content/10/3/e034299.full |
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