Abstract
SummaryBackgroundDisparities in mortality rates according to socioeconomic position (SEP) have been rising in England. We describe the association between recent changes in socioeconomic inequality and trends in mortality disparities for different age and sex groups at small-area level in England.MethodsVital registration data from the Office for National Statistics on resident population size and number of deaths in each Lower Super Output Area (LSOA) in England from 2002 to 2018 were stratified by sex and 5-year age group. We grouped LSOA into ventiles of the Index of Multiple Deprivation (IMD), our indicator of SEP. We examined time trends in smoothed mortality rates, using 3 year moving averages for the period 2003-2017, by age across the IMD distribution. We measured mortality inequalities using the ratio of mortality rates between different deprivation groups. We calculated mortality rate ratios between the most and the least deprived 10% of areas (Total Inequality) and between the median and least deprived (Lower Inequality) 10% of areas by year, gender and age group, to examine where in the distribution of deprivation trends in mortality inequality arose.FindingsAmong <1 year olds, the inequality in mortality rates between the poorest 10% of LSOAs and the richest 10% of LSOAs fell between 2003 and 2017 by 22•7% for men and 22•8% for women. The largest inequalities were observed among 40 to 54 year olds. This inequality increased over the study period – from 3•2 times higher mortality rates for men in the most as opposed to the least deprived 10% of LSOAs in 2003 to 3•3 times in 2017. The rise was from 2•4 to 2•6 for women. Age groups ≥65 years, who experience the highest mortality risk, had low but rising inequality. Men and women aged 65 to 79 living in the most deprived LSOAs had a mortality rate 1•9 times higher than the least deprived in 2003 but this had increased to 2•2 times higher for women and 2•3 times higher for men by 2017. This was due to rising inequality in both halves of the distribution – between the top 10% of LSOA and the middle, and between the middle and the bottom 10% of LSOA.InterpretationOverall mortality inequality rose in England but there were substantial differences in the trends for specific age and sex groups. Infant and child mortality inequality fell. At older ages, mortality inequality rose across cohorts, although in different ways, as each cohort's exposure to life-course to labour market inequality has differed. Policy goals of reducing mortality inequality will be best met by a focus on the risk factors that are specific to particular age and deprivation groups.FundingEconomic and Social Research Council, through the ESRC Centre for the Microeconomic Analysis of Public Policy at the IFS. We gratefully acknowledge the support of the Nuffield Foundation, grant reference WEL/43603. The project has been funded by the Nuffield Foundation, but the views expressed are those of the authors and not necessarily the Foundation. Visit www.nuffieldfoundation.org. Research at UCL Great Ormond Street Institute of Child Health is supported by the NIHR Great Ormond Street Hospital Biomedical Research Centre.
Highlights
Despite long-term rises in life expectancy and falling mortality [1] in England, mortality rates have not been falling across the Please cite this article as: L
This study included all deaths registered in England between 2002 and 2018 (n= 921 million), of which 518 % were in females, 482% were in males, and 01% (n=56,432) occurred among infants
For
Summary
Despite long-term rises in life expectancy and falling mortality [1] in England, mortality rates have not been falling across the Please cite this article as: L. Following a similar search strategy to Bennet et al (2018), we searched PubMed from its inception up to 7th May 2019 using the terms “life expectancy” AND “inequality” AND (“trend” OR “decomposition”) AND (“England” or “United Kingdom”) and the websites of Office for National Statistics (ONS) and Public Health England (PHE) to update with any new publications since their original search. We identified only one further study of mortality trends in England or the UK by socio-economic position. We found a few papers examining age-specific mortality inequality, we found no papers that explored differences at different parts of the socioeconomic distribution in England. Life course exposures to other risk factors, such as smoking, in earlier time periods are important to consider
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