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Regional variations in mortality rates in England and Wales: An analysis using multi-level modelling

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  • Langford, Ian H.
  • Bentham, Graham

Abstract

Mortality rates in England and Wales display a persistent regional pattern indicating generally poorer health in the North and West. Some of this is simply a reflection of regional differences in the extent of social deprivation which is known to exert a profound influence on health. Part of the pattern may also be the result of regional differences in urbanization which also affect mortality rates. However, there may be important regional differences over and above these compositional effects. This study attempts to establish the magnitude of such independent regional differences in mortality rates by using the techniques of multi-level modelling. Standardized mortality rates (SMRs) for males and females under 65 for 1989-1991 in local authority districts are grouped into categories using the ACORN classification scheme. The Townsend Index is included as a measure of social deprivation. Using a cross-classified multi-level model, it is shown that region accounts for approximately four times more variation in SMRs than is explained by the ACORN classification. Analysis of diagnostic residuals show a clear North-South divide in excess mortality when both regional and socio-economic classification of districts are modelled simultaneously, a possibility allowed for by the use of a multi-level model.

Suggested Citation

  • Langford, Ian H. & Bentham, Graham, 1996. "Regional variations in mortality rates in England and Wales: An analysis using multi-level modelling," Social Science & Medicine, Elsevier, vol. 42(6), pages 897-908, March.
    • Handle: RePEc:eee:socmed:v:42:y:1996:i:6:p:897-908
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    Cited by:

    1. Andrews, Gavin J. & Cutchin, Malcolm & McCracken, Kevin & Phillips, David R. & Wiles, Janine, 2007. "Geographical Gerontology: The constitution of a discipline," Social Science & Medicine, Elsevier, vol. 65(1), pages 151-168, July.
    2. French, Katherine Meriel & Jones, Kelvyn, 2006. "Impact of definition on the study of avoidable mortality: Geographical trends in British deaths 1981-1998 using Charlton and Holland's definitions," Social Science & Medicine, Elsevier, vol. 62(6), pages 1443-1456, March.
    3. Thomas Plümper & Denise Laroze & Eric Neumayer, 2018. "Regional inequalities in premature mortality in Great Britain," PLOS ONE, Public Library of Science, vol. 13(2), pages 1-16, February.
    4. Antonio Clavero Barranquero & Mª. Luz González Alvarez, 2005. "A survey of econometric models to analyze the demand and utilisation of health care," Hacienda Pública Española / Review of Public Economics, IEF, vol. 173(2), pages 129-162, June.
    5. Masashige Saito & Katsunori Kondo & Naoki Kondo & Aya Abe & Toshiyuki Ojima & Kayo Suzuki & the JAGES group, 2014. "Relative Deprivation, Poverty, and Subjective Health: JAGES Cross-Sectional Study," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-9, October.
    6. Tatiana V. Kossova & Elena V. Kossova & Maria A. Sheluntcova, 2014. "Investigating The Volume And Structure Of Alcohol Consumption And Their Impact On Life Expectancy In Russian Regions," HSE Working papers WP BRP 82/EC/2014, National Research University Higher School of Economics.
    7. Wang, Lu & Hu, Wei, 2013. "Immigrant health, place effect and regional disparities in Canada," Social Science & Medicine, Elsevier, vol. 98(C), pages 8-17.
    8. Kossova, Tatiana V. (Коссова, Татьяна В.) & Kossova, Elena V. (Коссова, Елена) & Sheluntsova, Maria A. (Шелунцова, Мария), 2017. "Estimating the Impact of Alcohol Consumption on Mortality and Life Expectancy in Russian Regions [Влияние Потребления Алкоголя На Смертность И Ожидаемую Продолжительность Жизни В Регионах России]," Ekonomicheskaya Politika / Economic Policy, Russian Presidential Academy of National Economy and Public Administration, vol. 1, pages 58-83, February.
    9. Jan Saarela & Fjalar Finnäs, 2009. "Geographic Ancestry and Cause-specific Mortality in a National Population," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 28(2), pages 169-194, April.
    10. Peter Congdon, 1997. "Multilevel and Clustering Analysis of Health Outcomes in Small Areas," European Journal of Population, Springer;European Association for Population Studies, vol. 13(4), pages 305-338, December.
    11. Martin Gächter & Engelbert Theurl, 2010. "Convergence of the Health Status at the Local Level: Empirical Evidence from Austria," NRN working papers 2010-09, The Austrian Center for Labor Economics and the Analysis of the Welfare State, Johannes Kepler University Linz, Austria.

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