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Journal Article

Geographical trends in infant mortality: England and Wales, 1970-2006.

Paul Norman1, Ian N. Gregory, Danny Dorling, Allan Baker 
01 Jan 2008-Health Statistics Quarterly (Health Stat Q)-Iss: 40, pp 18-29
Topics: Infant mortality (58%)

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Citations
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Journal ArticleDOI
TL;DR: There was insufficient evidence of adequate quality to recommend routine implementation of any of the programmes as a means of reducing infant mortality in disadvantaged/vulnerable women.
Abstract: Background: Infant mortality has shown a steady decline in recent years but a marked socioeconomic gradient persists. Antenatal care is generally thought to be an effective method of improving pregnancy outcomes, but the effectiveness of specific antenatal care programmes as a means of reducing infant mortality in socioeconomically disadvantaged and vulnerable groups of women has not been rigorously evaluated. Methods: We conducted a systematic review, focusing on evidence from high income countries, to evaluate the effectiveness of alternative models of organising or delivering antenatal care to disadvantaged and vulnerable groups of women vs. standard antenatal care. We searched Medline, Embase, Cinahl, PsychINFO, HMIC, CENTRAL, DARE, MIDIRS and a number of online resources to identify relevant randomised and observational studies. We assessed effects on infant mortality and its major medical causes (preterm birth, congenital anomalies and sudden infant death syndrome (SIDS)). Results: We identified 36 distinct eligible studies covering a wide range of interventions, including group antenatal care, clinic-based augmented care, teenage clinics, prenatal substance abuse programmes, home visiting programmes, maternal care coordination and nutritional programmes. Fifteen studies had adequate internal validity: of these, only one was considered to demonstrate a beneficial effect on an outcome of interest. Six interventions were considered ‘promising’. Conclusions: There was insufficient evidence of adequate quality to recommend routine implementation of any of the programmes as a means of reducing infant mortality in disadvantaged/vulnerable women. Several interventions merit further more rigorous evaluation.

137 citations


Cites background from "Geographical trends in infant morta..."

  • ...But throughout this period infant mortality has shown marked and persistent socioeconomic gradients within countries, even in countries with universal healthcare access [2-4]....

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Journal ArticleDOI
Paul Norman1
Abstract: The measurement of area level deprivation is the subject of a wide and ongoing debate regarding the appropriateness of the geographical scale of analysis, the input indicator variables and the method used to combine them into a single figure index. Whilst differences exist, there are strong correlations between schemes. Many policy-related and academic studies use deprivation scores calculated cross-sectionally to identify areas in need of regeneration and to explain variations in health outcomes. It would be useful then to identify whether small areas have changed their level of deprivation over time and thereby be able to: monitor the effect of industry closure; assess the impact of area-based planning initiatives; or determine whether a change in the level of deprivation leads to a change in health. However, the changing relationship with an outcome cannot be judged if the ‘before’ and ‘after’ situations are based on deprivation measures which use different, often time-point specific variables, methods and geographies. Here, for the whole of the UK, inputs to the Townsend index obtained from the 1991 and 2001 Censuses have been harmonised in terms of variable detail and with the 1991 data converted to the 2001 Census ward geography. Deprivation has been calculated so that the 1991 scores are directly comparable with those for 2001. Change over time can be then identified. Measured in this way, deprivation is generally shown to have eased due to downward trends in levels of lack of access to a car, non-home ownership, household overcrowding but most particularly, to reductions in levels of unemployment. Despite these trends, not all locations became less deprived with gradients of deprivation largely persisting within the UK’s constituent countries and in different area types. For England, Wales and Scotland, the calculation of Townsend scores can readily be backdated to incorporate data from the 1971 and 1981 Censuses to create a 1971–2001 set of comparable deprivation scores. The approach can also be applied to the Carstairs index. Due to differences in data availability prior to 1991, incorporating small areas in Northern Ireland would be challenging.

117 citations


Journal ArticleDOI
TL;DR: It is found that male premature mortality rates rose by over 14% in Scotland over the 10-year period between the early 1990s and 2000s in persistently deprived areas and that the rise among men in Scotland was driven by results for Glasgow where mortality rates rising by over 15% during the decade.
Abstract: In the international literature, many studies find strong relationships between area-based measures of deprivation and mortality. In the U.K., mortality rates have generally fallen in recent decades but the life expectancy gap between the most and least deprived areas has widened, with a number of Scottish studies highlighting increased mortality rates in deprived areas especially in Glasgow. However, these studies relate health outcomes at different time points against period-specific measures of deprivation which may not be comparable over time. Using longitudinal deprivation measures where levels of area deprivation are made comparable over time, a recent study demonstrated how levels of mortality change in relation to changing or persistent levels of (non-) deprivation over time. The results showed that areas which were persistently deprived in Scotland experienced a rise in premature mortality rates by 9.5% between 1981 and 2001. Here, focussing on persistently deprived areas we extended the coverage to the whole of the U.K. to assess whether, between 1991 and 2001, rising premature mortality rates in persistently deprived areas are a Scottish only phenomenon or whether similar patterns are evident elsewhere and for men and women separately. We found that male premature mortality rates rose by over 14% in Scotland over the 10-year period between the early 1990s and 2000s in persistently deprived areas. We found no significant rise in mortality elsewhere in the U.K. and that the rise among men in Scotland was driven by results for Glasgow where mortality rates rose by over 15% during the decade. Our analyses demonstrate the importance of identifying areas experiencing persistent poverty. These results justify even more of a public health focus on Glasgow and further work is needed to understand the demographic factors, such as health selective migration, immobility and population residualisation, which may contribute to these findings.

66 citations


Journal ArticleDOI
TL;DR: It is demonstrated that premature mortality rates increased significantly over this twenty year period in 638 persistently most deprived areas of Scotland, and it is suggested that these persistency most deprived Scottish areas deserve special attention and may be particularly appropriate sites for public health interventions related to these causes of premature death.
Abstract: A common approach for measuring geographical inequalities in health has been to calculate deprivation scores for small areas and then to aggregate these into quintiles. Mortality rates may then be compared for the highest and lowest deprivation quintiles at two points in time and the change in the difference between the rates determines the extent to which inequalities have widened or narrowed. This 'period-specific' approach to measuring inequalities is problematic both because deprivation calculated at different points in time is not directly comparable, and because the boundaries of the areas used for such analyses often change during the study period. Using 10,058 small areas for Scotland whose boundaries do not change between 1981 and 2001 we examine the deprivation (im)mobility of areas, identifying those that are persistently well-off, stable or deprived and those that improved or worsened during the period. We focus particularly on the 638 persistently most deprived areas. We demonstrate, first and importantly, that premature mortality rates increased significantly over this twenty year period in these areas. Second, we examine which causes of death are mainly responsible for this increase; the risk of death from chronic liver disease, mental disorders due to alcohol, suicide and 'other' causes increased considerably. The geographical approach we describe here is novel and provides new insights into the relationship between deprivation and premature mortality. We suggest that these persistently most deprived Scottish areas deserve special attention and may be particularly appropriate sites for public health interventions related to these causes of premature death.

43 citations


Journal ArticleDOI
01 Jan 2012-Geoforum
Abstract: We describe contemporaneous changes in environmental quality and social deprivation in English local authority districts over four decades, using secondary source GIS modelled data on environmentally intrusive development. The distribution of this development is described with respect to the Townsend material deprivation score, corroborated against the Breadline Britain index. Spatial patterns of environmental intrusion and material deprivation change markedly over the period, although a clear environmental inequality remains throughout. However, it is not the most deprived who experience the greatest decline in their environmental quality, as most of the increase in environmental intrusion occurs in those districts whose population were amongst the most affluent in the early 1960s. We note that the environmental justice implications of these observations are dependent upon conceptions of justice held, and reflect on the challenge of testing, through empirical longitudinal analysis, the notion that environmental sustainability and social justice are incompatible.

34 citations


References
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Book
23 Nov 1987
TL;DR: The design of experiments, analysis of the means of small samples using the t-c Distribution, and selection of the statistical method for clinical measurement and the structure of human populations are reviewed.
Abstract: Introduction The design of experiments Sampling and observational studies Summarizing data Presenting data Probability The Normal Distribution Estimation, standard error, and confidence intervals Significance tests Analysis of the means of small samples using the t-c Distribution Choosing the statistical method Clinical measurement Mortality statistics and the structure of human populations Solutions to exercises.

2,240 citations


Book
26 Nov 1987
Abstract: * El libro se ha traducido por el Instituto Nacional de Higiene, Epidemiologia y Microbiologia, y sus 10 capitulos se publicaran proximamente en esta Revista. Publicado por la Editorial Routledge, Londres y Nueva York, 1989, 211 paginas. En ingles. El libro presenta nuevas evidencias de las desigualdades en salud encontradas entre poblaciones o comunidades en diferentes areas del norte de Inglaterra y relata las tendencias a largo plazo que tienen lugar en los patrones de salud de Inglaterra, explora hasta donde las desigualdades en los niveles de salud pueden ser explicadas por la carencia material.

1,415 citations


Journal ArticleDOI
TL;DR: The Scottish deprivation score and the Townsend index are found to explain most variation, and to adhere most closely to the concept of material disadvantage.
Abstract: A number of indexes of deprivation which have been devised or adopted for use by the health services are examined in relation to their performance in explaining the variation observed in a range of health measures, using data for postcode sectors in Scotland The Scottish deprivation score and the Townsend index are found to explain most variation, and to adhere most closely to the concept of material disadvantage The Jarman score is less effective as a result of the inclusion of individual variables which are seen to correlate very weakly, even negatively, with the health indicators The use of these measures in relation to resource allocation and the new GP contract is discussed

527 citations


Journal ArticleDOI
Abstract: Using results from the World Fertility Survey (WFS) for 28 countries, socioeconomic differences in neonatal, postneonatal, and child mortality were examined. To maintain some degree of comparability and to make presentation of the results feasible, focus was on 5 variables which are available for each survey. It can be argued that each of the 5 socioeconomic variables considered here--mother's education, mother's work status since marriage, current or most recent husband of mother's occupation and education, and current type of place of residence of mother--affects infant and child mortality, although often as surrogates for other variables which were usually not directly available. For over 24 countries, the neonatal mortality rate varied from 84 in Nepal to 15 in Malaysia. In Nepal the rate for children of the skilled and unskilled was high (124) but where the husband had received 7 or more years of education the rate of 54 was low. At the other extreme, rates in Malaysia varied from 5 when mother's had 7 or more years of education to 23 for offspring of the least educated husbands. The highest overall postneonatal rate of 89 was again found in Nepal and the lowest national rate in Trinidad and Tobago at 13. In 9 out of 24 countries the high values were over 3 times as great as the low values and the absolute difference exceeded 30/1000 in 13 countries. Differences on child mortality are substantial, reflecting the greater influence of socioeconomic factors on mortality in early childhood. Nationally, the values ranged from 186 in Senegal to a low of 8 in Trinidad and Tobago. In only Haiti, Guyana, and Pakistan did the ratio of the maximum to the minimum rates for sizeable groups fall below 2. At the other extreme, in 5 countries the ratio exceeded 10 and in a further 6 was above 4. Differences between the high and low groups within countries exceeded 30 in 18 out of 28 countries and were over 50 in 10 of these. In 9 countries the highest rates occurred among mothers with no education and in a further 6 among husbands with no education. Education of mother, followed by education of her husband and his occupation were generally the strongest explanatory variables. The work status of the mother was not likely to be an important explanatory variable in these analyses. Results of a multivariate analysis suggested intriguing differences in the relative roles of different socioeconomic variables. Mother's education seemed to play an important role in determining children's chances of surviving in several Latin American and South East Asian countries. In no country did husband's level of education appear in all 3 models. The occupation of the husband was possibly the purest indicator of socioeconomic status, and this factor appeared in the models for all 3 segments of infant and child mortality. Mother's work status appeared least often.

322 citations


Journal ArticleDOI
TL;DR: Overall it is found that between 1971 and 1991, inequalities in health increased between the least and most deprived areas, compared with the health-deprivation relationship which would have existed if peoples' locations and deprivation patterns had stayed geographically constant.
Abstract: Population migration is a major determinant of an area's age-sex structure and socio-economic characteristics. The suggestion that migration can contribute to an increase or decrease in place-specific rates of illness is not new. However, differences in health status between small geographical locations that may be affected by the inter-relationships between health, area-based deprivation and migration are under-researched. Using the Office for National Statistics (ONS) England and Wales Longitudinal Study (LS) 1971-1991, this research tracks individuals to identify any systematic sorting of people that has contributed to the area-level relationships between health (limiting long-term illness and mortality) and deprivation (Carstairs quintiles). The results demonstrate that among the young, migrants are generally healthier than non-migrants. Migrants who move from more to less deprived locations are healthier than migrants who move from less to more deprived locations. Within less deprived areas migrants are healthier than non-migrants but within deprived areas migrants are less healthy than non-migrants. Over the 20 year period, the largest absolute flow is by relatively healthy migrants moving away from more deprived areas towards less deprived areas. The effect is to raise ill-health and mortality rates in the origins and lower them in the destinations. This is reinforced by a significant group of people in poor health who move from less to more deprived locations. In contrast, a small group of unhealthy people moved away from more deprived into less deprived areas. These countercurrents of less healthy people have a slight ameliorating effect on the health-deprivation relationship. Whilst health-deprivation relationships are more marked for migrants there are also health (dis-) benefits for non-migrants if their location becomes relatively more or less deprived over time. Overall we found that between 1971 and 1991, inequalities in health increased between the least and most deprived areas, compared with the health-deprivation relationship which would have existed if peoples' locations and deprivation patterns had stayed geographically constant. Migration, rather than changes in the deprivation of the area that non-migrants live in, accounts for the large majority of change.

292 citations