Ward, Joseph; (2021) Understanding excess child and adolescent mortality in the United Kingdom compared with the EU15+ countries. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background Understanding why mortality in children and young people (CYP) in the UK is higher than similar high-income countries can inform efforts to improve outcomes. Methods I used data from the World Mortality Database, Office for National Statistics, and Global Burden of Disease Study to describe current patterns and long-term trends in UK CYP mortality, and compare this to a group of similar countries (the EU5+). I then used Hospital Episode Statistics data to understand how health service factors may contribute to the UK’s poor outcomes, and identify patterns of healthcare activity associated with mortality hazard. I finally place concerns regarding UK adolescent mortality in an international context, and examine global trends in deaths in 10-24 year olds. Results I found large differences in rates of mortality decline in the UK by age group and cause, with adolescents lagging behind other age groups. Improvements in UK mortality since 1970 have also been slower than the EU15+. I found the UK to currently have significantly higher CYP mortality for respiratory conditions, neurological conditions, common infections, and diabetes and endocrine conditions, but good outcomes for injuries. I found some areas of England to have mortality rates comparable with the best performing EU15+ countries, and that levels of deprivation explain much of the geographic variation in UK CYP mortality. Amongst CYP admitted with epilepsy, asthma and diabetes, (conditions where the UK has high mortality), recurrent attendances to hospital, missed appointments, mental health contacts, and difficulties transitioning to adult services, were all associated with increased mortality hazard. Global trends in adolescent mortality mirrored concerns in the UK, with poor progress compared with younger groups, despite most causes of death being preventable. Conclusions Interventions to improve UK CYP mortality require action across multiple health determinants. This should include addressing high levels of CYP poverty, but also further examination of the contribution of health service factors.

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