Magnetic resonance imaging to assess familial risk in relatives of women with endometriosis

Abstract

In places where the population has shrunk, the average mortality is high compared with places in which the population has grown. The correlation between population change and all-cause standardised mortality ratios was –0·62 (p<0·001); for standardised mortality ratios for the male population, the correlation was –0·68 (p<0·001); and for the female population was –0·50 (p<0·001). All correlations were weighted by population size in 1991, but weighting made little difference to the findings. Analysis of male and female cause-specific mortality showed strong correlations between population change and most broad cause-of-death groups (accidental deaths excepted). To investigate whether the relation between population change and mortality merely reflects differences in degree of deprivation, we calculated partial correlations between allcause standardised mortality ratios in men and women together and population changes between 1971 and 1991, controlling for the proportion of the population in social classes IV and V or with unclassified social class in 1991. The correlation was weakened but remained substantial at –0·49 (p<0·001). Finally, we found the correlations between population change between 1971 and 1991 and change in standardised mortality ratio during 1969–73 and 1990–92 to be –0·37 (p<0·001), which suggests that change in population size and change in mortality accompany each other. Although most studies have tended to focus on economic factors (work and wages), people also move to improve their physical and social environment. The quality of life factors include issues such as cost of living, the image and ambience of a place, available amenities and services, notions of community, crime, pace of life, degrees of pollution, healthcare provision, and quality of housing. 2–4 These factors are thought to underlie differences in health statuses between areas, but they are not adequately indexed by conventional measures of deprivation. The people who remain in shrinking areas need environmental improvement and health services. At present, resources are allocated largely according to population size, and local and health authority budgets have therefore fallen most in these shrinking areas over time. New funding arrangements, such as health action zones 5 will not reverse this trend.