Trends in social inequalities in male mortality, 2001-08. Intercensal estimates for England and Wales.

BACKGROUND: This article presents estimates of mortality rates for men of working age by the National Statistics Socio-economic Classification (NS-SEC). Previously it has been possible to produce such mortality rates only at the time of a census, when populations are enumerated by occupation and NS-SEC. This is the first time that annual intercensal estimates have been produced, enabling the measurement of health inequalities by NS-SEC for the period 2001-08. METHODS: The Labour Force Survey (LFS) was used to provide population denominators by age and NS-SEC for men aged 25-64 for each year between 2001 and 2008. Numbers of deaths for the corresponding period were obtained from death registrations, and age-standardised mortality rates were derived. A number of measures of the inequality in mortality rates across socio-economic classes were compared. RESULTS: There has been a steady decrease in mortality rates for all NS-SEC classes over the period, 2001-08. Mortality rates for the 'Routine' class declined on average by around 11 deaths per 100,000 population per year, almost double that of the 'Higher managerial and professional' class. Absolute differences between the mortality of the least and most advantaged classes showed a small decline based on three different measures. Relative differences, however, increased over this period. In 2001 the mortality rate of those in routine and manual occupations was 2.0 times that of those in managerial and professional occupations. In 2008 that ratio had risen to 2.3. This pattern of declining absolute but rising relative inequalities is a well known phenomenon in the context of declining overall mortality rates. CONCLUSIONS: The results presented suggest that annual trends in inequalities in mortality at the national level can be effectively monitored using LFS-based measures. This would complement the current measures that are based on area of residence rather than the socio-economic position of the individual.

Intercensal denominators - feasibility of using the Labour Force Survey to estimate mortality rates by NS-SEC.

BACKGROUND: The purpose of this analysis is to investigate the feasibility of using the Labour Force Survey (LFS) to provide population denominators for the estimation of mortality rates by the National Statistics Socio-economic Classification (NS-SEC). This is in order to contribute to the monitoring of health inequalities over time. Currently it is possible to produce mortality rates only at the time of a census when populations are enumerated by occupation and NS-SEC. METHODS: The Labour Force Survey (LFS) was used to provide population denominators by age, sex and NS-SEC for various time periods. Numerators for mortality rates were derived by obtaining aggregate deaths by age group and NS-SEC analytic class for men aged 25-64. Standardised mortality rates were then derived. Results for 2001-03 were compared with published estimates which used 2001 Census-based denominators. RESULTS: Significant differences were detected for most NS-SEC classes between mortality rate estimates, based on the 2001 Census, and those based on the contemporary LFS dataset. However the results for different years, based on LFS denominators, suggest that a series of mortality rates using LFS-based denominators appeared to have internal consistency. The LFS-based estimates showed a statistically significant decrease in mortality rates between the periods 2001-03 and 2005-07, across all but one NS-SEC classes. The precision of LFS-based estimates at different levels of geography was also assessed in order to determine the feasibility of using these estimates to monitor inequalities at sub-national level. CONCLUSIONS: The LFS can be used to produce regular population denominators for the estimation of mortality rates, to assess health inequalities by NS-SEC for men at the level of England & Wales, both on an annual basis and over three-year time periods. It is recommended that, in order for the LFS-based estimates to be effective over time, they would have to be related to each other rather than to the census-based ones. At the level of Government Office Region (GOR), it would also be possible to do this, but on a three-year period basis only. Below this level of geography, estimates would be insufficiently precise. Information exists on the LFS to produce a similar analysis for women.

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.

Demographic, behavioural and socio-economic influences on the survival of retired people--evidence from a ten year follow up study of the General Household Survey, 1994.

This article reports on a longitudinal analysis of a sample of residents who were aged 65 or over when interviewed for the 1994 General Household Survey. It investigates the associations between various personal characteristics as established at the interview and the probability of survival during a ten year follow-up period. Smoking was the most important factor of those measured in determining the likelihood of survival. Smokers at the time of the interview had a mortality risk, on average, 78 per cent greater than non-smokers. Non-drinkers and those who had less than one unit of alcohol per week at the time of the interview appeared to have a higher mortality risk than those who drank between one unit and the recommended government maximum per week. However, further analysis suggested that this result might be a product of the health status of individuals at the time of the interview. Type of housing tenure and region of residence were better predictors of mortality risk than occupation-based social class.

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

This analysis of mortality in women aged 25-59 in 2001-03 found that those in the least advantaged social economic class had a mortality rate around twice that of women in the most advantaged class. This article uses the National Statistics Socio-economic Classification (NS-SEC) and examines the relative merits of classification based on a woman's 'own' occupation as opposed to a 'combined' classification which also takes into account the husband's NS-SEC class, where available. The results demonstrate a strong socio-economic gradient in mortality for adult women under both classification methods. Under the 'combined' classification, women in the least advantaged NS-SEC class had a mortality rate 2.6 times that of those in the most advantaged class. Based on the women's'own' occupation, the comparable ratio was 1.9. These results set a benchmark for the future monitoring of socio-economic mortality inequalities in women, and also provide a comparison between inequalities affecting women and men.

Regional differences in male mortality inequalities using the National Statistics Socio-Economic Classification, England and Wales, 2001-03.

This article represents the first use by the Office for National Statistics of the National Statistics Socio-economic Classification (NS-SEC) to analyse regional variations in inequalities in male mortality. It is part of a serie of articles on social inequalities in mortality by NS-SEC. Deaths in th years 2001-03 among men aged 25-64, from all causes and selected major cause groups, are examined in each of the Government Office Regions of England and in Wales. The results provide insights into both social gradients in mortality within regions, and regional differences in mortality for each NS-SEC class. The socioeconomic differences in mortality were more marked for men in Wales, the North East and the North West. The regional differences in mortality were small for the most advantaged classes and greatest for the least advantaged classes.