25 April 2023
Health: underlying cause of death, life expectancy, and healthy life expectancy
This Statistical Bulletin presents new estimates of the underlying cause of death for people dying on St Helena between 2003 and 2022, and estimates of life expectancy and healthy life expectancy. The new estimates of underlying cause of death and healthy life expectancy were first prepared by the Statistics Office for the 2022 St Helena Health Joint Strategic Needs Assessment, which was conducted by the St Helena Government and the UK Health Security Agency.
Download this Bulletin, or get the data
A PDF version of this Bulletin can be downloaded here. A data file in Excel format with statistics on health (underlying cause of death, life expectancy, and healthy life expectancy) can be downloaded here.
Underlying cause of death, 2003-22
Cardiovascular diseases, malignant neoplasms (i.e. cancers), and diabetes accounted for around 31 deaths per year, on average, over the last two decades, which is around 60% of all deaths on the island. Of these three groups, cardiovascular diseases accounted for most deaths, just over fifteen per year. Cancers were the underlying cause for 11 deaths per year, and diabetes was the underlying cause for five deaths per year (Chart 1).
Chart 1. Underlying cause of death, average number of deaths per year (2003 to 2022)
Chart 1 illustrates the similarities and differences in the underlying cause of male and female deaths. Cardiovascular disease was the largest underlying cause for deaths of both men and women, and the prevalence was similar: it caused 29% of male deaths and 32% of female deaths. However, men were more at risk from dying due to cancer than women, with 25% of male deaths compared to 18% for women.
Within the group of cardiovascular diseases, the three most common causes of death for both males and females in 2003 to 2022 were ischaemic heart disease (where the heart has insufficient oxygen), stroke, and hypertensive heart disease (i.e. caused by high blood pressure) (Chart 2). During this period, males were more susceptible to both ischaemic heart disease than females: 44% of all male cardiovascular disease deaths, compared to 32% of female cardiovascular deaths.
Chart 2. Major underlying causes of death within the cardiovascular disease group, 2003 to 2022, number of deaths
Within the group of cancers (i.e. malignant neoplasms) that were an underlying cause of death, the most common types among men were trachea, bronchus and lung cancer, colon and rectum cancer, and stomach cancer. These three cancers accounted for 79 male deaths between 2003 and 2022 (Chart 3). Among women, the most common types were breast cancer, colon and rectum cancers, and pancreatic cancer. These three cancers accounted for 29 female deaths between 2003 and 2022.
Chart 3. Major underlying causes of death within the malignant neoplasm disease group, 2003 to 2022, number of deaths
Life expectancy and healthy life expectancy
Life expectancy is the average number of years lived by people who have died in a particular period. It varies by age and by sex, and typically the longer a person lives, the longer their life expectancy will be. For example, the life expectancy of a male at birth on St Helena is estimated to be around 74, based on the deaths that occurred between 2013 and 2022. But for males who have already lived to 60 years of age, their average life expectancy is estimated to be around 81, an additional 21 years. Similarly, the life expectancy of a female at birth is estimated to be 81, and females who have lived to 60 have a life expectancy of 85, an additional 25 years.
Healthy life expectancy is an alternative measure of life expectancy that takes account of the health of individuals. It is derived from a question in the 2021 Population Census that asked ‘How is your health in general’; answers ‘very good’, ‘good’ and ‘fair’ are taken to indicate reasonable health, and ‘poor’ and ‘very poor’ to indicate an unhealthy state. For St Helena, males at birth have a healthy life expectancy of around 59. But at 60 years of age healthy life expectancy rises to 71 – an expected additional 11 years of healthy life. Females have a healthy life expectancy of 60 at birth, and around 72 at 60 years of age – an expected additional 12 years of healthy life.
Chart 4. Life expectancy (2013 to 2022) and healthy life expectancy (2021)
Underlying cause of death. These estimates are derived from the St Helena register of deaths. Conditions are stated on the death register in two parts: Part I lists the diseases or conditions directly relating to the death, in antecedent order (a, b and c), and Part II lists other significant conditions contributing to the death, but not related to the disease or condition causing it.
The St Helena death register includes all deaths that occur on St Helena; since 2018, deaths of residents that occur abroad (for example, during a medical referral overseas) may also be registered on St Helena, although this is not compulsory. Because of the relatively small numbers involved, deaths classified by underlying cause are grouped into decades (i.e. periods of ten years), rather than reported in single years.
For statistical purposes the International Statistical Classification of Disease and Related Health Problems (ICD-10) underlying cause of death codes are assigned to each death, using the World Health Organisation ICD-10 on-line browser and the ICD-10 mortality coding rules in Chapter 4 of Volume 2 of the ICD-10 manual. A freely available software coding application (‘Iris’) is used to help ensure that the complex ICD-10 mortality coding rules are followed; this is developed and maintained by the Iris Institute within the German Federal Institute for Drugs and Medical Devices, and is used in Europe and in the UK.
For tabulation and analysis purposes, underlying cause of death codes have been grouped according to the classification used by the World Health Organisation in their latest estimates of country-level deaths by cause for years 2000-2019, which can be found in Annex A of the WHO Global Health Estimates Technical Paper WHO/DDI/DNA/GHE/2020.2.
Life expectancy and healthy life expectancy. Life expectancy is an estimate of the average years lived after a specific age, based on the population and death rates prevalent for those that have died in the previous ten years (ten years is used for St Helena as the population is relatively small; typically, larger countries calculate life expectancy from deaths in the previous one or two years).
Healthy Life Expectancy is an estimate of the average years lived after a specific age in a very good, good, or fair state of health, as self-reported in the 2021 Census; additionally, all those in hospital or in the Community Care Centre on Census Night are assumed to be in a poor state of health. The methodology for calculating both life and healthy life expectancy is based on a standard life table, using a template provided by the UK Office for National Statistics.
Note that summary statistics on life expectancy are also provided in the Statistics Office data file on population and demography: ‘Population.xls”.
Contact us and find out more
The team at the Statistics Office currently comprises Neil Fantom, Statistical Commissioner, and Kelly Clingham and Justine Joshua, Senior Statistical Assistants. Please visit us in person; the Statistics Office is on the second floor of the Post Office, Jamestown. Call by, we would love to see you! You can also contact us by telephone: our direct line is 22138. If calling from overseas, the international dialling code for St Helena is +290. Our general office email address is: email@example.com, or you can email team members directly (the format is firstname.lastname@example.org). For more statistical data and reports, covering many aspects of St Helena’s social and economic development, please visit us on the web: www.sainthelena.gov.sh/st-helena/statistics.