19. Deaths attributable to lifestyle factors

Transcription

1 Deaths attributable to lifestyle factors 19.1/19.2 Smoking and alcohol attributable SMRs (Attributable fractions of a selected list 79; 80 of ICD codes) Introductory sections of this report describe how wider determinants of health, such as lifestyle choices over whether to smoke, what to eat, how much to drink, and whether to exercise, impact on levels of individual health. At a locality level, such determinants can result in inequalities in health, health outcomes, and access to care based on levels of need, across whole communities. Higher levels of smoking, and alcohol consumption, in particular, impact on health, and many diagnostic causes of morbidity and mortality can be attributed to these risk factors. Maps 19.1 and 19.2 demonstrate regional variations in age standardised mortality ratios (regional average of 100), for deaths that can be attributed to smoking and alcohol (for residents aged under 75). For this analysis, cause-specific attributable fractions relating to alcohol have been taken from the national Alcohol Harm Reduction Strategy 81. While counterpart cause specific attributable fractions relating to smoking have been taken from the SAMMEC model, produced by the CDC (Atlanta, USA) 82. Data are summarised at the MSOA level of geography. Higher than average SMRs are observed within urban (typically more deprived) localities, particularly in Manchester and Liverpool, though spreading outwards from these conurbation centres across the region. In addition, the maps show similar geographic distributions to those already described for lung cancer, as well as, for example, coronary heart disease, where smoking and alcohol are closely related to death rates. One variation between the maps is for Blackpool, where the ratio for alcohol related deaths is the highest in the North West. The North West Local Authorities with the highest smoking attributable standardised mortality ratios (for under 75s) are Manchester (140), Liverpool (131) and Knowsley (127); the lowest are Macclesfield (64), South Lakeland (65) and Eden (65). Thus, a Manchester resident is 40% more likely to die as a result of smoking, than is the average North West resident. The North West Local Authorities with the highest alcohol attributable standardised mortality ratios (for under 75s) are Blackpool (159), Manchester (142) and Liverpool (131); the lowest are South Lakeland (65), Ribble Valley (67) and Eden (67). Thus, a Blackpool resident is 59% more likely to die as a result of alcohol than is the average North West resident. Just as for all-cause mortality, we have shown figures of smoking and alcohol attributable mortality in the form of directly standardised rates per 100,000 persons, using the European Standard Population. Figures 19.1a and 19.1b demonstrate marked differences in death rates attributable to smoking by deprivation and lifestyle group; the under 75 rate for those from the most deprived quintile of population being, three times the rate for the most affluent quintile of population within the region (137 compared to 47). This degree of relationship is also apparent by geodemographic grouping; with persons in the Urban Challenge lifestyle areas being three and a half times more likely to die from a smoking attributable cause than those in the Mature Oaks areas. Smoking attributable death rates in New Starters areas are slightly higher than would be expected from their trend rate of income deprivation, while counterpart rates in Multicultural Centres are slightly lower. Figure 19.1c shows that smoking attributable death rates are high in predominantly Black areas. Smoking attributable mortality for urban residents is about one and a half times those for rural residents (Figure 19.1d), with the lowest rates in villages, hamlets and isolated settlements. Figures 19.2a and 19.2b demonstrate the counterpart differences in death rates attributable to alcohol by deprivation and lifestyle group; the under 75 rate for those from the most deprived quintile of population, being over three times the rate for the most affluent quintile of population within the region (49 compared to 16), a marginally stronger relationship than is found for smoking related mortality. This stronger relationship is also apparent by geodemographic grouping; with persons in the Urban Challenge lifestyle areas being five times more likely to die from an alcohol attributable cause than those in the Mature Oaks areas. The rate in the Urban Challenge areas is higher than would be expected from their trend rate of income deprivation and a similar (but even more marked) blip is observed in the New Starters lifestyle areas, (for example, as found within Manchester, Lancaster, Preston and Liverpool). Alcohol-attributable deaths amongst these groups contribute a substantial part of the gap between North West regional and national life expectancy estimates. Figure 19.2c shows that alcohol attributable death rates are high in predominantly Black areas. Alcohol attributable mortality for urban residents is about one and a quarter times those for rural residents (Figure 19.2d), with the lowest rates in villages, hamlets and isolated settlements.

2 166 Figure 19.1: Mortality Attributable to Smoking (SAMMEC attribution factors) mortality of North West residents under 75: ONS A B C D Key: Category North West

3 167 Map 19.1: Mortality Attributable to Smoking (SAMMEC attribution factors) mortality of North West residents under 75: ONS

4 168 Figure 19.2: Mortality Attributable to Alcohol (Alcohol Harm Reduction Strategy attribution factors) mortality of North West residents under 75: ONS A B C D Key: Category North West

5 169 Map 19.2: Mortality Attributable to Alcohol mortality of North West residents under 75: ONS