Widening inequality of health in northern England, 1981-91

Abstract Objective: To identify relative and absolute changes in mortality in the Northern region of England between 1981 and 1991. Design: 1981 and 1991 census data were used to rank 678 wards on an index of material deprivation composed of four variables (unemployment, car ownership, housing tenure, household over-crowding). Standardised mortality ratios (all causes) were calculated for various periods between 1981 and 1991 and for different age categories. Setting: Counties of Cleveland, Cumbria, Durham, Northumberland, and Tyne and Wear. Results: During 1981-91 mortality differentials widened between the most affluent and deprived fifths of wards in all age categories under 75 years. The decline in the relative position of the poorest areas was particularly great, and there was no narrowing of inequalities across the remainder of the socioeconomic spectrum. In absolute terms, there were improvements in mortality in all age categories in the most affluent areas. In the poorest areas improvements in the 55-64 age group were balanced by increased mortality among men aged 15-44, a slight rise among women aged 65-74, and static rates among men aged 45-54. Conclusions: These results re-emphasise the case for linking mortality patterns with material conditions rather than individual behaviour.