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      Does selective migration alter socioeconomic inequalities in mortality in Wales?: a record-linked total population e-cohort study ☆

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          Abstract

          Recent studies found evidence of health selective migration whereby healthy people move to less deprived areas and less healthy people move to or stay in more deprived areas. There is no consensus, however, on whether this influences health inequalities. Measures of socio-economic inequalities in mortality and life expectancy are widely used by government and health services to track changes over time but do not consider the effect of migration. This study aims to investigate whether and to what extent migration altered the observed socioeconomic gradient in mortality. Data for the population of Wales (3,136,881) registered with the National Health Service on 01/01/2006 and follow-up for 24 quarters were individually record-linked to ONS mortality files. This included moves between lower super output areas (LSOAs), deprivation quintiles and rural-urban class at each quarter, age, sex, and date of death. Cox regression models were used to estimate the hazard ratios for the deprivation quintiles in all-cause mortality, as well as deprivation change between the start and end of the study. We found evidence of health selective migration in some groups, for example people aged under 75 leaving the most deprived areas having a higher mortality risk than those they left behind, suggesting widening inequalities, but also found the opposite pattern for other migration groups. For all ages, those who lived in the most deprived quintile had a 57% higher risk of death than those in the least deprived quintile, allowing deprivation to vary with moves over time. There was little change in this risk when people were artificially kept in their deprivation quintile of origin (54% higher). Overall, migration during the six year window did not substantially alter the deprivation gradient in mortality in Wales between 2006 and 2011.

          Highlights

          • •

            Health selective migration was found for selected subgroups.

          • •

            Change to inequalities varied by direction of deprivation change and age group.

          • •

            Migration overall did not alter the socioeconomic gradient in mortality in Wales.

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          The first-year growth response to growth hormone treatment predicts the long-term prepubertal growth response in children

          Berit Kriström, Jovanna Dahlgren, Aimon Niklasson … (2009)
          Background Pretreatment auxological variables, such as birth size and parental heights, are important predictors of the growth response to GH treatment. For children with missing pretreatment data, published prediction models cannot be used. The objective was to construct and validate a prediction model for children with missing background data based on the observed first-year growth response to GH. The accuracy and reliability of the model should be comparable with our previously published prediction model relying on pretreatment data. The design used was mathematical curve fitting on observed growth response data from children treated with a GH dose of 33 μg/kg/d. Methods Growth response data from 162 prepubertal children born at term were used to construct the model; the group comprised of 19% girls, 80% GH-deficient and 23% born SGA. For validation, data from 205 other children fulfilling the same inclusion and treatment criteria as the model group were used. The model was also tested on data from children born prematurely, children from other continents and children receiving a GH dose of 67 μg/kg/d. Results The GH response curve was similar for all children, but with an individual amplitude. The curve SD score depends on an individual factor combining the effect of dose and growth, the 'Response Score', and time on treatment, making prediction possible when the first-year growth response is known. The prediction interval (± 2 SDres) was ± 0.34 SDS for the second treatment year growth response, corresponding to ± 1.2 cm for a 3-year-old child and ± 1.8 cm for a 7-year-old child. For the 1–4-year prediction, the SDres was 0.13 SDS/year and for the 1–7-year prediction it was 0.57 SDS (i.e. < 0.1 SDS/year). Conclusion The model based on the observed first-year growth response on GH is valid worldwide for the prediction of up to 7 years of prepubertal growth in children with GHD/ISS, born AGA/SGA and born preterm/term, and can be used as an aid in medical decision making.
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            Increasing inequalities in health: is it an artefact caused by the selective movement of people?

            Sheelah Connolly, Michael Rosato, Dermot O’Reilly (2007)
            Changes in health socio-economic inequalities are currently measured by comparing the mortality gradient across aggregates of small administrative areas at two points in time. However, this methodology may be flawed as it ignores population movement, which previous research has shown to be selective, with a net loss of the more affluent (and possibly healthier) residents from deprived to more affluent areas. This paper investigates whether selective migration contributed sufficiently to the observed socio-economic gradients in mortality in England and Wales throughout the 1990s so as to invalidate the current method of monitoring health inequalities. The ONS Longitudinal Study for England and Wales was used to calculate directly standardised mortality rates (DSR) by decile of deprivation in 1991 and 2001. The DSRs for 2001 were calculated twice, once according to decile of residence in 2001, and also according to the original decile in 1991. Selective migration was found to make an important contribution in explaining increases in inequalities between areas, accounting for about 50% of the increase for those aged less than 75. At the older age groups, however, selective migration was responsible for a narrowing of mortality differentials over time. These results indicate that caution should be exercised when using repeated ecological studies in assessing the extent of changes in inequalities over time.
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              Are health inequalities between differently deprived areas evident at different ages? A longitudinal study of census records in England and Wales, 1991-2001.

              Paul E. Norman, Paul Boyle (2014)
              The notion that mortality inequalities between differently deprived areas vary by age is logical since not all causes of death increase in risk with age and not all causes of death are related to the gradient of deprivation. In addition to the cause-age and cause-deprivation relationships, population migration may redistribute the population such that the health-deprivation relationship varies by age. We calculate cross-sectional all cause mortality and self-reported limiting long-term illness (LLTI) rate ratios of most to least deprived areas to demonstrate inequalities at different ages. We use longitudinal data to investigate whether there are changes in the distribution of cohorts between differently deprived areas over time and whether gradients of LLTI with deprivation also change. We find similar deprivation inequalities by age for all cause mortality and self-reported health with less inequality for young adults and the elderly but the greatest inequalities during mid life. Over time there are systematic movements of cohorts between differently deprived areas and associated increases and decreases in the gradient of LLTI across deprivation. It seems likely that population migration does influence inequalities by age. Further work should investigate whether the situation exists for other morbidities and, to better inform public health policy, whether restricting summary measures of area health to ages between 30 and 60 when inequalities are greatest will highlight between area differences.
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                Author and article information

                Contributors
                Andrea Gartner
                Journal
                Journal ID (nlm-ta): SSM Popul Health
                Journal ID (iso-abbrev): SSM Popul Health
                Title: SSM - Population Health
                Publisher: Elsevier
                ISSN (Electronic): 2352-8273
                Publication date PMC-release: 24 May 2018
                Publication date Collection: August 2018
                Publication date (Electronic): 24 May 2018
                Volume: 5
                Pages: 48-54
                Affiliations
                [a ]Division of Population Medicine, School of Medicine, Neuadd Meirionnydd, Cardiff University, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, United Kingdom
                [b ]Public Health Wales NHS Trust, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, United Kingdom
                Author notes
                [* ]Corresponding author. gartnera@ 123456cardiff.ac.uk
                Article
                Publisher ID: S2352-8273(18)30019-3
                DOI: 10.1016/j.ssmph.2018.05.004
                PMC ID: 5993157
                SO-VID: 7aa6c7e9-2b1c-44cd-8f56-1b0824890921
                Copyright © © 2018 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 31 January 2018
                Date revision received : 8 May 2018
                Date accepted : 9 May 2018
                Categories
                Subject: Article

                Keywords: inequalities,selective migration,mortality,socioeconomic gradient
                Data availability:
                Keywords: inequalities, selective migration, mortality, socioeconomic gradient

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