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Multicenter Study
. 2010 Jul 22:341:c3639.
doi: 10.1136/bmj.c3639.

Inequalities in premature mortality in Britain: observational study from 1921 to 2007

Bethan Thomas  1 , Danny Dorling, George Davey Smith
Affiliations
Multicenter Study

Inequalities in premature mortality in Britain: observational study from 1921 to 2007

Bethan Thomas et al. BMJ. .

Abstract

Objective: To report on the extent of inequality in premature mortality as measured between geographical areas in Britain.

Design: Observational study of routinely collected mortality data and public records. Population subdivided by age, sex, and geographical area (parliamentary constituencies from 1991 to2007, pre-1974 local authorities over a longer time span).

Setting: Great Britain.

Participants: Entire population aged under 75 from 1990 to 2007, and entire population aged under 65 in the periods 1921-39, 1950-3, 1959-63, 1969-73, and 1981-2007.

Main outcome measure: Relative index of inequality (RII) and ratios of inequality in age-sex standardised mortality ratios under ages 75 and 65. The relative index of inequality is the relative rate of mortality for the hypothetically worst-off compared with the hypothetically best-off person in the population, assuming a linear association between socioeconomic position and risk of mortality. The ratio of inequality is the ratio of the standardised mortality ratio of the most deprived 10% to the least deprived 10%.

Results: When measured by the relative index of inequality, geographical inequalities in age-sex standardised rates of mortality below age 75 have increased every two years from 1990-1 to 2006-7 without exception. Over this period the relative index of inequality increased from 1.61 (95% confidence interval 1.52 to 1.69) in 1990-1 to 2.14 (2.02 to 2.27) in 2006-7. Simple ratios indicated a brief period around 2001 when a small reduction in inequality was recorded, but this was quickly reversed and inequalities up to the age of 75 have now reached the highest levels reported since at least 1990. Similarly, inequalities in mortality ratios under the age of 65 improved slightly in the early years of this century but the latest figures surpass the most extreme previously reported. Comparison of crudely age-sex standardised rates for those below age 65 from historical records showed that geographical inequalities in mortality are higher in the most recent decade than in any similar time period for which records are available since at least 1921.

Conclusions: Inequalities in premature mortality between areas of Britain continued to rise steadily during the first decade of the 21st century. The last time in the long economic record that inequalities were almost as high was in the lead up to the economic crash of 1929 and the economic depression of the 1930s. The economic crash of 2008 might precede even greater inequalities in mortality between areas in Britain.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that all authors had: no financial support for the submitted work from anyone other than their employer; no financial relationships with commercial entities that might have an interest in the submitted work; and no non-financial interests that may be relevant to the submitted work.

Figures

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Fig 1 Gini coefficient of equivalised inequality in income after tax and before housing costs, 1961 to 2007-8. Data are for Great Britain before 2002-3 and for UK subsequently. Source: Institute for Fiscal Studies
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Fig 2 Difference in life expectancy at birth between the best and worst off districts, 1999-2008
See this image and copyright information in PMC

Comment in

References

    1. Department of Health. Independent inquiry into inequalities in health. Stationery Office, 1998.
    1. Department of Health. Tackling health inequalities: 10 years on. Department of Health, 2009.
    1. Marmot M, Atkinson T, Bell J, Black C, Broadfoot P, Cumberlege J, et al. Fair society, healthy lives: the Marmot Review Executive Summary. Marmot Review Team, 2010.
    1. Dorling D, Thomas B. Geographical inequalities in health over the last century. In: Graham H, ed. Understanding health inequalities. Open University Press, 2009.
    1. Davey Smith G, Dorling D, Mitchell R, Shaw M. Health inequalities in Britain: continuing increases up to the end of the 20th century. J Epidemiol Community Health 2002;56:434-5. - PMC - PubMed

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