Life expectancy in Ireland is now above the EU average, demonstrating the success achieved in supporting people to maintain good health as well as providing access to effective healthcare services during illness, according to the annual report of the HSE for 2020.
Life expectancy has risen by two years for women and 2.5 years for men since 2008, with women living to 84.1 years and men to 80.5 years in 2018. The most significant increase in life expectancy is driven by reduced mortality rates from major diseases. However, life expectancy is socially patterned and remains lower for unskilled workers compared to professional workers.
The HSE is responsible for providing healthcare to the population of Ireland, estimated to be 4.98 million in April 2020. This representsa population increase of 55,900 from April 2019 which, with the 64,500 increase seen in 2018/2019,is the largest annual increase since 2008. The population is growing across all regions and age groups, with the most significant growth seen in the older age groups.
The number of people aged 65 years and over has increased by 35.2% since 2009, more than double the EU average of 16% in the same period. Latest population projections indicate a 38% increase in the number of people aged over 65 years by 2031 anda 68% increase in the population aged over 85 years.
The annual report says population ageing presents a significant challenge for health service planning, exacerbated in 2020 by the impact of COVID-19. The rate of inpatient hospital care is over seven times greater among people aged 65 years and older, and 14 times greater for those aged 80 and over, compared to people aged 64 and younger. Similar patterns are seen across other health services including primary and community care services.
Health of the Population
Cancer, cardiovascular disease and respiratory disease continue to be the three most common chronic diseases, accounting for three quarters of deaths in Ireland although, overall, age-standardised mortality rates have declined. Approximately 32% of those over 18 years of age currently have one or more chronic diseases.
Over the past decade, the age-adjusted cancer incidence in Ireland is slowly declining for males and is stable for women. However, assuming that population cancer risk remains stable, demographic changes will lead to an approximate doubling of the number of cancers (excluding non-melanoma skin cancer) to 43,000 cases overall by 2045.
Frailty is estimated to affect 12.7% of adults aged 50 years and over and 21.5% of people aged 65 and over in Ireland. It is a significant risk factor for falls, deterioration in mental health and cognition, and disability among older adults which contributes to an increased need for health and social care services.
The suicide rate in 2018 was 9 per 100,000 (excluding late registered deaths) which is below the EU average for both males and females. However, both self-harm presentations to hospital (11,600 in 2017) and suicide in the 15-19 age cohort are above European averages. The age-standardised rate of individuals presenting to hospital following self-harm in 2019 was 206 per 100,000. This was 2% lower than the rate in 2018 and 8% lower than the peak rate recorded in 2010 (223 per 100,000).
The 2016 Census reported that 643,000 people (13.5%) had a longstanding illness or difficulty indicative of a disability. This represented an increase of 48,000 (8%) since 2011. Of these 224,000 (34.9%) were aged 65 years and over and 59,000 (9.2%) were aged less than 15 years.
Our social environment is a key determinant of health status. Poverty, socio-economic status and health are strongly interconnected. Census 2016 reported that 22.5% of the population were exposed to disadvantage and that between 2011 and 2016, the numbers exposed to deprivation increasedby 9.1% with those living in extreme disadvantage increasing by 9.8%. For those living in the most deprived areas, life expectancy at birth of males and females in 2016 was 79.4 and 83.2 years respectively compared to 84.4 and 87.7 years respectively for those living in the most affluent areas.
Mitigating Disadvantage In 2020
The COVID-19 pandemic again highlighted the importance of improving access to health services to help mitigate disadvantage. At the end of the year, almost 1.6 million people in Ireland held a medical card and almost 530,000 held a general practitioner (GP) visit card, making it easier to access essential healthcare.
Ethnic and minority groups within our population include Travellers (30,987), international protection applicants (1,566 applications for international protection received in 2020, a 67% decrease on figures for 2019) and those who are homeless (6,032 adults and 1,034 families listed as homeless).
Research has shown that marginalised groups have a lower life expectancy and more complex health needs than the general population, and the improvement of health outcomes for these groups is a key priority.