Age specific trends in mortality disparities by socio-economic deprivation in small geographical areas of England, 2002-2018: A retrospective registry study

Abstract

Summary Background Disparities 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. Methods Vital 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. Findings Among <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. Interpretation Overall 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. Funding Economic 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 Nuff...

Do vaccinations reduce inequality in Covid-19 mortality? Evidence from England

“…They find that one in three premature deaths can be attributed to socioeconomic inequality and that mortality inequality increased during the study period. Kraftman et al (2021) conduct a similar study and also find that overall inequality increased in England during this period, with substantial differences across age groups. Mortality inequality fell for infants and children, but increased for older cohorts.…”

Health inequalities

“…However, conclusions about progress in the UK depend upon how mortality inequality is defined, how geographic units are grouped, and the period under study. Kraftman, Hardelid and Banks (2021) use finer geographic units (LSOAs), and measure mortality inequality as the ratio of mortality in the most deprived to the least deprived decile. Over the 2002-04 to 2015-17 period, the largest inequalities were among 40-to 54-year olds; mortality rates for men and women in this age group were three times higher in the most deprived decile than in the least deprived in 2015-17.…”

“…(Note that premature mortality is one of the components of the Health Deprivation and Disability Domain score, which carries weight in the IMD used by Marmot et al (2020a). and Kraftman, Hardelid and Banks (2021) remove the health domain from the IMD, because its presence introduces a circularity, and will induce an automatic relationship between socioeconomic and physical deprivation and mortality.) Marmot et al (2020a) find a drop of 0.3 years in life expectancy for women in the most deprived decile over the period 2010-12 to 2016-18, and only weak life expectancy growth for women in the next three most deprived deciles.…”