Investigating Health Inequalities Using Mortality Data

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Investigating Health Inequalities Using Mortality
Data

• Doris HainInformation Specialist
• Erpho
• 13 Jan 2009

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Health Inequalities setting the scene

• Health inequalities exist between various social
  groups genders, ethnic groups, occupations,
  geographical areas, etc.

This presentation is mostly about variations in
mortality due to deprivation.

• We use the deprivation score (IMD2007) of the
  area as a proxy for the social status of the
  person who died (?services, detailed information).

• By grouping similarly deprived areas into fifths
  and by pooling 3 years death data, we accumulate
  sufficiently big numbers to get statistically
  significant results.

The focus is on the gap between the most deprived
and other groups and the change in this gap over
time.
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Health Inequalities measuring the gap
Mortality rates are, generally speaking, falling,
but
the gap is widening, if policies dont
successfully counteract this trend.
Trend in all age, all cause mortality (DSR) of
the most deprived 20 against the rest of the
population in the East of England
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Health Inequalities measuring the gap
Absolute gap Worse off Reference group
Limited comparability because it depends on the
context
Worse off Reference group Reference
group
Relative gap
for Life expectancy (-1)
With falling rates, a narrowing of the gap in
relative terms is harder to achieve !
Absolute gap 100Relative gap 25
Absolute gap 100Relative gap 50
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Health Inequalities - Essex vs East of England ?
With one quarter of the population, Essex
contributes too much to the East of England to be
significantly different.
Essex PCTs (incl. Thurrock and Southend) have a
share of 5-7 of the total population each
significantly worse than East of England
not significantly different from the East of
England
significantly better than East of England
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Health Inequalities - within Essex

• Death data analysed by gender, for
• all age, all cause mortality ,
• premature mortality (under 75) from all
  causes, cancers,
• circulatory diseases,
• smoking attributable mortality, and
• life expectancy.
• ( under 15 mortality)

• For the most deprived fifth of areas in
  comparison with
• the least deprived fifth (bottom/top)
• the area in total (bottom/average)
• all the rest (20/80)
• the East of England

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Essex Deprivation Quintiles by Middle Layer
Super Output Areas
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Health Inequalities - within Essex
Life expectancy
Rising but the most deprived not as fast as the
rest. All gaps between most deprived and the rest
are significant in Essex, apart from female
cancer .
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Health Inequalities - within Essex
All age, all cause mortality
Deprived males are improving more but from a much
worse level. Female gaps tend to be narrower but
seem to be widening here.
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Health Inequalities - within Essex
Changes in inequalities in all age, all cause
mortality
Unclear trend for males overall much flatter
curve than females. Female gaps seem to soar
now almost as big as male gap.
Males
Females
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Health Inequalities - within Essex
Premature mortality (under 75) from circulatory
disease
Females Half the rate but less favourable
development. Bottom fifth stands out the rest
is very similar.
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Health Inequalities - within Essex
Changes in inequalities in premature mortality
from circulatory disease
Slow widening of the relative gap for males,
rapid widening for females. Absolute gap for
males slightly narrowing (59?54) and widening for
females (18?30).
Males
Females
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Health Inequalities - within Essex
Premature mortality (under 75) from cancer
Female and male rates more similar and gaps
smaller. Some female gaps not even significant.
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Health Inequalities - within Essex
Changes in inequalities in premature mortality
from cancer
More varied picture. Male relative gaps seem to
fall female unclear trend. Best off dont
stand out.
Males
Females
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Health Inequalities - within Essex
Smoking-attributable mortality
Scale! Female Male/2 Female absolute gap width
Male/2, but male gap static, female gap growing
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Health Inequalities - within Essex
Changes in inequalities in smoking-attributable
mortality
Female gaps are widening massively, gentle rise
for males.
Females
Males
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Health Inequalities - Life expectancy within
Essex PCTS
South East Essex
West Essex
North East Essex
Mid Essex
South West Essex
Essex County
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Health Inequalities - Smoking deaths within
Essex PCTS
South East Essex
West Essex
North East Essex
Mid Essex
South West Essex
Essex County
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Health Inequalities summary

• Health in the most deprived areas is generally
  worse than everywhere else (not just best off
  areas).

• Falling numbers make it difficult to reduce the
  relative gaps absolute gaps tend to be roughly
  constant.

• Male health shows worse figures and bigger
  (absolute) gaps than female results, but
  generally the more encouraging trends.

• There seems to be an indication of an emerging
  problem in female health inequalities All
  (relative) gaps appear to be widening in recent
  years, some at a massive rate.

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Health Inequalities Profiles 2008 All data and
charts downloadable from http//www.erpho.org.uk/
viewResource.aspx?id18243 Thank you!