Skip to main content

Research Repository

Advanced Search

Explaining North-South disparities in mortality rates among 25-44 year olds in England: a longitudinal population study




Background: There has been a marked recent increase in excess mortality for adults aged 25-44 in the North compared to the South of England. We examined the underlying causes of the excess mortality and the relative contribution of socioeconomic deprivation.

Methods: Mortality data for adults aged 25-44 were aggregated and compared between England’s five northernmost versus five southernmost Government Office Regions, between 1981 and 2016. Poisson regression models, adjusted for age and sex, were used to quantify excess mortality in the North by underlying cause of death (accidents, alcohol-related, cardiovascular disease and diabetes, drug poisoning, suicide, cancer, other causes). The role of measured deprivation in explaining the excess, and regional variability in the excess were also explored.

Findings: A mortality divide appeared in the mid-1990s and rapidly increased thereafter for deaths attributed to accidents, alcohol and drug poisoning. Mortality rates for these conditions increased nationwide, but more quickly in the North. National mortality rates for cardiovascular deaths declined over the study period, but a long-standing gap between North and South persisted. Between 2014 and 2016, estimated excess numbers of death in the North for those aged 25-44 were 1881 for females and 3530 for males. Measured deprivation explained up to two-thirds of the excess mortality in the North. By 2016, in addition to the persistent North-South gap, mortality rates London were at least 13% lower than in all other regions of the North or South of England.

Interpretation: Sharp rises in deaths from accidents, alcohol and drug poisoning appear to have created new health divisions between England’s regions, possibly from exacerbated existing social and health inequalities which have been experienced by multiple generations. These divisions may indicate increasing psychological distress, despair and risk-taking among young and middle-aged adults, particularly outside London.

Acceptance Date Aug 30, 2018
Publication Date Oct 31, 2018
Journal Lancet Public Health
Print ISSN 2468-2667
Publisher Elsevier
Keywords England; inequalities; socioeconomic; North-South divide; all-cause mortality; cause-specific mortality; index of multiple deprivation (IMD); suicide; alcohol; cardiovascular; accidents; drugs; cancer.
Publisher URL