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#ClinicSpeak & #ResearchSpeak: healthcare inequality and mortality


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Why should you die earlier because you live in the North of England? #ClinicSpeak #ResearchSpeak

As I get older I seem to be getting more political, more outraged and more upset by healthcare inequality. I posted on this topic last month. The paper below that has just been published, and was allover the news yesterday, demonstrates a country of two tales. If you live in the North of England you are destined to die prematurely. The paper concludes with the statement:

"This profound and worsening structural inequality requires more equitable economic, social and health policies, including potential reactions to the England-wide loss of improvement in premature mortality."

Why is this relevant to MS? Because it plays out in the MS space as well; please see  'A Lottery of Treatment and Care' document below from the MS Society. MS services, access to MS services, poor lifestyle (diet, exercise), comorbidities (other diseases) are only a few examples that are affected by inequality that will also impact on outcomes for people with MS and contribute to the North-South divide.  

When I have attended the MS Life meeting in Manchester in the past I would spend 1 or 2 days running an informal MS clinic. Attendees at the Manchester meeting, who tend to be from the North of England, would tell me stories about no, or limited, access to continence advisers, functional electric stimulation, MS nurse specialists, cognitive behavioural and other therapists, DMTs and much, much more. The problems are not because of the services provided by the specialist units in the North - they are excellent - but, it is an institutionalised problem of poor access to these units and low expectations from pwMS and their families. 

We as healthcare professionals working in the NHS should be ashamed of ourselves; ashamed to be presiding over such a disparity in health outcomes. I am going to ask Julia Pakpoor, who is a collaborator of ours, to look into mortality of MSers in England. I hypothesise that if you have MS and live in the North of England you are likely to die earlier. I hope I am proved wrong. 


Buchan et al. North-South disparities in English mortality 1965–2015: longitudinal population study.  J Epidemiol Community Health 2017;71:928–936.

Background: Social, economic and health disparities between northern and southern England have persisted despite Government policies to reduce them. We examine long-term trends in premature mortality in northern and southern England across age groups, and whether mortality patterns changed after the 2008–2009 Great Recession.

Methods: Population-wide longitudinal (1965–2015) study of mortality in England's five northernmost versus four southernmost Government Office Regions – halves of overall population. Main outcome measure: directly age-sex adjusted mortality rates; northern excess mortality (percentage excess northern vs southern deaths, age-sex adjusted).

Results: From 1965 to 2010, premature mortality (deaths per 10 000 aged <75 years) declined from 64 to 28 in southern versus 72 to 35 in northern England. From 2010 to 2015 the rate of decline in premature mortality plateaued in northern and southern England. For most age groups, northern excess mortality remained consistent from 1965 to 2015. For 25–34 and 35–44 age groups, however, northern excess mortality increased sharply between 1995 and 2015: from 2.2% (95% CI –3.2% to 7.6%) to 29.3% (95% CI 21.0% to 37.6%); and 3.3% (95% CI –1.0% to 7.6%) to 49.4% (95% CI 42.8% to 55.9%), respectively. This was due to northern mortality increasing (ages 25–34) or plateauing (ages 35–44) from the mid-1990s while southern mortality mainly declined.

Conclusions: England's northern excess mortality has been consistent among those aged <25 and 45+ for the past five decades but risen alarmingly among those aged 25–44 since the mid-90s, long before the Great Recession. This profound and worsening structural inequality requires more equitable economic, social and health policies, including potential reactions to the England-wide loss of improvement in premature mortality.

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