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The effect on morbidity of variability in deprivation and population stability in England and Wales: an investigation at small-area level

Author

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  • Boyle, Paul J.
  • Gatrell, Anthony C.
  • Duke-Williams, Oliver

Abstract

We seek to determine whether variability in deprivation at small area level, and population stability, influence standardised morbidity ratios in England and Wales. A regression analysis was conducted with data from the 1991 British Census, in order to explain variation in morbidity. Both an area deprivation score (for electoral wards) and the within-area variability of deprivation scores were examined as possible determinants of morbidity (self-reported, limiting, long-term illness). Particular attention was focused on a spatially-sensitive measure of the variability of deprivation scores within a wider 'locality'. There was a significant, positive relationship between age-standardised limiting, long-term illness and deprivation. The variation in area deprivation scores within the small areas themselves was also significant and positive. However, the variation in deprivation scores calculated for both an electoral ward and its contiguous neighbours (the locality) was slightly more significant. Areas with higher relative levels of in-migration also had significantly lower standardised morbidity ratios. Multivariate models showed that the deprivation score, the variation in deprivation scores for the broader locality, and the measure of migration, were all significant in combination. Residual analysis showed that many areas in London had lower levels of morbidity than expected, while electoral wards in the coal mining valleys of South Wales had higher levels than expected. We conclude that, for small areas (wards) in England and Wales, morbidity is related to deprivation, variation in deprivation within and surrounding each area, and the proportion of the population that are migrants. Variations in deprivation influence standardised morbidity rates, and policies which widen inequalities will influence health outcomes. Resource allocation based simply on measures of deprivation, which ignore population change within the area and variations in deprivation in the locality, may be inefficient.

Suggested Citation

  • Boyle, Paul J. & Gatrell, Anthony C. & Duke-Williams, Oliver, 1999. "The effect on morbidity of variability in deprivation and population stability in England and Wales: an investigation at small-area level," Social Science & Medicine, Elsevier, vol. 49(6), pages 791-799, September.
    • Handle: RePEc:eee:socmed:v:49:y:1999:i:6:p:791-799
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    Cited by:

    1. Cox, Matthew & Boyle, Paul J. & Davey, Peter G. & Feng, Zhiqiang & Morris, Andrew D., 2007. "Locality deprivation and Type 2 diabetes incidence: A local test of relative inequalities," Social Science & Medicine, Elsevier, vol. 65(9), pages 1953-1964, November.
    2. Taylor, Joanna & Twigg, Liz & Moon, Graham, 2014. "The convergent validity of three surveys as alternative sources of health information to the 2011 UK census," Social Science & Medicine, Elsevier, vol. 116(C), pages 187-192.
    3. Enrico Ivaldi, 2016. "Material and social deprivation in Italy: an analysis on a regional basis," Eastern European Business and Economics Journal, Eastern European Business and Economics Studies Centre, vol. 2(3), pages 248-268.
    4. Stefano Landi & Enrico Ivaldi & Angela Testi, 2018. "Measuring Change Over Time in Socio-economic Deprivation and Health in an Urban Context: The Case Study of Genoa," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 139(2), pages 745-785, September.
    5. Dominic Brown & Philip Rees, 2006. "Trends in local and small area mortality and morbidity in Yorkshire and the Humber: Monitoring health inequalities," Regional Studies, Taylor & Francis Journals, vol. 40(5), pages 437-458.
    6. Alaimo, Leonardo Salvatore & Ivaldi, Enrico & Landi, Stefano & Maggino, Filomena, 2022. "Measuring and evaluating socio-economic inequality in small areas: An application to the urban units of the Municipality of Genoa," Socio-Economic Planning Sciences, Elsevier, vol. 83(C).
    7. Curtis, Sarah & Setia, Maninder S. & Quesnel-Vallee, Amelie, 2009. "Socio-geographic mobility and health status: A longitudinal analysis using the National Population Health Survey of Canada," Social Science & Medicine, Elsevier, vol. 69(12), pages 1845-1853, December.
    8. O'Reilly, Dermot & Rosato, Michael, 2010. "Dissonances in self-reported health and mortality across denominational groups in Northern Ireland," Social Science & Medicine, Elsevier, vol. 71(5), pages 1011-1017, September.
    9. Norman, Paul & Boyle, Paul & Exeter, Daniel & Feng, Zhiqiang & Popham, Frank, 2011. "Rising premature mortality in the UK’s persistently deprived areas: Only a Scottish phenomenon?," Social Science & Medicine, Elsevier, vol. 73(11), pages 1575-1584.
    10. Angela Testi & Enrico Ivaldi, 2011. "Measuring Progress in Health through Deprivation Indexes," Review of Economics & Finance, Better Advances Press, Canada, vol. 1, pages 49-57, April.
    11. Angela Testi & Enrico Ivaldi, 2009. "Material versus social deprivation and health: a case study of an urban area," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 10(3), pages 323-328, July.
    12. Shelton, Nicola Jane, 2009. "Regional risk factors for health inequalities in Scotland and England and the "Scottish effect"," Social Science & Medicine, Elsevier, vol. 69(5), pages 761-767, September.
    13. Cummins, Steven & Curtis, Sarah & Diez-Roux, Ana V. & Macintyre, Sally, 2007. "Understanding and representing 'place' in health research: A relational approach," Social Science & Medicine, Elsevier, vol. 65(9), pages 1825-1838, November.

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