2002 年至 2019 年英格兰 6791 个社区的预期寿命和死亡率：民事登记数据的高分辨率时空分析。

BACKGROUND: High-resolution data for how mortality and longevity have changed in England, UK are scarce. We aimed to estimate trends from 2002 to 2019 in life expectancy and probabilities of death at different ages for all 6791 middle-layer super output areas (MSOAs) in England. METHODS: We performed a high-resolution spatiotemporal analysis of civil registration data from the UK Small Area Health Statistics Unit research database using de-identified data for all deaths in England from 2002 to 2019, with information on age, sex, and MSOA of residence, and population counts by age, sex, and MSOA. We used a Bayesian hierarchical model to obtain estimates of age-specific death rates by sharing information across age groups, MSOAs, and years. We used life table methods to calculate life expectancy at birth and probabilities of death in different ages by sex and MSOA. FINDINGS: In 2002-06 and 2006-10, all but a few (0-1%) MSOAs had a life expectancy increase for female and male sexes. In 2010-14, female life expectancy decreased in 351 (5·2%) of 6791 MSOAs. By 2014-19, the number of MSOAs with declining life expectancy was 1270 (18·7%) for women and 784 (11·5%) for men. The life expectancy increase from 2002 to 2019 was smaller in MSOAs where life expectancy had been lower in 2002 (mostly northern urban MSOAs), and larger in MSOAs where life expectancy had been higher in 2002 (mostly MSOAs in and around London). As a result of these trends, the gap between the first and 99th percentiles of MSOA life expectancy for women increased from 10·7 years (95% credible interval 10·4-10·9) in 2002 to reach 14·2 years (13·9-14·5) in 2019, and for men increased from 11·5 years (11·3-11·7) in 2002 to 13·6 years (13·4-13·9) in 2019. INTERPRETATION: In the decade before the COVID-19 pandemic, life expectancy declined in increasing numbers of communities in England. To ensure that this trend does not continue or worsen, there is a need for pro-equity economic and social policies, and greater investment in public health and health care throughout the entire country. FUNDING: Wellcome Trust, Imperial College London, Medical Research Council, Health Data Research UK, and National Institutes of Health Research.

背景：英国英格兰地区有关死亡率和预期寿命变化的高分辨率数据稀缺。本研究旨在估算 2002 年至 2019 年期间英格兰所有 6791 个中层超级输出区（MSOAs）的预期寿命和不同年龄死亡概率的趋势。

方法：我们使用英国小区域卫生统计单位研究数据库中的公民登记数据进行了高分辨率时空分析，使用了 2002 年至 2019 年期间英格兰所有死亡的去识别数据，数据包括年龄、性别和居住的 MSOA 以及按年龄、性别和 MSOA 划分的人口计数。我们使用贝叶斯分层模型通过在年龄组、MSOA 和年份之间共享信息来获得特定年龄死亡率的估计值。我们使用生命表方法计算了不同性别和 MSOA 下出生时的预期寿命和不同年龄的死亡概率。

结果：在 2002-06 年和 2006-10 年期间，除了少数（0-1%）MSOAs 外，女性和男性的预期寿命都有所增加。在 2010-14 年，女性预期寿命在 6791 个 MSOAs 中有 351 个（5.2%）下降。到 2014-19 年，女性预期寿命下降的 MSOAs 数量为 1270 个（18.7%），男性为 784 个（11.5%）。2002 年至 2019 年期间，预期寿命增长幅度较小的 MSOAs 是 2002 年预期寿命较低的北部城市 MSOAs，而 2002 年预期寿命较高的 MSOAs 增长幅度较大（主要是伦敦及其周边地区的 MSOAs）。由于这些趋势，女性 MSOA 预期寿命的第 1 个和第 99 个百分位数之间的差距从 2002 年的 10.7 年（95%可信区间 10.4-10.9）增加到 2019 年的 14.2 年（13.9-14.5），男性的差距从 2002 年的 11.5 年（11.3-11.7）增加到 2019 年的 13.6 年（13.4-13.9）。

解释：在 COVID-19 大流行之前的十年中，英格兰越来越多的社区的预期寿命下降。为了确保这种趋势不会继续或恶化，需要采取公平的经济和社会政策，并在全国范围内加大对公共卫生和医疗保健的投资。

资金：惠康信托基金会、伦敦帝国理工学院、医学研究理事会、英国健康数据研究署和美国国立卫生研究院。