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      Monitoring health inequalities: life expectancy and small area deprivation in New Zealand

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      1 , , 1
      Population Health Metrics
      BioMed Central

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          Abstract

          Background

          Socioeconomic and ethnic inequalities in health are of great concern, and life expectancy provides a readily understood means of monitoring such inequalities. The objectives of this study are to (1) measure life expectancy by socioeconomic deprivation and ethnicity, and (2) describe trends in the deprivation gradient in life expectancy since the mid-1990s.

          Methods

          Three years of national mortality data have been combined with mid-point population denominators to produce life tables within nationally determined levels of small area deprivation (NZDep96) for three ethnic group: European, Mäori and Pacific peoples. This process has been repeated for the periods 1995–97, 1996–98, 1997–99 and 1998–2000.

          Results

          There was a strong relationship between increasing small area deprivation and decreasing life expectancy. Through the mid- to late 1990s, males living in the most deprived small areas in New Zealand experienced life expectancies at birth approximately nine years less than their counterparts living in the least deprived areas; for females the corresponding difference was under seven years.

          Mäori and Pacific life expectancies at birth were lower than those of Europeans at each level of deprivation.

          Over the study period (1995–2000) the gradient in life expectancy across deprivation deciles remained stable.

          Conclusion

          Small area deprivation analyses of life expectancy could be repeated routinely at regular intervals, which would provide a useful approach to monitoring trends in socioeconomic, geographic, ethnic and gender inequalities in mortality.

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          Most cited references14

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          Deprivation indices: their interpretation and use in relation to health.

          To examine the use of deprivation indices in relation to health. This paper reviews selected publications which illustrate the diversity of use of deprivation indices in the past decade. Most of this work is based in the major routine databases which exist in this country: the census, population, mortality, cancer register, and health service records all now incorporate a postcode identifier which permits the derivation of data at small area level, and thus the examination of health events in relation to the characteristics of that area - usually ward or postcode sector. The small area approach provides a valuable tool both in deprivation and in other epidemiological studies which examine the influence of the environment on health. The setting is various journals and official publications. The link between deprivation and health has been clearly demonstrated in a number of studies, with populations living in deprived areas exhibiting levels of mortality, particularly below the age of 65, which vastly exceed those in affluent areas. In the decade 1981-91, these differentials increased in Scotland and the Northern Health Region and inequalities in health are shown to have widened. Analysis shows that particular causes of death and sites of cancer are more likely to reflect the influence of socio-economic factors. The work so far mostly shows the associations between these factors and health measures and more investigation is required into the determinants of health, which are likely to reside as much in past as in current circumstances. A measure of deprivation has proved of value in excluding the likely variation in the incidence of disease in studies directed towards determining the influence of the physical environment on populations living in the vicinity of possible harmful industrial processes. A deprivation measure has been adopted by the Department of Health as a basis for making enhanced payments to general practitioners for patients living in these areas, but the resource allocation formula for allocating funds to regional authorities has failed to incorporate such a measure in the formula. An area measure of deprivation has proved a valuable tool in examining differentials in health and death and is likely to prove of continuing value to health authorities in planning the delivery of health care. Future work should strive to examine the determinants of health as well as the associations, although this is unlikely to be possible through the routine databases which have provided the main basis for analysis so far.
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            Social deprivation and premature mortality: regional comparison across England.

            To investigate the pattern and size of the relationship between social deprivation in electoral wards and premature mortality for each health region in England. Ecological study using 1981 census variables and data on mortality for 1981-5. 14 regional health authorities in England. Mortality under the age of 65 years from all causes, coronary heart disease, and smoking related diseases in men and women. Increasing deprivation was significantly associated with mortality from all causes, coronary heart disease, and smoking related diseases. The relationship was linear with no apparent threshold. Correlation coefficients were generally greater for deaths from all causes and smoking related diseases and for men compared with women. The slope of the relationship between deprivation and mortality varied among regions. Variations in mortality still existed between regions for equal levels of deprivation. Deprivation of an area and premature mortality are strongly linked. The effects of deprivation can be seen throughout the range of affluence and are not limited to the poorest areas. Current targets for reducing coronary heart disease mortality may be achievable if the mortality in poor areas can be reduced to the rates in affluent areas.
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              Anonymous linkage of New Zealand mortality and Census data.

              The New Zealand Census-Mortality Study (NZCMS) aims to investigate socio-economic mortality gradients in New Zealand, by anonymously linking Census and mortality records. To describe the record linkage method, and to estimate the magnitude of bias in that linkage by demographic and socio-economic factors. Anonymous 1991 Census records, and mortality records for decedents aged 0-74 years on Census night and dying in the three-year period 1991-94, were probabilistically linked using Automatch. Bias in the record linkage was determined by comparing the demographic and socio-economic profile of linked mortality records to unlinked mortality records. 31,635 of 41,310 (76.6%) mortality records were linked to one of 3,373,896 Census records. The percentage of mortality records linked to a Census record was lowest for 20-24 year old decedents (49.0%) and highest for 65-69 year old decedents (81.0%). By ethnic group, 63.4%, 57.7%, and 78.6% of Maori, Pacific, and decedents of other ethnic groups, respectively, were linked. Controlling for demographic factors, decedents from the most deprived decile of small areas were 8% less likely to be linked than decedents from the least deprived decile, and male decedents from the lowest occupational class were 6% less likely to be linked than decedents from the highest occupational class. The proportion and accuracy of mortality records linked was satisfactorily high. Future estimates of the relative risk of mortality by socio-economic status will be modestly under-estimated by 5-10%.
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                Author and article information

                Journal
                Popul Health Metr
                Population Health Metrics
                BioMed Central (London )
                1478-7954
                2003
                14 April 2003
                : 1
                : 2
                Affiliations
                [1 ]Public Health Directorate, Ministry of Health, Wellington, New Zealand
                Article
                1478-7954-1-2
                10.1186/1478-7954-1-2
                156625
                12773214
                dbe5fcab-0e1e-4404-91e0-b2d1c43f1d47
                Copyright © 2003 Tobias and Cheung; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.
                History
                : 11 March 2003
                : 14 April 2003
                Categories
                Research

                Health & Social care
                Health & Social care

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