Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK; National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM), Manchester, UK.
Division of Psychology and Mental Health, University of Manchester, Manchester, UK; National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM), Manchester, UK.
Lancet. 2023 Nov;402 Suppl 1:S31. doi: 10.1016/S0140-6736(23)02124-4.
Deaths of Despair (DoD) are socially patterned causes of death encompassing drug and alcohol misuse and suicide. DoDs are strongly associated with socioeconomic disadvantage. England has high levels of inequalities, so we hypothesised the existence of marked geographical variations in DoD. We aimed to yield new knowledge on the spatial distribution of DoD, and area-level socioeconomic factors that predict DoD risk in England.
This observational study was conducted using ICD-10 coded deaths for 307 local authorities in England during 2019-21. Deaths were grouped to non-overlapping categories of drug-related death, alcohol-specific death, and suicide. The mean contributions of each of these causes to the total number of DoD in England were calculated with Poisson exact confidence intervals. Standardised mortality ratios (SMRs) for DoD were generated for each local authority population. A multivariable regression model for DoD risk was developed using 25 socioeconomic variables.
An estimated 46 200 people lost their lives due to DoD between Jan 1, 2019, and Dec 31, 2021. Regional SMRs ranged from 57·4 (SD 16·1) in London to 144·1 (SD 26·8) in the northeast of England (p<0·0001). Alcohol-specific deaths were the largest contributor of DoD, accounting for 44·1% of DoD (95% CI 43·5-44·8), followed by drug-related death (28·1%, 27·7-28·6) and suicide (27·7%, 27·2-28·2). Living in the North, living alone, White British ethnicity, lower inward migration, economic inactivity, income deprivation in older people, employment in elementary occupations, unemployment, and education deprivation in adults were significantly associated with higher DoD rates in England.
DoD in England are spatially patterned, with northern regions experiencing a considerably higher burden of mortality from these avoidable causes. A key limitation is ecological bias. This study provides novel insights into area-level risk factors for DoD in England.
National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM).
绝望死亡（DoD）是包含药物和酒精滥用及自杀在内的具有社会模式的死亡原因。DoD 与社会经济劣势密切相关。英国不平等程度很高，因此我们假设 DoD 在地理上存在明显的差异。我们旨在提供有关 DoD 的空间分布以及预测英格兰 DoD 风险的地区社会经济因素的新知识。
本观察性研究使用 2019 年至 2021 年英格兰 307 个地方当局的 ICD-10 编码死亡数据进行。将死亡分为药物相关死亡、特定于酒精的死亡和自杀等不重叠的类别。用泊松精确置信区间计算这些原因对英格兰总 DoD 死亡人数的平均贡献。为每个地方当局的人口生成了 DoD 的标准化死亡率（SMR）。使用 25 个社会经济变量开发了 DoD 风险的多变量回归模型。
在 2019 年 1 月 1 日至 2021 年 12 月 31 日期间，估计有 46200 人因 DoD 而丧生。区域 SMR 范围从伦敦的 57.4（SD 16.1）到英格兰东北部的 144.1（SD 26.8）（p<0.0001）。特定于酒精的死亡是 DoD 的最大贡献者，占 DoD 的 44.1%（95%CI 43.5-44.8），其次是药物相关死亡（28.1%，27.7-28.6）和自杀（27.7%，27.2-28.2）。生活在北部、独居、白种英国人种、较低的向内移民、经济不活跃、老年人收入贫困、从事初级职业、失业和成年人教育贫困与英格兰更高的 DoD 发生率显著相关。
英格兰的 DoD 存在空间模式，北部地区因这些可避免的原因而经历了更高的死亡率负担。一个关键的限制是生态偏差。本研究提供了有关英格兰 DoD 的地区危险因素的新见解。
国家卫生与保健研究所（NIHR）应用研究合作Greater Manchester（ARC-GM）。
