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Steel, Nicholas 
ORCID: https://orcid.org/0000-0003-1528-140X
(2025)
Changing life expectancy in European countries 1990-2021: Causes and risk factors from the Global Burden of Disease Study 2021.
The Lancet Public Health.
ISSN 2468-2667
(In Press)
Abstract
Background Decades of steady improvements in life expectancy in Europe slowed around 2011, well before the COVID-19 pandemic, for reasons which remain disputed. We aimed to show how changes in risk factors and cause-specific death rates in different countries related to changes in life expectancy in those countries before and during the COVID-19 pandemic. Methods We used Global Burden of Disease 2021 Study data and methods to compare changes in life expectancy, causes of death and population exposure to risk factors in 16 European Economic Area (EEA) countries and the United Kingdom for three time periods, 1990-2011, 2011-2019 and 2019-2021. Changes in life expectancy and causes of death were estimated using an established life expectancy cause-specific decomposition method and compared with summary exposure values of risk factors for the major causes of death. Findings Mean annual improvement in life expectancy slowed in 2011-2019 compared to 1990-2011 in all countries except for Norway with 0.03 years increase (0.23 (standard error (SE) 0.012), 0.21 (SE 0.004)) respectively) ranging from Iceland with -0.01 years decrease (0.17 (SE 0.050), 0.19 (SE 0.015) to England with -0.18 years decrease (0.07 (SE 0.005), 0.25 (SE 0.002)). In 2019-2021, all countries except for Denmark, Belgium, Ireland, Norway, Sweden and Iceland experienced an absolute fall in life expectancy. Cardiovascular diseases and neoplasms were responsible for the largest slowdown in life expectancy improvements from 2011 to 2019, and respiratory infections and other COVID-19 pandemic-related deaths were responsible for the falls in life expectancy from 2019 to 2021. Deaths from cardiovascular diseases and neoplasms were attributable to high systolic blood pressure, dietary risks, tobacco, high LDL cholesterol, high body-mass index, occupational risks, high alcohol use, and other risks including low physical activity. Exposure to major risks differed by country, with widespread trends from 1990-2021 for increasing high body mass index and decreasing tobacco use. Interpretation The countries that best maintained improvements in life expectancy after 2011 (Norway, Iceland, Sweden, Denmark, Belgium) did so through greater reductions in mortality from cardiovascular diseases and neoplasms, underpinned by lower exposures to major risks, possibly mitigated by better government policies. These countries’ continued improvements in life expectancy from 2019-2021 suggest that they were better prepared to withstand the COVID-19 pandemic. In contrast, those countries with the greatest slowdown in life expectancy improvements after 2011 went on to experience the biggest falls in life expectancy from 2019-2021. This suggests that government policies that make populations healthier also build resilience to future shocks. These policies include reducing population exposure to major upstream risks for cardiovascular diseases and neoplasms such as harmful diets and low physical activity, tackling the commercial determinants of poor health, and ensuring access to affordable health services.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | sdg 3 - good health and well-being ,/dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| Depositing User: | LivePure Connector |
| Date Deposited: | 16 Jan 2025 01:09 |
| Last Modified: | 20 Jan 2025 01:07 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/98215 |
| DOI: |
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