The government has made tackling health inequalities one of its top priorities. This article investigates spatial variations in mortality in the region and demonstrates that whilst life expectancy is rising, mortality disparities are widening

Brown, Dominic

Rees, Phil

University of Queensland eSpace

THE REGIONAL REVIEW MAY 2002 
 
IS YORKSHIRE AND THE HUMBER SUFFERING FROM 
WIDENING HEALTH INEQUALITIES? 
 
DOMINIC BROWN AND PHIL REES 
UNIVERSITY OF LEEDS 
 
The government has made tackling health inequalities one of its top priorities. This article investigates spatial variations in 
mortality in the region and demonstrates that whilst life expectancy is rising, mortality disparities are widening. 
 
Patterns of health across the United Kingdom are well known with areas in Scotland, Wales and the North East of England 
consistently found to experience the worst levels of health. In contrast to this, southern England and especially areas in the South 
East experience the best levels of health. This broad regional analysis does not provide information on the extent to which 
health inequalities operate at finer spatial scales. In this article, we consider trends in health inequalities within Yorkshire and 
the Humber at the ward and district scales (including Unitary Authorities) by looking at mortality disparities. 
Our research compares two periods, 1990-1992 and 1996-1998, using levels of inequality experienced by the whole population 
but also by different demographic and social groups. Standardised mortality ratios (SMRs) and life expectancy at birth have been 
calculated and used as indicators of health status. SMRs are death rates adjusted to remove the influence of age structure. To 
calculate the SMRs and life expectancy statistics, annual mortality figures and mid-year populations at risk have been averaged 
over three years to account for yearly variation in the data. Townsend deprivation scores have been used to quantify deprivation in 
1991, whilst the DETR/ DTLR Index of Multiple Deprivation 2000 was used to quantify deprivation in 1998. All the results are 
presented for 1998 geographical boundaries, with all statistics harmonised to this standard year. 
 
INTRA-REGIONAL MORTALITY 
Areas in rural North Yorkshire generally experience lower levels of mortality than those areas in the mostly urban and 
industrial South Yorkshire. Furthermore, the relatively affluent suburban areas also display lower mortality levels than the more 
deprived inner city areas. These trends are evident in Figure 1, which shows male SMRs in 1990-92, but are also consistent 
over time with the distribution of mortality in 1996-98 following similar patterns. 
Lower Swaledale, a ward in Richmondshire, has the lowest male SMR for both time periods, values of 14 and 38 respectively. 
In contrast, Tong and Bradford Moor, both wards of Bradford, have the highest male SMRs, of 153 and 150 respectively, in 1990-
92. In 1996-98, these two wards were still amongst the worst in the region but were not as low in the rankings as they were in 
1990-92. Scorton ward in Richmond was also amongst the worst five wards in both periods, with SMRs of 158 and 162 
respectively. 
Wards in North Yorkshire on average have the lowest SMRs, whilst wards in South Yorkshire have the highest. This is 
consistent for both 1990-92 and 1996-98. North Yorkshire, though, consistently has the highest standard deviations (21.95 and 
22.18) showing that it has a large range of SMRs as indicated by the maximum and minimum for the region being 14 and 158 
respectively in 1990-92 and 28 and 174 in 1996-98. The standard deviations for SMRs in the Humber for both periods are also 
high. This is explained by the relatively low SMRs in the rural parts of the county and the high SMRs in the urban areas, such 
as in Kingston-upon-Hull. 
 
LIFE EXPECTANCY 
It is evident that areas of worst health have persisted over the decade. In 1990-92 and 1996-98, average district life expectancy 
at birth was lower in the region than for England and Wales for both males and females. The 1996-98 levels, though, were 
higher than those for 1990-92 indicating absolute improvements in health over the period (Table 1). Average district life 
expectancy figures mask inter-district variation as shown by the maximum and minimum figures calculated. Ryedale was 
consistently found to have the longest life expectancy for males and females over both time periods. Bradford and Calderdale had 
the lowest life expectancies in 1990-92 for males and females, though in 1996-98, Kingston upon Hull and Barnsley had the 
lowest life expectancies at birth. 
Ordering the expectancies into quintiles and comparing the average life expectancy for the highest and lowest quintiles 
provides interesting results (Table 2). It is evident that inequalities for males are consistently higher than for females over the 
time period. It is also apparent that the difference between the highest and lowest quintiles for males and females is widening 
over time. 
 
Figure 1. Male SMRs for wards in Yorkshire and the Humber, 1990-92 and 1996-98 
 
TABLE 1. Life expectancy at birth (in years) by gender for all districts in Yorkshire and the Humber, 1990-92 and 1996-
98 
 
 
TABLE 2. Average life expectancy at birth (in years), by quintile, for districts and wards in Yorkshire and the Humber, 
1990-92 and 1996-98 
 
 
TABLE 3. IMD scores for districts in Yorkshire and the Humber, 1990-92 and 1996-98 
 
 
In 1990-92, the lowest male quintile had an average life expectancy of 71.9 years, compared to 74.7 years for the highest 
quintile – a difference of 2.8 years. In 1996-98, this difference increased by 0.6 years to 3.4 years difference in life expectancy. This 
trend was also true for females, though the differences were less: 2.0 years in 1990-92 and 2.7 years in 1996-98. Analysis of 
these trends at the ward scale reveals even more startling differences as shown in Table 2. It is clear from these results that 
health inequalities in the region are widening and that the gap between the lowest and highest quintiles is greater at the ward scale 
than for districts. It is also evident that males experience greater inequalities than females. 
 
 
Figure 2. Male adult relative index of inequality, 1990-92 and 1996-98 
 
FURTHER INDICES OF MORTALITY DISPARITY 
Attention now focuses on mortality inequalities by age group. Standardized mortality ratios were calculated for three age 
groups using the age disaggregation in the vital statistics data as a guide to the groupings – children, adults and the retired. 
Two indices were used to quantify more precisely the degree of inequality in mortality experience: the Index of 
Mortality Disparity (IMD) and the Relative Index of Inequality (RII) (Dorling et al., 2000; Dorling personal communication, 
2002). These indexes use the information for all wards and districts, whereas the previous measures are dependent on fewer 
observations. The IMD compares the relative distribution of population to the relative distribution of mortality. The absolute 
difference between the two distributions is summed over the whole region and then divided by two. The index has a range 
from 0 to 100 with 0 indicating an even distribution of mortality, whilst 100 indicates a very uneven distribution. 
In this analysis, the IMD has been used to measure the inequality in mortality distributions within different demographic 
groups both at district and ward scales, whilst the RII is used to investigate the inequality experienced between different types of 
groups (social or economic). In this analysis the calculation of the RII involves plotting a ward’s ‘transformed ordered 
deprivation score’ against its SMR. The transformation process involves ordering the wards according to deprivation, from 
lowest to highest, and then calculating the percentage of the region’s population more deprived than the population of each 
ward. A regression line is then fitted and the index score calculated as the slope of the line divided by its intercept (where the 
line cuts the vertical axis). 
IMD inequalities were found to be higher for males than females both at district and ward scales. Disaggregating the 
indices by age shows that inequalities within the retired age groups are consistently the lowest 
over the time period, with retired females having the lowest levels of inequality. The child age groups show great variability 
between gender and years – caused by the relatively low levels of mortality on which the figures are based. As a result of this, 
it is the adult ages for both males and females that show the most constant levels of greater inequality. 
Table 3 shows that the male adult age group has shown the greatest change over time (difference calculated as 1996-98 
score minus 1990-92 score). Therefore not only is mortality distribution between male adults amongst the most unequal in the 
region, it is also the age group in which inequalities are growing the fastest. 
These trends persist when examined in relation to deprivation. Results for the analysis using the RII are consistent with 
that of the IMD. The scores demonstrate that inequalities in mortality ratios between affluent and deprived wards are 
widening over time, with male adult mortality ratios widening the most. The RII score is 0.90 in 1990-92 and 1.31 in 1996-
98 (Figure 2). This is still true when wards are ordered into quintiles to remove the effect that extreme wards will have on the 
results. 
 
CONCLUSION 
 
In conclusion, it has been shown that absolute levels of health in the region are increasing. People’s health improved 
between 1990-92 and 1996-98 as shown by life expectancy at birth increasing by an average of 1.5 years for districts in the 
region. Relative improvements in health, though, have been variable between areas. At both district and ward scales, it has been 
shown that relatively healthy areas have been getting healthier at a faster rate than the least healthy areas. This has led to 
increased polarisation of results and so an increase in mortality inequality between areas has resulted. It has also been found 
that males experience greater levels of inequality than females and the retired age groups show the lowest levels of 
inequality and adult ages the greatest. 
 
 
REFERENCE 
Dorling, D., Davey Smith, G. and Shaw, M. (2000) Analysis of trends in premature mortality by Labour voting in the 1997 
general election, British Medical Journal, 322: 1336-7. 
 


Is Yorkshire and the Humber Suffering from Widening Health Inequalities?

http://espace.library.uq.edu.au/view/UQ:7910/pr_rr_may02.pdf

Is Yorkshire and the Humber Suffering from Widening Health Inequalities?

Abstract

Similar works

Full text

Available Versions

University of Queensland eSpace