The equalisation hypothesis and changes in geographical inequalities of age based mortality in England, 2002–2004 to 2008–2010

Abstract

The equalisation hypothesis argues that during adolescence and early adulthood, inequality in mortality declines and begins to even out. However the evidence for this phenomenon is contested and mainly based on old data. This study proposes to examine how age-specific inequalities in mortality rates have changed over the past decade, during a time of widening health inequalities. To test this, mortality rates were calculated for deprivation quintiles in England, split by individual ages and sex for three time periods (2002-2004, 2005-2007 and 2008-2010). The results showed evidence for equalisation, with a clear decline in the ratio of mortality rates during late adolescence. However this decline was not accounted for by traditional explanations of the hypothesis. Overall, geographical inequalities were shown to be widening for the majority of ages, although there was some narrowing of patterns observed.

Are health inequalities between differently deprived areas evident at different ages? A longitudinal study of census records in England and Wales, 1991–2001

“…Studies which adopt the latter comparison tend to conclude that health selective migration does not enlarge inequalities (e.g. Martikainen et al, 2008;& 2013. This approach is analogous to the social mobility research which finds that social class gradients in health are constrained not exaggerated by mobility (e.g.…”

“…Further work should use age-specific rates of different morbidities aggregated across deprivation quintiles to explore whether inequalities are evident at all ages for different illnesses. Given the specific mortality differences found for males and females (Dibben and Popham, 2013;Green, 2013), cause-specific morbidity rates should also be disaggregated by sex.…”

“…Dibben and Popham (2013) investigate these phenomena and provide a compelling argument that in late adolescence, heightened exposure to the risk of land transport accidents increases levels of mortality in the least deprived areas such that inequalities disappear at this age. Using a similar framework, Green (2013) also found an equalisation of mortality differentials in early adulthood but that mortality rates for transport accidents declined during the 2000s in less deprived areas. He concludes (p. 98) that "social inequality is not consistent across the life course and during adolescence there is a clear decline in the level of inequality" and that "equalisation is only truly evident amongst the very elderly.…”

“…Whilst population movements away from more deprived locations tend to exaggerate overall inequalities between areas (Norman et al, 2011), not all studies find this to be the case . In terms of health differences between areas by age, the evidence is also mixed with Kibele and Janssen (2013) determining that mortality variations between areas are exaggerated by migration whilst other studies (Martikainen et al, 2008;& 2013 find that health selective migration does not enlarge inequalities.…”

“…The previous cross-sectional (Dibben & Popham, 2013) and time-series (Green, 2013) analyses are important because they help our understanding of which causes of death have distinctive relationships with age and deprivation. What we add here is the use of morbidity, since self-reported health can have greater area deprivation inequalities than mortality (Norman & Bambra, 2007), and through the use of a longitudinal approach an understanding of the demographic drivers which lead to differences in population structures (Rees et al, 2013).…”