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North-South disparities in English mortality1965–2015: longitudinal population study
  1. Iain E Buchan1,2,3,
  2. Evangelos Kontopantelis1,2,3,4,
  3. Matthew Sperrin1,2,3,
  4. Tarani Chandola5,
  5. Tim Doran6
  1. 1 Farr Institute, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
  2. 2 Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
  3. 3 NIHR Manchester Biomedical Research Centre, Central Manchester Foundation NHS Trust, Manchester, UK
  4. 4 School for Primary Care Research, Radcliffe Observatory Quarter, National Institute for Health Research, Manchester, UK
  5. 5 School of Social Sciences, University of Manchester, Manchester, UK
  6. 6 Department of Health Sciences, University of York, York, UK
  1. Correspondence to Professor Iain E Buchan, University of Manchester, Vaughan House, Portsmouth St, Manchester M13 9GB, UK; buchan{at}


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.

  • inequalities
  • mortality
  • geography

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  • Contributors IB designed the study in consultation with all authors. EK extracted the data from all sources and performed the analyses with MS and IB. IB, EK, MS, TD and TC wrote the manuscript. IB is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding This work was supported by MRC Health eResearch Centre grant MR/K006665/1 and the NIHR Manchester Biomedical Research Centre grant.

  • Competing interests None declared.

  • Patient consent The MRC Health eResearch Centre's patient and public involvement group H@PPI ( has advised on: the dissemination plans for this work, including social media and ways the results might be updated and rebroadcast when ONS publish new data.

  • Ethics approval This study did not require ethics approval as it used only publicly available population level data.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data used in this study are freely available from the authors upon request.

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