ABSTRACT
Several studies have indicated widening social class differences in mortality in Britain in the 1970s,1-8 indeed, a widening gap can be traced back to the 1950s.9 Given this long trend towards widening inequality in health, it would be surprising if differences in mortality were found to narrow in the 1980s, and increasing disparities in mortality through the 1980s have already been reported for Glasgow.10 The decade has been one of profound social and economic change, with two major recessions, a widening of income differentials,11 and a reduction of the real income of the poorest 10% of households in the population.12 Nevertheless, changes in mortality among different sections of the population need careful identification. In this paper we examine relative and absolute changes in mortality (all causes) in people aged under 75 between 1981 and 1991 in the area administered by Northern Regional Health Authority (the five counties of Cleveland, Cumbria, Durham, Northumberland, and Tyne and Wear). This builds on our earlier study of inequalities in health in this region of three million people.1,2
Socioeconomic and population data were drawn from the 1981 and 1991 censuses and mortality data (1981-91) were taken from death records of the Office of Population Censuses and Surveys for the 678 wards used in our earlier study.1,2 The index of deprivation created previously was reconstructed with data from the 1991 census. This index was constructed by means of z scores, combining four variables selected to reflect distinctive aspects of material wellbeing – unemployment, car ownership, non-owner occupation, and household overcrowding. Any method of combining several variables with different distributions into a single index will have drawbacks,13 but the z score is widely used and at ward level gives similar results to other methods.14
