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. 2017 Aug 28;7(8):e016936.
doi: 10.1136/bmjopen-2017-016936.

Integrating national surveys to estimate small area variations in poor health and limiting long-term illness in Great Britain

Graham Moon  1 , Grant Aitken  2 , Joanna Taylor  3 , Liz Twigg  4
Affiliations

Integrating national surveys to estimate small area variations in poor health and limiting long-term illness in Great Britain

Graham Moon et al. BMJ Open. .

Abstract

Objectives: This study aims to address, for the first time, the challenges of constructing small area estimates of health status using linked national surveys. The study also seeks to assess the concordance of these small area estimates with data from national censuses.

Setting: Population level health status in England, Scotland and Wales.

Participants: A linked integrated dataset of 23 374 survey respondents (16+ years) from the 2011 waves of the Health Survey for England (n=8603), the Scottish Health Survey (n=7537) and the Welsh Health Survey (n=7234).

Primary and secondary outcome measures: Population prevalence of poorer self-rated health and limiting long-term illness. A multilevel small area estimation modelling approach was used to estimate prevalence of these outcomes for middle super output areas in England and Wales and intermediate zones in Scotland. The estimates were then compared with matched measures from the contemporaneous 2011 UK Census.

Results: There was a strong positive association between the small area estimates and matched census measures for all three countries for both poorer self-rated health (r=0.828, 95% CI 0.821 to 0.834) and limiting long-term illness (r=0.831, 95% CI 0.824 to 0.837), although systematic differences were evident, and small area estimation tended to indicate higher prevalences than census data.

Conclusions: Despite strong concordance, variations in the small area prevalences of poorer self-rated health and limiting long-term illness evident in census data cannot be replicated perfectly using small area estimation with linked national surveys. This reflects a lack of harmonisation between surveys over question wording and design. The nature of small area estimates as 'expected values' also needs to be better understood.

Keywords: limiting long-term illness; self-rated general health; small area estimation; survey methodology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Small area estimations versus census estimates: limiting long-term illness (A) and poorer self-reported general health (B).
See this image and copyright information in PMC

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