Widening North-South gap blamed on poverty related deaths in younger adults

A major study of mortality across England attributes socioeconomic deprivation for sharp rises in deaths among 22 to 44-year-olds living in the North of England.

Led by Professor Evan Kontopantelis at the University of Manchester, with Keele University’s Professor Mamas Mamas and Professor Tim Doran at the University of York, the team found that deaths from accidents, alcohol and drug poisoning increased nationwide, but more quickly in the North, where deprivation tends to be greater and more widespread. Suicide among men, especially at ages 30-34, and cancer deaths among women were also important factors.

The authors of The Lancet Public Health paper, published today, say the data reveals a profoundly concerning gap in mortality between the North and the South, especially in men.

National cardiovascular death rates declined over the study period, though the North-South gap still persists.

Professor Mamas Mamas, Professor of Cardiology at Keele University, who co-authored the study explains:

“Despite national cardiovascular initiatives resulting in marked reductions in mortality rates from cardiovascular diseases over the past decade, our work shows important inequalities between the North and South, with a significant proportion of excess mortality in older patients due to cardiovascular disease.

“We need to understand whether this is due to a worse risk factor profile in the North, or relates to access to cardiac services, both of which need to be better targeted in order to reduce inequalities."
The research was funded by the Medical Research Council and the Wellcome Trust.

Previous research has shown that men between 25-44 living in the most deprived areas are five times more likely to die from alcohol-related diseases. And the risk for women is four times greater. Previous research has also found that unskilled men aged 25-39 are 10-20 times more likely to die from alcohol-related causes, compared to professionals.

Professor Kontopantelis, University of Manchester said:

“Sharp rises in deaths from accidents, suicide, alcohol misuse, smoking, cancer and drug addiction appear to have created new health divisions between England’s regions and are profoundly concerning. These causes of death are all strongly associated with socioeconomic deprivation.

“Alcohol for example, underpins the steep and sustained increase in liver cirrhosis deaths in Britain from the 1990s, when the North-South divide in mortality for those aged 25-44 started to emerge.”

It is widely known that mortality rates for cancer are higher in more deprived areas and have worse survival rates where smoking and alcohol abuse is more prevalent. And heroin and crack cocaine addiction and deaths from drug overdoses are also strongly associated with deprivation.

Mortality data for adults aged 25-44 were aggregated and compared between England’s five northernmost versus its five southernmost Government Office Regions, between 1981 and 2016.

It revealed that, although there was little difference between early deaths in the North and the South in the 1990s, by 2016 a gap had opened up nonetheless.

Over three years between 2014 and 2016, 3530 more men and 1881 more women aged between 25 and 44 died in the North than in the South, when population and age are taken into account.

Professor Kontopantelis added:

“The reasons for the divide are complex and reach back centuries, with extreme concentration of power, wealth and opportunity in the capital having a malign effect on the rest of the country. England’s centralist tradition has blighted successive generations, and without major structural change will continue to damage public health.

“Worse health outcomes in the North reflect higher average levels of deprivation, and the sex difference we find in the North-South mortality gap is plausibly related to greater susceptibility of men to those socioeconomic pressures.

“If these recent trends are not stopped, the national gains made from falling cardiovascular deaths will be overridden, and excess mortality in the North may exceed 50%.”