Trends in socio-economic inequalities in female mortality, 2001-08. Intercensal estimates for England and Wales.

BACKGROUND: This article presents estimates of annual mortality rates for women of working age by the National Statistics Socio-economic Classification (NS-SEC) for the period 2001 to 2008. Until recently, it was possible to produce such mortality rates only at the time of the decennial census when populations are enumerated by occupation and NS-SEC. In 2010, ONS published annual intercensal male mortality rates using the Labour Force Survey (LFS) to provide population estimates by age and NS-SEC. This article produces the corresponding estimates for women aged 25 to 59. METHODS: The LFS was used to estimate female populations by age and NS-SEC for each year between 2001 and 2008. Numbers of deaths were obtained from death registrations. For both deaths and populations, the combined method of NS-SEC classification was used, whereby the most advantaged of a married woman's and her husband's NS-SEC was used to assign the woman to an NS-SEC class. Single women were classified according to their own NS-SEC. Age-standardised mortality rates were derived for each NS-SEC class by year and a number of measures of inequality estimated for each year so that any trends could be identified. RESULTS: While overall mortality rates for women declined over the period, this was not true for all NS-SEC classes. Managerial and professional occupations and Routine occupations experienced a statistically significant decline in mortality rate over the period. There was no clear trend for the other classes. Absolute measures of inequality showed no clear trend over the period, but relative inequalities tended to increase. Routine occupations had the greatest decline in mortality rate over the period of approximately five deaths per 100,000 per annum. CONCLUSIONS: Socio-economic inequalities in the mortality rates of women appeared to increase between 2001 and 2008. However, the results for women were not as clear as for men with four out of the seven analytic NS-SEC classes not having a statistically significant downward trend in mortality. The degree of annual volatility in the measures suggests that at the current low levels of mortality of working age women, the LFS could not be used to provide population denominators below the national level. Possibly, three-year moving averages would be better trend indicators, but this would reduce the timeliness of the data to some extent.

Social inequalities in alcohol-related adult mortality by National Statistics Socio-economic Classification, England and Wales, 2001-03.

BACKGROUND: This article is the first analysis of the social inequalities in adult alcohol-related mortality in England and Wales at the start of the 21st century, using the National Statistics Socio-economic Classification (NS-SEC). It presents the socio-economic patterns of alcohol-related mortality by gender, age and region, for England and Wales as a whole, Wales and the regions of England. METHODS: Death registrations provided the number of deaths for working age adults, using the National Statistics definition of alcohol-related mortality. Population estimates for England and Wales in 2001-03 were used to estimate alcohol-related mortality rates by sex, five-year age group, NS-SEC and region. Inequalities were measured using ratios of alcohol-related mortality rates between the least and most advantaged classes. RESULTS: There were substantial socio-economic variations in adult alcohol-related mortality, with the inequalities being greater for women than for men. The mortality rate of men in the Routine class was 3.5 times those of men in Higher and Managerial occupations, while for women the corresponding figure was 5.7 times. Greater socio-economic inequalities in mortality were observed for men aged 25-49 than for men aged 50-64; however the highest mortality rate of men occurred for Routine workers aged 50-54. Women in the Routine class experienced mortality rates markedly higher than other classes. The highest mortality rate of women also occurred for Routine workers, but at a younger age than for men (45-49). Within England, the North-West showed the largest inequalities, with particularly high rates in the Routine class for both sexes. In general, there was no association between levels of mortality and socio-economic gradients in mortality across the English regions and Wales. CONCLUSIONS: Rates of alcohol-related mortality in England and Wales increased significantly for people between the early 1990s and early 21st century, and were substantially greater for those in more disadvantaged socio-economic classes. There is also evidence that these socio-economic differences were greater at younger ages, especially for men at ages 25-49.

Social inequalities in fatal childhood accidents and assaults: England and Wales, 2001-03.

BACKGROUND: This article presents age-specific mortality rates of children for selected causes of accidents and assault using the National Statistics Socio-economic Classification (NS-SEC). The study is an analysis of the social inequalities in fatal childhood accidents and assault at the start of the 21st century. It aims to identify the causes and age groups for which these inequalities are the widest. METHODS: In order to classify children by NS-SEC, the most advantaged class of the biological or adoptive parents was used. Death registrations provided the number of deaths from accidents and assault for children aged from 28 days to 15 years, in England and Wales, between 2001 and 2003. The population of children by NS-SEC and age group was obtained from the 2001 Census. Age-specific mortality rates were estimated. Inequalities were measured using socio-economic gradients in mortality. RESULTS: There were wide social inequalities in fatal accidents and assaults for children aged between 28 days and 15 years. The overall mortality rate in the routine class was 64 per million children aged up to 15, 4.5 times the rate of children with parents in the higher managerial and professional class. The greatest inequalities in accidental mortality for children in that age group were observed for fire and pedestrian accidents, followed by accidental suffocation. Infants at least 28 days but less than one year were subject to the widest inequalities of all age groups in fatal accidents and assault. The highest mortality rate in this study resulted from assault on babies whose parents could not be classified by occupation. Pedestrian and other transport accidents were the greatest causes of death for children between 5 and 15 years old. Inequalities were much larger for pedestrian than for other transport accidents for children aged 14 years and under. The leading cause of death for children aged less than five years was suffocation, followed by drowning and exposure to fire/hot substances. In that age group, the risk of death from exposure to fire was significantly higher for children whose parents could not be classified by occupation. CONCLUSIONS: Substantial social inequalities in childhood mortality from accidents and assault existed in 2001-03. Reducing the large inequalities between the most advantaged class and the most disadvantaged group in the non-occupied category, would make a substantial impact on childhood deaths from accidents and assaults. If the mortality rates in the latter group were the same as in the most advantaged managerial and professional class, deaths of infants of at least 28 days but less than one year, from assault would be reduced by 62 per cent. Deaths from fire, accidental suffocation and pedestrian accidents in the under fives would be reduced by 50 per cent, 25 per cent and 28 per cent respectively. Deaths in pedestrian and transport accidents for children aged 5-15 would be reduced by 25 per cent and 16 per cent respectively.

Social inequalities in female mortality by region and by selected causes of death, England and Wales, 2001-03.

This article reports on social inequalities in female mortality by region and cause of death for women aged 25-59 years in England and Wales in the period 2001-03. It is the first official compilation of detailed mortality statistics for women based on the National Statistics Socio-economic Classification (NS-SEC). It is part of a series of articles measuring inequalities in adult mortality. The results demonstrate a strong socio-economic effect on the mortality of women in all regions. This pattern remained consistent between regions. There were marked differences in the socio-economic gradient by cause. Mortality rates for women in the least and most advantaged NS-SEC classes were similar for breast cancer. In contrast, compared to women in the most advantaged class, mortality rates were three times as high for the least advantaged women for lung cancer and cerebrovascular disease, around five times as high for ischaemic heart disease and all digestive diseases, and six times as high for respiratory diseases.