Objective: To examine if the rankings of state HIV age-standardized death rates (ASDRs) changed if different standard population (SP) was used.

Design: A cross-sectional population-based observational study. Setting 36 states in the United States.

Participants: People died from 2015 to 2019.

Main outcome measures: State HIV ASDR using 4 SPs, namely WHO2000, US2000, US2mor020, and Eur2011–2030.

Results: The rankings of 19 states did not change when ASDRs were calculated using US2000 and US2020. Of the 17 states whose rankings changed, the rankings of 9 states calculated using US2000 were higher than those calculated using US2020; in 8 states, the rankings were lower. The states with the greatest changes in rankings between US2000 and US2020 were Kentucky (12th and 9th, respectively) and Massachusetts (8th and 11th, respectively).

Conclusions: State ASDRs calculated using the current official SP (US2000) weigh middle-age HIV death rates more heavily than older-age HIV death rates, resulting in lower ASDRs among states with higher older-age HIV death rates.

1. Database contents

The Russian Short-Term Mortality Fluctuations database (RusSTMF) contains a series of standardized and crude death rates for men, women and both sexes for Russia as a whole and its regions for the period from 2000 to 2021.

All the output indicators presented in the database are calculated based on data of deaths registered by the Vital Registry Office. The weekly death counts are calculated based on depersonalized individual data provided by the Russian Federal State Statistics Service (Rosstat) at the request of the HSE. Time coverage: 03.01.2000 (Week 1) – 31.12.2021 (Week 1148)

2. A brief description of the input data on deaths

Date of death: date of occurrence

Unit of time: week

First and last days of the week: Monday – Sunday

First and last week of the year: The weeks are organized according to ISO 8601:2004 guidelines. Each week of the year, including the first and last, contains 7 days. In order to get 7-day weeks, the days of previous years are included in this first week (if January 1 fell on Tuesday, Wednesday or Thursday) or in the last calendar week (if December 31 fell on Thursday, Friday or Saturday).

Age groups: the entire population

Sex: men, women, both sexes (men and women combined)

Restrictions and data changes: data on deaths in the Pskov region were excluded for weeks 9-13 of 2012

Note: Deaths with an unknown date of occurrence (unknown year, month, or day) account for about 0.3% of all deaths and are excluded from the calculation of week-age-specific and standardized death rates.

3. Description of the week-specific mortality rates data file

Week-specific standardized death rates for Russia as a whole and its regions are contained in a single data file presented in .csv format. The format of data allows its uploading into any system for statistical analysis. Each record (row) in the data file contains data for one calendar year, one week, one territory, one sex.

The decimal point is dot (.)

The first element of the row is the territory code ("PopCode" column), the second element is the year ("Year" column), the third element ("Week" column) is the week of the year, the fourth element ("Sex" column) is sex (F – female, M – male, B – both sexes combined). This is followed by a column "CDR" with the value of the crude death rate and "SDR" with the value of the standardized death rate. If the indicator cannot be calculated for some combination of year, sex, and territory, then the corresponding meaningful data elements in the data file are replaced with ".".

The probability of dying between birth and the exact age of 1, expressed per 1,000 live births. The data is sorted by both sex and total and includes a range of values from 1900 to 2019. The calculation for infant mortality rates is derived from a standard period abridged life table using the age-specific deaths and mid-year population counts from civil registration data. This data is sourced from the UN Inter-Agency Group for Child Mortality Estimation. The UN IGME uses the same estimation method across all countries to arrive at a smooth trend curve of age-specific mortality rates. The estimates are based on high quality nationally representative data including statistics from civil registration systems, results from household surveys, and censuses. The child mortality estimates are produced in conjunction with national level agencies such as a country’s Ministry of Health, National Statistics Office, or other relevant agencies.

Life expectancy at a given age is a summary measure of mortality rates present in a population (estimated as the area under the survival curve), and represents the average number of years an individual at that age is expected to live if current age-specific mortality rates apply now and in the future. A complementary metric is the number of Life Years Lost, which is used to measure the reduction in life expectancy for a specific group of persons, for example those diagnosed with a specific disease or condition (e.g. smoking). However, calculation of life expectancy among those with a specific disease is not straightforward for diseases that are not present at birth, and previous studies have considered a fixed age at onset of the disease, e.g. at age 15 or 20 years. In this paper, we present the R package lillies (freely available through the Comprehensive R Archive Network; CRAN) to guide the reader on how to implement a recently-introduced method to estimate excess Life Years Lost associated with a disease or condition that overcomes these limitations. In addition, we show how to decompose the total number of Life Years Lost into specific causes of death through a competing risks model, and how to calculate confidence intervals for the estimates using non-parametric bootstrap. We provide a description on how to use the method when the researcher has access to individual-level data (e.g. electronic healthcare and mortality records) and when only aggregated-level data are available.

This data shows premature deaths (Age under 75), numbers and rates by gender, as 3-year moving-averages.

All-Cause Mortality rates are a summary indicator of population health status. All-cause mortality is related to Life Expectancy, and both may be influenced by health inequalities.

Directly Age-Standardised Rates (DASR) are shown in the data (where numbers are sufficient) so that death rates can be directly compared between areas. The DASR calculation applies Age-specific rates to a Standard (European) population to cancel out possible effects on crude rates due to different age structures among populations, thus enabling direct comparisons of rates.

A limitation on using mortalities as a proxy for prevalence of health conditions is that mortalities may give an incomplete view of health conditions in an area, as ill-health might not lead to premature death.

Data source: Office for Health Improvement and Disparities (OHID), Public Health Outcomes Framework (PHOF) indicator ID 108. This data is updated annually.

Abstract copyright UK Data Service and data collection copyright owner. The dataset was originally created to allow the construction of age-specific mortality series and cohort mortality series for particular diseases, from the mid-nineteenth century to the present (in conjunction with the comparable mortality database created by the Office of National Statistics which covers 1901 – present). The dataset is fairly comprehensive and therefore allows both fine analysis of trends in single causes and also the construction of consistent aggregated categories of causes over time. Additionally, comparison of trends in individual causes can be used to infer transfers of deaths between categories over time, that may cause artifactual changes in mortality rates of particular causes. The data are presented by sex, allowing calculation of sex ratios. The age-specific and annual nature of the dataset allows the analysis of cause-specific mortality by birth cohort (assuming low migration at the national level). The database can be used in conjunction with the ONS database “Historic Mortality and Population Data, 1901-1992”, already in the UK Data Archive collection as SN 2902, to create continuous cause-of-death series for the period 1848-1992 (or later, if using more recent versions of the ONS database).

This data shows premature deaths (Age under 75), numbers and rates by gender, as 3-year moving-averages. All-Cause Mortality rates are a summary indicator of population health status. All-cause mortality is related to Life Expectancy, and both may be influenced by health inequalities. Directly Age-Standardised Rates (DASR) are shown in the data (where numbers are sufficient) so that death rates can be directly compared between areas. The DASR calculation applies Age-specific rates to a Standard (European) population to cancel out possible effects on crude rates due to different age structures among populations, thus enabling direct comparisons of rates. A limitation on using mortalities as a proxy for prevalence of health conditions is that mortalities may give an incomplete view of health conditions in an area, as ill-health might not lead to premature death. Data source: Office for Health Improvement and Disparities (OHID), Public Health Outcomes Framework (PHOF) indicator ID 108. This data is updated annually.

Mortality indicators standardized by sex and cause of death. Year: 2010. Territory: Province of Lucca. Indicators: number of deaths observed, number of deaths expected, number of excess deaths, standardised mortality ratio. Standardisation method applied: indirect. Reference population (standard population): Residents in the geographical area of the Centre (Tuscany, Umbria, Marche, Lazio). Primary data source (number of deaths observed, population resident in the province of Lucca, sex- and age-specific mortality rates of the population resident in the Centro district): ISTAT. Calculation of indicators: Statistical Office of the Province of Lucca.

The dataset was originally created to allow the construction of age-specific mortality series and cohort mortality series for particular diseases, from the mid-nineteenth century to the present (in conjunction with the comparable mortality database created by the Office of National Statistics which covers 1901 – present). The dataset is fairly comprehensive and therefore allows both fine analysis of trends in single causes and also the construction of consistent aggregated categories of causes over time. Additionally, comparison of trends in individual causes can be used to infer transfers of deaths between categories over time, that may cause artifactual changes in mortality rates of particular causes. The data are presented by sex, allowing calculation of sex ratios. The age-specific and annual nature of the dataset allows the analysis of cause-specific mortality by birth cohort (assuming low migration at the national level). The database can be used in conjunction with the ONS database “Historic Mortality and Population Data, 1901-1992”, already in the UK Data Archive collection as SN 2902, to create continuous cause-of-death series for the period 1848-1992 (or later, if using more recent versions of the ONS database).

VITAL SIGNS INDICATOR Life Expectancy (EQ6)

FULL MEASURE NAME Life Expectancy

LAST UPDATED April 2017

DESCRIPTION Life expectancy refers to the average number of years a newborn is expected to live if mortality patterns remain the same. The measure reflects the mortality rate across a population for a point in time.

DATA SOURCE State of California, Department of Health: Death Records (1990-2013) No link

California Department of Finance: Population Estimates Annual Intercensal Population Estimates (1990-2010) Table P-2: County Population by Age (2010-2013) http://www.dof.ca.gov/Forecasting/Demographics/Estimates/

U.S. Census Bureau: Decennial Census ZCTA Population (2000-2010) http://factfinder.census.gov

U.S. Census Bureau: American Community Survey 5-Year Population Estimates (2013) http://factfinder.census.gov

CONTACT INFORMATION vitalsigns.info@mtc.ca.gov

METHODOLOGY NOTES (across all datasets for this indicator) Life expectancy is commonly used as a measure of the health of a population. Life expectancy does not reflect how long any given individual is expected to live; rather, it is an artificial measure that captures an aspect of the mortality rates across a population that can be compared across time and populations. More information about the determinants of life expectancy that may lead to differences in life expectancy between neighborhoods can be found in the Bay Area Regional Health Inequities Initiative (BARHII) Health Inequities in the Bay Area report at http://www.barhii.org/wp-content/uploads/2015/09/barhii_hiba.pdf. Vital Signs measures life expectancy at birth (as opposed to cohort life expectancy). A statistical model was used to estimate life expectancy for Bay Area counties and ZIP Codes based on current life tables which require both age and mortality data. A life table is a table which shows, for each age, the survivorship of a people from a certain population.

Current life tables were created using death records and population estimates by age. The California Department of Public Health provided death records based on the California death certificate information. Records include age at death and residential ZIP Code. Single-year age population estimates at the regional- and county-level comes from the California Department of Finance population estimates and projections for ages 0-100+. Population estimates for ages 100 and over are aggregated to a single age interval. Using this data, death rates in a population within age groups for a given year are computed to form unabridged life tables (as opposed to abridged life tables). To calculate life expectancy, the probability of dying between the jth and (j+1)st birthday is assumed uniform after age 1. Special consideration is taken to account for infant mortality.

For the ZIP Code-level life expectancy calculation, it is assumed that postal ZIP Codes share the same boundaries as ZIP Code Census Tabulation Areas (ZCTAs). More information on the relationship between ZIP Codes and ZCTAs can be found at http://www.census.gov/geo/reference/zctas.html. ZIP Code-level data uses three years of mortality data to make robust estimates due to small sample size. Year 2013 ZIP Code life expectancy estimates reflects death records from 2011 through 2013. 2013 is the last year with available mortality data. Death records for ZIP Codes with zero population (like those associated with P.O. Boxes) were assigned to the nearest ZIP Code with population. ZIP Code population for 2000 estimates comes from the Decennial Census. ZIP Code population for 2013 estimates are from the American Community Survey (5-Year Average). ACS estimates are adjusted using Decennial Census data for more accurate population estimates. An adjustment factor was calculated using the ratio between the 2010 Decennial Census population estimates and the 2012 ACS 5-Year (with middle year 2010) population estimates. This adjustment factor is particularly important for ZCTAs with high homeless population (not living in group quarters) where the ACS may underestimate the ZCTA population and therefore underestimate the life expectancy. The ACS provides ZIP Code population by age in five-year age intervals. Single-year age population estimates were calculated by distributing population within an age interval to single-year ages using the county distribution. Counties were assigned to ZIP Codes based on majority land-area.

ZIP Codes in the Bay Area vary in population from over 10,000 residents to less than 20 residents. Traditional life expectancy estimation (like the one used for the regional- and county-level Vital Signs estimates) cannot be used because they are highly inaccurate for small populations and may result in over/underestimation of life expectancy. To avoid inaccurate estimates, ZIP Codes with populations of less than 5,000 were aggregated with neighboring ZIP Codes until the merged areas had a population of more than 5,000. ZIP Code 94103, representing Treasure Island, was dropped from the dataset due to its small population and having no bordering ZIP Codes. In this way, the original 305 Bay Area ZIP Codes were reduced to 217 ZIP Code areas for 2013 estimates. Next, a form of Bayesian random-effects analysis was used which established a prior distribution of the probability of death at each age using the regional distribution. This prior is used to shore up the life expectancy calculations where data were sparse.

This data shows premature deaths (Age under 75) from Respiratory Disease, numbers and rates by gender, as 3-year moving-averages.

Smoking is the major cause of chronic obstructive pulmonary disease (COPD), one of the major Respiratory diseases. COPD (which includes chronic bronchitis and emphysema) results in many hospital admissions. Respiratory diseases can also be caused by environmental factors (such as pollution, or housing conditions) and influenza. Respiratory disease mortality rates show a socio-economic gradient.

Directly Age-Standardised Rates (DASR) are shown in the data, where numbers are sufficient, so that death rates can be directly compared between areas. The DASR calculation applies Age-specific rates to a Standard (European) population to cancel out possible effects on crude rates due to different age structures among populations, thus enabling direct comparisons of rates.

A limitation on using mortalities as a proxy for prevalence of health conditions is that mortalities may give an incomplete view of health conditions in an area, as ill-health might not lead to premature death.

Data source: Public Health England, Public Health Outcomes Framework (PHOF) indicator 4.07i. This data is updated annually.

Indicator 3.4.1Mortality rate attributed to Cardiovascular disease, cancer, diabetes, or chronic respiratory disease.Methodology:There are 4 steps involved in the calculation of this indicator:1. Estimation of life table of the country population or estimation of WHO life tables, based on the UN World Population Prospects 2012 revision.2. Cause-of-death distributions by five years age groups and mid-year population distribution by five years age groups .3. Calculation of age-specific mortality rates from the four main NCDs for each five-year age range between 30 and 70.4. Calculation of the probability of dying between the ages of 30 and 70 years from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases.Finally, converting the probabilities of dying into percentages.Data Source:Ministry of Public Health - Accounts of the National Planning Council.

This data shows deaths (of people age 10 and over) from Suicide and Undetermined Injury, numbers and rates by gender, as 3-year moving-averages.

Suicide is a significant cause of premature deaths occurring generally at younger ages than other common causes of premature mortality. It may also be seen as an indicator of underlying rates of mental ill-health.

Directly Age-Standardised Rates (DASR) are shown in the data, where numbers are sufficient, so that death rates can be directly compared between areas. The DASR calculation applies Age-specific rates to a Standard (European) population to cancel out possible effects on crude rates due to different age structures among populations, thus enabling direct comparisons of rates.

The figures in this dataset include deaths recorded as suicide (people age 10 and over) and undetermined injury (age 15 and over) as those are mostly likely also to have been caused by self-harm rather than unverifiable accident, neglect or abuse. The population denominators for rates are age 10 and over. Low numbers may result in zero values or missing data.

Data source: Office for Health Improvement and Disparities (OHID), Public Health Outcomes Framework (PHOF) indicator 41001 (E10). This data is updated annually.

Abstract copyright UK Data Service and data collection copyright owner. This study comprises a complete transcription of all the district-level tables which are the main contents of each of the Registrar-General for England and Wales Decennial Supplements from 1851-60 to 1901-10; these are supplements to the 25th, 35th, 45th, 55th, 65th and 75th Annual Reports. The reports for 1851-1900 were computerised by a project led by Professor Robert Woods of Liverpool University, creating a large set of spreadsheets, one for each district in each decade. These were assembled into a single large file by the Great Britain Historical GIS, working in collaboration with Hamish James of the UK Data Archive. The GBHGIS team computerised the 1901-10 report, checked all data against the original reports, and added identifiers linking the districts to the digital boundary data they had created. For each district in each decade, the reports cross-tabulate causes of death against age. In some decades, there are separate tables for each district for males and females, and the causes of death vary between decades. There were c. 630 districts, the exact number varying by decade. Main Topics: Decennial cause of death data for Registration Districts in England and Wales cross-classified by age and sometimes by sex. The study also includes a separate table, mainly derived, containing age- and gender-specific counts of deaths, without cause information and organised to simplify calculation of standardised mortality rates.

This data shows premature deaths (Age under 75) from Circulatory Disease, numbers and rates by gender, as 3-year moving-averages.

Circulatory diseases include heart diseases and stroke, and others. Socio-economic and lifestyle factors are associated with circulatory disease deaths and inequalities in circulatory disease rates. Modifiable risk factors include smoking, excess weight, diet, and physical inactivity.

Directly Age-Standardised Rates (DASR) are shown in the data, where numbers are sufficient, so that death rates can be directly compared between areas. The DASR calculation applies Age-specific rates to a Standard (European) population to cancel out possible effects on crude rates due to different age structures among populations, thus enabling direct comparisons of rates.

A limitation on using mortalities as a proxy for prevalence of health conditions is that mortalities may give an incomplete view of health conditions in an area, as ill-health might not lead to premature death.

Data source: NHS Digital Compendium hub, dataset unique identifier P00395. This data is updated annually.

This data shows premature deaths (Age under 75) from all Cancers, numbers and rates by gender, as 3-year moving-averages.

Cancers are a major cause of premature deaths. Inequalities exist in cancer rates between the most deprived areas and the most affluent areas.

Directly Age-Standardised Rates (DASR) are shown in the data (where numbers are sufficient) so that death rates can be directly compared between areas. The DASR calculation applies Age-specific rates to a Standard (European) population to cancel out possible effects on crude rates due to different age structures among populations, thus enabling direct comparisons of rates.

A limitation on using mortalities as a proxy for prevalence of health conditions is that mortalities may give an incomplete view of health conditions in an area, as ill-health might not lead to premature death.

Data source: NHS Health and Social Care Information Centre (NHS-HSCIC) (Dataset unique identifier P00399). This data is updated annually.

This data shows premature deaths (Age under 75) from Liver Disease, numbers and rates by gender, as 3-year moving-averages.

Most liver disease is preventable and much is influenced by alcohol consumption and obesity prevalence, which are both amenable to public health interventions.

Directly Age-Standardised Rates (DASR) are shown in the data (where numbers are sufficient) so that death rates can be directly compared between areas. The DASR calculation applies Age-specific rates to a Standard (European) population to cancel out possible effects on crude rates due to different age structures among populations, thus enabling direct comparisons of rates.

A limitation on using mortalities as a proxy for prevalence of health conditions is that mortalities may give an incomplete view of health conditions in an area, as ill-health might not lead to premature death.

Data source: Public Health England, Public Health Outcomes Framework (PHOF) indicator 4.06i. The data is updated annually.

Deaths from alcohol-related conditions, all ages, directly age-standardised rate per 100,000 population (standardised to the European standard population).

Rationale Alcohol consumption is a contributing factor to hospital admissions and deaths from a diverse range of conditions. Alcohol misuse is estimated to cost the NHS about £3.5 billion per year and society as a whole £21 billion annually.

The Government has said that everyone has a role to play in reducing the harmful use of alcohol - this indicator is one of the key contributions by the Government (and the Department of Health and Social Care) to promote measurable, evidence-based prevention activities at a local level, and supports the national ambitions to reduce harm set out in the Government's Alcohol Strategy. This ambition is part of the monitoring arrangements for the Responsibility Deal Alcohol Network. Alcohol-related deaths can be reduced through local interventions to reduce alcohol misuse and harm.

The proportion of disease attributable to alcohol (alcohol attributable fraction) is calculated using a relative risk (a fraction between 0 and 1) specific to each disease, age group, and sex combined with the prevalence of alcohol consumption in the population. All mortality records are extracted that contain an attributable disease and the age and sex-specific fraction applied. The results are summed into quinary age bands for the numerator and a directly standardised rate calculated using the European Standard Population. This revised indicator uses updated alcohol attributable fractions, based on new relative risks from ‘Alcohol-attributable fractions for England: an update’ (1) published by PHE in 2020. A detailed comparison between the 2013 and 2020 alcohol attributable fractions is available in Appendix 3 of the PHE report (2). A consultation was also undertaken with stakeholders where the impact of the new methodology on the LAPE indicators was quantified and explored (3).

The calculation that underlies all alcohol-related indicators has been updated to take account of the latest academic evidence and more recent alcohol-consumption figures. The result has been that the newly published mortality and admission rates are lower than those previously published. This is due to a change in methodology, mainly because alcohol consumption across the population has reduced since 2010. Therefore, the number of deaths and hospital admissions that we attribute to alcohol has reduced because in general people are drinking less today than they were when the original calculation was made.

Figures published previously did not misrepresent the burden of alcohol based on the previous evidence – the methodology used in this update is as close as sources and data allow to the original method. Though the number of deaths and admissions attributed to alcohol each year has reduced, the direction of trend and the key inequalities due to alcohol harm remain the same. Alcohol remains a significant burden on the health of the population and the harm alcohol causes to individuals remains unchanged.

References:

PHE (2020) Alcohol-attributable fractions for England: an update PHE (2020) Alcohol-attributable fractions for England: an update: Appendix 3 PHE (2021) Proposed changes for calculating alcohol-related mortality

Definition of numerator Deaths from alcohol-related conditions based on underlying cause of death, registered in the calendar year for all ages. Each alcohol-related death is assigned an alcohol attributable fraction based on underlying cause of death (and all cause of deaths fields for the conditions: ethanol poisoning, methanol poisoning, toxic effect of alcohol). Alcohol-attributable fractions were not available for children.

Mortality data includes all deaths registered in the calendar year where the local authority of usual residence of the deceased is one of the English geographies and an alcohol attributable diagnosis is given as the underlying cause of death. Counts of deaths for years up to and including 2019 have been adjusted where needed to take account of the MUSE ICD-10 coding change introduced in 2020. Detailed guidance on the MUSE implementation is available at: MUSE implementation guidance.

Counts of deaths for years up to and including 2013 have been double adjusted by applying comparability ratios from both the IRIS coding change and the MUSE coding change where needed to take account of both the MUSE ICD-10 coding change and the IRIS ICD-10 coding change introduced in 2014. The detailed guidance on the IRIS implementation is available at: IRIS implementation guidance.

Counts of deaths for years up to and including 2010 have been triple adjusted by applying comparability ratios from the 2011 coding change, the IRIS coding change, and the MUSE coding change where needed to take account of the MUSE ICD-10 coding change, the IRIS ICD-10 coding change, and the ICD-10 coding change introduced in 2011. The detailed guidance on the 2011 implementation is available at: 2011 implementation guidance.

Definition of denominator ONS mid-year population estimates aggregated into quinary age bands.

Caveats There is the potential for the underlying cause of death to be incorrectly attributed on the death certificate and the cause of death misclassified. Alcohol-attributable fractions were not available for children. Conditions where low levels of alcohol consumption are protective (have a negative alcohol-attributable fraction) are not included in the calculation of the indicator.

The confidence intervals do not take into account the uncertainty involved in the calculation of the AAFs – that is, the proportion of deaths that are caused by alcohol and the alcohol consumption prevalence that are included in the AAF formula are only an estimate and so include uncertainty. The confidence intervals published here are based only on the observed number of deaths and do not account for this uncertainty in the calculation of attributable fraction - as such the intervals may be too narrow.

This data shows premature deaths (Age under 75) from Cardiovascular Disease, numbers and rates by gender, as 3-year moving-averages. Cardiovascular Disease include heart diseases and stroke, and others. Socio-economic and lifestyle factors are associated with circulatory disease deaths and inequalities in circulatory disease rates. Modifiable risk factors include smoking, excess weight, diet, and physical inactivity. Directly Age-Standardised Rates (DASR) are shown in the data, where numbers are sufficient, so that death rates can be directly compared between areas. The DASR calculation applies Age-specific rates to a Standard (European) population to cancel out possible effects on crude rates due to different age structures among populations, thus enabling direct comparisons of rates. A limitation on using mortalities as a proxy for prevalence of health conditions is that mortalities may give an incomplete view of health conditions in an area, as ill-health might not lead to premature death. Data source: NHS Digital (now part of NHS England) Compendium hub, dataset unique identifier P00395. This data is updated annually. Note: Compendium Mortality Consultation 2022 NHS Digital is currently analysing the results of the consultation that closed on 14 September 2022. In the meantime the next publication is on hold. 6 February 2023 10:55 AM

Potential years of life lost (PYLL) due to alcohol-related conditions, all ages, directly age-standardised per 100,000 population (standardised to the ESP).

Rationale Alcohol consumption is a contributing factor to hospital admissions and deaths from a diverse range of conditions. Alcohol misuse is estimated to cost the NHS about £3.5 billion per year and society as a whole £21 billion annually. The Government has said that everyone has a role to play in reducing the harmful use of alcohol - this indicator is one of the key contributions by the Government (and the Department of Health and Social Care) to promote measurable, evidence-based prevention activities at a local level, and supports the national ambitions to reduce harm set out in the Government's Alcohol Strategy. This ambition is part of the monitoring arrangements for the Responsibility Deal Alcohol Network. Alcohol-related deaths can be reduced through local interventions to reduce alcohol misuse and harm.

Potential years of life lost (PYLL) is a measure of the potential number of years lost when a person dies prematurely. The basic concept of PYLL is that deaths at younger ages are weighted more heavily than those at older ages. The advantage in doing this is that deaths at younger ages may be seen as less important if cause-specific death rates were just used on their own in highlighting the burden of disease and injury, since conditions such as cancer and heart disease usually occur at older ages and have relatively high mortality rates.

To enable comparisons between areas and over time, PYLL rates are age-standardised to represent the PYLL if each area had the same population structure as the 2013 European Standard Population (ESP). PYLL rates are presented as years of life lost per 100,000 population.

Definition of numerator The number of age-specific alcohol-related deaths multiplied by the national life expectancy for each age group and summed to give the total potential years of life lost due to alcohol-related conditions.

Definition of denominator ONS Mid-Year Population Estimates aggregated into quinary age bands.

Caveats There is the potential for the underlying cause of death to be incorrectly attributed on the death certificate and the cause of death misclassified. Alcohol-attributable fractions were not available for children. Conditions where low levels of alcohol consumption are protective (have a negative alcohol-attributable fraction) are not included in the calculation of the indicator.

The national life expectancies for England have been used for all sub-national geographies to illustrate the disparities in the burden caused by alcohol between local areas and the national average.

The confidence intervals do not take into account the uncertainty involved in the calculation of the AAFs – that is, the proportion of deaths that are caused by alcohol and the alcohol consumption prevalence that are included in the AAF formula are only an estimate and so include uncertainty. The confidence intervals published here are based only on the observed number of deaths and do not account for this uncertainty in the calculation of attributable fraction - as such the intervals may be too narrow.