The avoidable mortality rate in 2020 was the highest in England since 2010, and the highest in Wales and Scotland since 2012

Avoidable death

Avoidable deaths in Great Britain accounted for 22.8% (153,008 deaths) of total deaths across all ages (672,015 deaths) in 2020, which is the highest figure since 2010, according to new figures from the Office for National Statistics (ONS).

The data show the number of deaths in Great Britain that could have been avoided through effective and timely public health and primary prevention interventions in 2020. The figures categorise COVID-19 as a preventable cause of death. All figures apply to people less than 75 years old.

Overall, the avoidable mortality rate was the highest in England since 2010, and the highest in Wales and Scotland since 2012.

‘These data are clearly concerning, but raise as many questions as they answer’, said Martin McKee PhD, Professor of European Public Health at The London School of Hygiene & Tropical Medicine. ‘It is really quite difficult to interpret these data against the background of the pandemic, and it will be necessary to drill down to understand better what is happening.’

Overall, 68.6% of deaths in 2020 were attributed to conditions considered to be preventable (104,929.5 deaths), and conditions considered treatable comprised 45.78% of these deaths (48,078.5 deaths, 31.4% of the total). Alcohol- and drug-related disorders were the only categories in which the mortality rate has statistically significantly increased since 2001.

‘Neoplasms (cancers) continue to be the largest cause of avoidable mortality’, said a spokesperson from the ONS. ‘COVID 19 has been included as a cause of avoidable mortality for the first time in this data, which is consistent with the international definition of avoidable death as set out by the Organisation for Economic Co-operation and Development.’

Causes of avoidable deaths

The figures provide an in-depth breakdown by cause of avoidable death overall, as well as by country (England, Scotland, and Wales) and by CCG (in England) and health board (Wales), among other categories. Rates were age-standardised mortality rates expressed per 100,000 people and standardised to the 2013 European Standard Population.

For deaths due to COVID-19, Wales had the highest avoidable mortality rate, with 36.1 deaths per 100,000 people, whereas Scotland had the lowest, with 28.5 deaths per 100,000 people. England reported 34.9 deaths attributable to COVID-19 per 100,000 people in 2020.

For alcohol- and drug-related deaths, Scotland had the highest avoidable mortality rate, with 52.1 deaths per 100,000 people (up from 39.3 per 100,000 in 2001), which was statistically significantly higher than the rates for England (24.0 deaths per 100,000 people, up from 17.8 per 100,000 in 2001), which was the lowest rate, and Wales (25.3 per 100,000 people, up from 21.2 per 100,000 in 2001). These rates have shown fluctuation over time, but are statistically significantly higher in 2020 compared with 2001 for all countries.

Since 2012, avoidable mortality rates from alcohol- and drug-related deaths increased by a staggering 63.3% in Scotland.

The ONS reports that, across countries, the increase in alcohol- and drug-related deaths was driven by ‘alcoholic liver disease, and accidental poisoning by, and exposure to, other unspecified drugs, medicaments, and biological substances.’

With respect to neoplasms, Scotland also had the highest avoidable mortality rate, with 98.0 deaths per 100,000 people, which was statistically significantly higher than Wales (86.6 deaths per 100,000) and England (77.8 deaths per 100,000 people).

The ONS report notes that mortality rates for neoplasms have declined, with rates statistically significantly lower in 2020 compared with 2001 for all three constituent countries of Great Britain. The gap between Scotland and England’s rates has narrowed since 2001.

Treatable and preventable mortality by CCG and health board

Treatable mortality was analysed by CCG and health board, and refers to causes of death that are mainly avoided through timely and effective healthcare interventions.

In 2020, Blackpool NHS CCG had the highest rate of treatable mortality for both men and women, with rates of 164.2 and 132.2 per 100,000 people, respectively.

These rates for men and women were statistically significantly higher than 83.8% and 81.0% for other CCGs, respectively, whereas the male avoidable mortality rate was 2.6 times higher than that of NHS West Suffolk CCG, and the female avoidable mortality rate was 2.4 times higher than that at NHS Herts Valleys CCG—which were the lowest rates, respectively.

Swansea Bay University Health Board in Wales had the highest treatable mortality rate for men, with 129.1 deaths per 100,000 males.

‘This was statistically significantly higher than 50.0% of other health boards. This was also 1.8 times higher than Powys Teaching Health Board, which had the lowest rate’, according to the ONS report.

For women, Cwm Taf Morgannwg University Health Board had the highest mortality rate, with 99.1 deaths per 100,000 females, 1.3 times higher than Powys Teaching Health Board, which had the lowest rate.

Preventable mortality figures were provided for the period 2018–2020, and were categorised by local authorities in England and unitary authorities in Wales. Blackpool had the highest rate of preventable mortality in men, with 355.8 deaths per 100,000, which was higher than 98.0% of other local authorities in England. It was also 3.2 times higher than Hart in Hampshire, which had the lowest rate.

In Wales, between 2018 and 2020, Merthyr Tydfil had the highest rates of preventable mortality, with 288.8 deaths per 100,000 males and 188.6 deaths per 100,000 females. These rates were 1.9 and 2.2 times higher, respectively, than Monmouthshire, which had the lowest rates.

This article originally appeared on Medscape. Guidelines and guidelines.co.uk are now part of the Medscape Professional Network—working together to support evidence-based best practice. Access a personalised clinical news feed and tools to support your daily practice at medscape.co.uk.

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