Has working-age morbidity been declining? Changes over time in survey measures of general health, chronic diseases, symptoms and biomarkers in England 1994-2014

Objectives: As life expectancy has increased in high-income countries, there has been a global debate about whether additional years of life are free from ill-health/disability. However, little attention has been given to changes over time in morbidity in the working-age population, particularly outside the US, despite its importance for health monitoring and social policy. This study therefore asks: what are the changes over time in working-age morbidity in England over two decades? Design, setting and participants: We use a high-quality annual cross-sectional survey, the Health Survey for England (‘HSE’) 1994-2014. HSE uses a random sample of the English household population, with a combined sample size of over 140,000 people. We produce a newly-harmonised version of HSE that maximises comparability over time, including new non-response weights. While HSE is used for monitoring population health, it has hitherto not used for investigating morbidity as a whole. Outcome measures: We analyse all 39 measures that are fully comparable over time – including chronic disease diagnoses, symptomatology and a number of biomarkers – adjusting for gender and age. Results: We find a mixed picture: we see improving cardiovascular and respiratory health, but deteriorations in obesity, diabetes, some biomarkers, and feelings of extreme anxiety/depression, alongside stability in moderate mental ill-health and musculoskeletal-related health. In several domains we also see stable or rising chronic disease diagnoses even where symptomatology has declined. While data limitations make it challenging to combine these measures into a single morbidity index, there is little systematic trend for declining morbidity to be seen in the measures that predict self-reported health most strongly. Conclusions: Despite considerable falls in working-age mortality – and the assumptions of many policymakers that morbidity will follow mortality – there is no systematic improvement in overall working-age morbidity in England from 1994 to 2014.