Published 10 September 2009, doi:10.1136/bmj.b3454
Cite this as: BMJ 2009;339:b3454

Research

Comparisons between geographies of mortality and deprivation from the 1900s and 2001: spatial analysis of census and mortality statistics

¹ Faculty of Arts and Social Sciences, Furness College, Lancaster University, Lancaster LA1 4YG

Objectives To examine the geographical relation between mortality and deprivation in England and Wales at the start of the 20th and 21st centuries. To explore the evidence for a strengthening or weakening of this relation over the century and test for relations between the mortality and deprivation patterns of a century ago and modern mortality and causes of death.

Design Census and mortality data for 634 districts from the 1900s directly compared with interpolated ward level data from 2001.

Setting Census data and national statistics for England and Wales in the 1900s and 2001.

Population Entire population in both periods.

Main outcome measures Standardised mortality ratios for all districts for both periods with additional cause specific ratios calculated for 2001. Deprivation (Carstairs) scores for each district in 2001, with comparable measure created for the 1900s. Correlations and partial correlations between deprivation scores and standardised mortality ratios in the 1900s and 2001 for the 614 districts for which all data were available.

Results The was no evidence of a significant change in the strength of the relation between deprivation and mortality between the start and end of the 20th century. Modern patterns of mortality and deprivation remain closely related to the patterns of a century ago. Even after adjustment for modern deprivation, standardised mortality ratios from the 1900s show a significant correlation with modern mortality and most modern causes of death. Conversely, however, there was no significant relation between deprivation in the 1900s and modern mortality for most causes of death after adjustment for modern deprivation.

Conclusions Despite all the medical, public health, social, economic, and political changes over the 20th century, patterns of poverty and mortality and the relations between them remain firmly entrenched. There is a strong relation between the mortality levels of a century ago and those of today. This goes beyond what would have been expected from the continuing relation between deprivation and mortality and holds true for most major modern causes of death.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    Twitter    What's this?

Relevant Article

The Ghost of Christmas Past: health effects of poverty in London in 1896 and 1991

Danny Dorling, Richard Mitchell, Mary Shaw, Scott Orford, and George Davey Smith
BMJ 2000 321: 1547-1551. [Abstract] [Full Text] [PDF]

Related external webpages:

Listen to a podcast interview with Ian Gregory

Rapid Responses:

Read all Rapid Responses

Le plus ca change le plus c'est le meme chose?

Jay S Kaufman
bmj.com, 11 Sep 2009 [Full text]

“loss of productive years due to economical deprivation” vis-ŕ-vis “mortality as a result of tobacco consumption”

Hemant Goswami, et al.
bmj.com, 12 Sep 2009 [Full text]

The effect of changes in the overall prevalence of an outcome on relative differences in experiencing and avoiding it

James P. Scanlan
bmj.com, 28 Dec 2009 [Full text]

Online poll

Find out more>>