The relationship between mortality and two indicators of morbidity.

Brennan, Mary E.; Clare, Philip H.

doi:10.1136/jech.34.2.134

Cited by 24 publications

(10 citation statements)

References 4 publications

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“…1 Mortality data can only provide a proxy for health rather than measure it directly, and there has been considerable debate about the limitations of the measure. [2][3][4][5][6] It has also been suggested that the inadequacy of the SMR as an indicator of morbidity would become more marked for lower levels of aggregation because of the smaller number of deaths involved, 3 although to date this suggestion has not been explored. 1 The introduction of a question on limiting long term illness (LLTI) in the 1991 UK census provided for the first time information on perceived levels of morbidity at the small area level.…”

mentioning

confidence: 99%

Interrelations between three proxies of health care need at the small area level: an urban/rural comparison

Barnett

Roderick

Martin³

et al. 2002

Journal of Epidemiology &Amp; Community Health

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Study objective: To examine the relations between geographical variations in mortality, morbidity, and deprivation at the small area level in the south west of England and to assess whether these relations vary between urban and rural areas. Design: A geographically based cross sectional study using 1991 census data on premature limiting long term illness (LLTI) and socioeconomic characteristics, and 1991-1996 data on all cause premature mortality. The interrelations between the three widely used proxies of health care need are examined using correlation coefficients and scatterplots. The distribution of standardised LLTI residuals from a regression analysis on mortality are mapped and compared with the distribution of urban and rural areas. Multilevel Poisson modelling investigates whether customised deprivation profiles improve upon a generic deprivation index in explaining the spatial variation in morbidity and mortality after controlling for age and sex. These relations are examined separately for urban, fringe, and rural areas. Setting: Nine counties in the south west of England. Participants: Those aged between 0-64 who reported having a LLTI in the 1991 census, and those who died during 1991-1996 aged 0-74. Main results: Relations between both health outcomes and generic deprivation indices are stronger in urban than rural areas. The replacement of generic with customised indices is an improvement in all area types, especially for LLTI in rural areas. The relation between mortality and morbidity is stronger in urban than rural areas, with levels of LLTI appearing to be greater in rural areas than would be predicted from mortality rates. Despite the weak direct relations between mortality and morbidity, there are strong relations between the customised deprivation indices computed to predict these outcomes in all area types. Conclusions: The improvement of the customised deprivation indices over the generic indices, and the similarity between the mortality and morbidity customised indices within area types highlights the importance of modelling urban and rural areas separately. Stronger relations between mortality and morbidity have been revealed at the local authority level in previous research providing empirical evidence that the inadequacy of mortality as a proxy for morbidity becomes more marked at lower levels of aggregation, especially in rural areas. Higher levels of LLTI than expected in rural areas may reflect different perceptions or differing patterns of illness. The stronger relations between the three proxies in urban than rural areas suggests that the choice of indicator will have less impact in urban than rural areas and strengthens the argument to develop better measures of health care need in rural areas.

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confidence: 99%

Interrelations between three proxies of health care need at the small area level: an urban/rural comparison

Barnett

Roderick

Martin³

et al. 2002

Journal of Epidemiology &Amp; Community Health

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“…Other critics argued that the correlation of SMRs with General Household Survey morbidity data was even worse sub-regionally (Ferrer, Moore and Stevens 1977;Snaith 1978). However, in a much larger study, Brennan and Clare (1980) found strong correlations below Area Health Authority level between mortality and two measures of sickness from the national census. They concluded that overall mortality could justifiably be used sub-regionally as a proxy for morbidity in allocation.…”

Section: Mortality and Morbidity Correlationsmentioning

confidence: 93%

Measuring Need in the National Health Service Resource Allocation Formula: Standardized Mortality Ratios or Social Deprivation?

Mays

1987

Public Administration

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All methods of dividing public expenditure between competing claims become contentious, particularly when they rely on social indicators of need. The Resource Allocation Working Party (RAW) formula devised in 1976 for distributing National Health Service financial resources fairly between different parts of England relies on the size, age/sex structure and mortality rates (in the form of standardized mortality ratios – SMRS) of populations as combined surrogates for their need for health care. This paper aims to demonstrate three things: first, that RAW'S approach in selecting SMRS was sure‐footed; second, that no better proxy of health care need which could be used in RAW has been produced since RAW; and third, that the continuing criticism of SMRS has been sustained by political pressures within the NHS. The result has been the application of ever more indirect and complex surrogates for‘need in the resource allocation process which are known to be contaminated by the prevailing unequal supply of health service facilities.

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“…Wards were defined as level 1, travel to work areas as level 2 and standard regions as level 3 (subscripts i,jand k respectively). The response variable (Yijk) was the natural logarithm of the health outcome measure (SMRs, SIRs and SPSRs for males and females).…”

Section: Methodsmentioning

confidence: 99%

Effect of labour market conditions on reporting of limiting long-term illness and permanent sickness in England and Wales.

Haynes

Bentham

Lovett

et al. 1997

Journal of Epidemiology & Community Health

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Study objective-To identify any bias in the reporting of limiting long term illness and permanent sickness due to labour market conditions, and show the absence of the effect in mortality rates. Design-A geographically based study using data from the 1991 census. Standardised ratios for mortality and long term illness in people aged 0-64 years and permanent sickness in people of working age were compared with Carstairs deprivation scores in multilevel models which separated the effects operating at three geographical scales: census wards, travel to work areas, and standard regions. Holding ward and regional effects constant, variations between travel to work areas were compared with long term unemployment rates.Setting-Altogether 8690 wards and 262 travel to work areas in England and Wales. Main results-Variations in mortality, limiting long term illness, and permanent sickness were related to Carstairs deprivation scores and standard region. With these relationships controlled, limiting long term illness and permanent sickness were significantly related to long term unemployment levels in travel to work areas, but mortality was not affected. Self reported morbidity was more sensitive to variations in long term unemployment rates in conditions of high social deprivation than in affluent populations. Conclusions-Limiting long term illnessand permanent sickness measures may reflect a tendency for higher positive response in difficult labour market conditions. For average social deprivation conditions, standardised limiting long term illness for people aged 0-64 years was 20% higher in travel to work areas where employment prospects were relatively poor compared with areas with relatively good employment prospects. This casts doubt on the use of limiting long term illness as an indicator of objective health care needs for resource allocation purposes at national level. illness is a selfreported measure and may reflect both "real" health status and other effects, such as differences in the way health is perceived and reported. The relative contribution of such effects to limiting long term illness prevalence rates is therefore of interest, and here we examine the potential influence of labour market conditions on the likelihood of reporting long term illness.The existing evidence of labour market influences on self reported morbidity comes largely from studies of permanent sickness or disability. Data on permanent sickness have been collected in successive UK censuses as a reason given for being unable to work. In the 1991 census the relevant question was: "Which of these things was the person doing last week?" with a range of possible responses including "was unable to work because of long term sickness or disability". Although permanent sickness was one of the few morbidity measures available at the local scale prior to the 1991 census, its use as a measure of general health status has been limited. Only people excluded from employment are covered by the census category, so children, most elderly people, a...

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The relationship between mortality and two indicators of morbidity.

Cited by 24 publications

References 4 publications

Interrelations between three proxies of health care need at the small area level: an urban/rural comparison

Interrelations between three proxies of health care need at the small area level: an urban/rural comparison

Measuring Need in the National Health Service Resource Allocation Formula: Standardized Mortality Ratios or Social Deprivation?

Effect of labour market conditions on reporting of limiting long-term illness and permanent sickness in England and Wales.

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