Abstract
OBJECTIVE--To identify relative and absolute changes in mortality in the Northern region of England between 1981 and 1991. DESIGN--1981 and 1991 census data were used to rank 678 wards on an index of material deprivation composed of four variables (unemployment, car ownership, housing tenure, household overcrowding). Standardised mortality ratios (all causes) were calculated for various periods between 1981 and 1991 and for different age categories. SETTING--Counties of Cleveland, Cumbria, Durham, Northumberland, and Tyne and Wear. RESULTS--During 1981-91 mortality differentials widened between the most affluent and deprived fifths of wards in all age categories under 75 years. The decline in the relative position of the poorest areas was particularly great, and there was no narrowing of inequalities across the remainder of the socioeconomic spectrum. In absolute terms, there were improvements in mortality in all age categories in the most affluent areas. In the poorest areas improvements in the 55-64 age group were balanced by increased mortality among men aged 15-44, a slight rise among women aged 65-74, and static rates among men aged 45-54. CONCLUSIONS--These results re-emphasise the case for linking mortality patterns with material conditions rather than individual behaviour.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Blane D., Smith G. D., Bartley M. Social class differences in years of potential life lost: size, trends, and principal causes. BMJ. 1990 Sep 1;301(6749):429–432. doi: 10.1136/bmj.301.6749.429. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fox A. J., Goldblatt P. O., Jones D. R. Social class mortality differentials: artefact, selection or life circumstances? J Epidemiol Community Health. 1985 Mar;39(1):1–8. doi: 10.1136/jech.39.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Marmot M. G., McDowall M. E. Mortality decline and widening social inequalities. Lancet. 1986 Aug 2;2(8501):274–276. doi: 10.1016/s0140-6736(86)92085-4. [DOI] [PubMed] [Google Scholar]
- Morris J. A., Gardner M. J. Calculating confidence intervals for relative risks (odds ratios) and standardised ratios and rates. Br Med J (Clin Res Ed) 1988 May 7;296(6632):1313–1316. doi: 10.1136/bmj.296.6632.1313. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Murray C. J., Chen L. C. In search of a contemporary theory for understanding mortality change. Soc Sci Med. 1993 Jan;36(2):143–155. doi: 10.1016/0277-9536(93)90206-j. [DOI] [PubMed] [Google Scholar]
- Pamuk E. R. Social class inequality in mortality from 1921 to 1972 in England and Wales. Popul Stud (Camb) 1985 Mar;39(1):17–31. doi: 10.1080/0032472031000141256. [DOI] [PubMed] [Google Scholar]
- Phillimore P., Reading R. A rural advantage? Urban-rural health differences in northern England. J Public Health Med. 1992 Sep;14(3):290–299. [PubMed] [Google Scholar]
- Smith G. D., Bartley M., Blane D. The Black report on socioeconomic inequalities in health 10 years on. BMJ. 1990 Aug 18;301(6748):373–377. doi: 10.1136/bmj.301.6748.373. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sterling T. D. Does smoking kill workers or working kill smokers? OR The mutual relationship between smoking, occupation, and respiratory disease. Int J Health Serv. 1978;8(3):437–452. doi: 10.2190/836R-HD65-G8JC-2CLF. [DOI] [PubMed] [Google Scholar]
- Strong P. M. Black on class and mortality: theory, method and history. J Public Health Med. 1990;12(3-4):168–180. doi: 10.1093/oxfordjournals.pubmed.a042542. [DOI] [PubMed] [Google Scholar]
- Wilkinson R. G. Class mortality differentials, income distribution and trends in poverty 1921-1981. J Soc Policy. 1989 Jul;18(3):307–335. doi: 10.1017/s0047279400017591. [DOI] [PubMed] [Google Scholar]