PMID- 33735693 OWN - NLM STAT- MEDLINE DCOM- 20210513 LR - 20210513 IS - 1476-5616 (Electronic) IS - 0033-3506 (Linking) VI - 193 DP - 2021 Apr TI - Life expectancy inequalities in Wales before COVID-19: an exploration of current contributions by age and cause of death and changes between 2002 and 2018. PG - 48-56 LID - S0033-3506(21)00047-0 [pii] LID - 10.1016/j.puhe.2021.01.025 [doi] AB - OBJECTIVES: The COVID-19 pandemic in Wales and the UK has highlighted significant and historic inequalities in health between social groups. To better understand the composition of these inequalities and inform planning after the pandemic, we undertook a decomposition of life expectancy inequalities between the most and least deprived quintiles for men and women by age and cause of death and explored trends between 2002 and 2018. STUDY DESIGN: Statistical decomposition of life expectancy inequalities by age and cause of death using routine population mortality datasets. METHODS: We used routine statistics from the Office for National Statistics for the period 2002-2018 on population and deaths in Wales stratified by age, gender, Welsh Index of Multiple Deprivation (WIMD) 2019 quintile and cause of death, categorised by International Classification of Disease, version 10, code into 15 categories of public health relevance. We aggregated data to 3-year rolling figures to account for low numbers of events in some groups annually. Next, we estimated life expectancy at birth by quintile, gender and period using life table methods. Lastly, we performed a decomposition analysis using the Arriaga method to identify the specific disease categories and ages at which excess deaths occur in more disadvantaged areas to highlight potential areas for action. RESULTS: Life expectancy inequalities between the most and least WIMD quintiles rose for both genders between 2002 and 2018: from 4.69 to 6.02 years for women (an increase of 1.33 years) and from 6.34 to 7.42 years for men (an increase of 1.08 years). Exploratory analysis of these trends suggested that the following were most influential for women: respiratory disease (1.50 years), cancers (1.36 years), circulatory disease (1.35 years) and digestive disease (0.51 years). For men, the gap was driven by circulatory disease (2.01 years), cancers (1.39 years), respiratory disease (1.25 years), digestive disease (0.79 years), drug- and alcohol-related conditions (0.54 years) and external causes (0.54 years). Contributions for women from respiratory disease, cancers, dementia and drug- and alcohol-related conditions appeared to be increasing, while among men, there were rising contributions from respiratory, digestive and circulatory disease. CONCLUSIONS: Life expectancy inequalities in Wales remain wide and have been increasing, particularly among women, with indications of worsening trends since 2010 following the introduction of fiscal austerity. As agencies recover from the pandemic, these findings should be considered alongside any resumption of services in Wales or future health and public policy. CI - Copyright (c) 2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved. FAU - Currie, J AU - Currie J AD - Division of Population Medicine, School of Medicine, Cardiff University, Division of Population Medicine, School of Medicine, Cardiff University, UHW Main Building, Heath Park, Cardiff, CF14 4XN, UK. Electronic address: jonny.currie@wales.nhs.uk. FAU - Boyce, T AU - Boyce T AD - Institute of Health Equity, Department for Epidemiology & Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK. FAU - Evans, L AU - Evans L AD - Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK. FAU - Luker, M AU - Luker M AD - Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK. FAU - Senior, S AU - Senior S AD - Division of Population Health, Health Services Research & Primary Care, University of Manchester, Oxford Road, Manchester, M13 9PL, UK. FAU - Hartt, M AU - Hartt M AD - Department of Geography and Planning, Queen's University, Mackintosh-Corry Hall, Room E208, Kingston, Ontario, Canada. FAU - Cottrell, S AU - Cottrell S AD - Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK. FAU - Lester, N AU - Lester N AD - Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK. FAU - Huws, D AU - Huws D AD - Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK. FAU - Humphreys, C AU - Humphreys C AD - Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK. FAU - Little, K AU - Little K AD - Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK. FAU - Adekanmbi, V AU - Adekanmbi V AD - Department of Population Health Sciences, Faculty of Life Sciences & Medicine, Great Maze Pond, Addison House, Guy's Campus, London SE1 9RT, UK. FAU - Paranjothy, S AU - Paranjothy S AD - Division of Population Medicine, School of Medicine, Cardiff University, Division of Population Medicine, School of Medicine, Cardiff University, UHW Main Building, Heath Park, Cardiff, CF14 4XN, UK. LA - eng PT - Journal Article DEP - 20210315 PL - Netherlands TA - Public Health JT - Public health JID - 0376507 SB - IM MH - Adolescent MH - Adult MH - Age Distribution MH - Aged MH - Aged, 80 and over MH - COVID-19 MH - Cause of Death/trends MH - Child MH - Child, Preschool MH - Female MH - *Health Status Disparities MH - Humans MH - Infant MH - Infant, Newborn MH - Life Expectancy/*trends MH - Male MH - Middle Aged MH - Socioeconomic Factors MH - Wales/epidemiology MH - Young Adult OTO - NOTNLM OT - Inequalities OT - Life expectancy OT - Public health EDAT- 2021/03/19 06:00 MHDA- 2021/05/14 06:00 CRDT- 2021/03/18 20:16 PHST- 2020/08/11 00:00 [received] PHST- 2020/11/26 00:00 [revised] PHST- 2021/01/28 00:00 [accepted] PHST- 2021/03/19 06:00 [pubmed] PHST- 2021/05/14 06:00 [medline] PHST- 2021/03/18 20:16 [entrez] AID - S0033-3506(21)00047-0 [pii] AID - 10.1016/j.puhe.2021.01.025 [doi] PST - ppublish SO - Public Health. 2021 Apr;193:48-56. doi: 10.1016/j.puhe.2021.01.025. Epub 2021 Mar 15.