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

BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b3454 (Published 10 September 2009) Cite this as: BMJ 2009;339:b3454
  1. Ian N Gregory, senior lecturer in digital humanities
  1. 1Faculty of Arts and Social Sciences, Furness College, Lancaster University, Lancaster LA1 4YG
  1. Correspondence to: I.Gregory{at}lancaster.ac.uk
  • Accepted 24 March 2009

Abstract

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.

Footnotes

  • Digital boundary data for 2001 census area statistics wards were provided through EDINA (http://edina.ac.uk/) UKBorders with the support of the ESRC (Economic and Social Research Council) and JISC (Joint Information Services Committee) and use boundary material that is copyright of the Crown. The 2001 VS data were created by the Office for National Statistics and distributed by the UK Data Archive, University of Essex. Crown copyright material is reproduced with the permission of the controller of HMSO. The original data creators, depositors, or copyright holders, the funders of the data collections (if different), and the UK Data Archive bear no responsibility for their further analysis or interpretation. Census output is Crown Copyright and is reproduced with the permission of the controller of HMSO. The ArcGIS software package produced by ESRI (www.esri.com) was used to standardise the geographical units used in this study. It also assisted the analysis and produced the maps.

  • Funding: This study was funded by the Leverhulme Trust under their early career fellowship scheme (ECF/40115).

  • Competing interests: None declared.

  • Ethical approval: Not required.

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