Transcript Exploring the impact of local trends in self-reported morbidity (1991-2001) on spatial health inequalities

Exploring the impact of local trends in selfreported morbidity (1991-2001) on spatial health
inequalities
BSPS conference 2011
York
9th September 2011
Alan Marshall (University of Leeds)
[email protected]
1
Aim
• Capture and project forwards district trends in
age/sex specific rates of limiting long term
illness between 1991 and 2001 up to 2021
• What factors might explain the persisting
spatial inequalities in the projections?
Other research on LLTI (1991-2001)
Author
Title
Description
Boyle, P. (2004)
What can we learn about
the nations health from the
2001 census?
Considers reasons for
increase in SIRs across
districts (1991-2001)
Dorling, D. Thomas, B.
People and Places a 2001
census atlas of the UK
Displays spatial patterns of
LLTI in 1991 and 2001
This research extends that above by:
•Considering change in LLTI by age and sex and district (relational models)
•Evaluating spatial patterns of LLTI using the ONS area classification (rather than
deprivation quintiles)
•Controlling for issues of LLTI question change (1991-2001) identified by Boyle
(2004) (and other e.g. Bajekal (2004))
•Examining what continuation of trends in district LLTI might imply for future
spatial patterns
•Providing a methodology to apply to 2011 census LLTI data
Validity of LLTI
• There are strong relationships between LLTI
and other health outcomes including all cause
and cause-specific mortality (Charlton, et al.
1994; Bentham, et al. 1995; Idler & Benyamini
1997) as well as sickness benefits claims from
different health conditions.
• Self-assessed – perceptions of illness
• Assessment involves physical condition,
expectation and comparison
Variability in the relationship between LLTI and
mortality
Scotland
England
Wales
Source: Mitchell 2005
1991 and 2001 LLTI census questions
1991 LLTI question
Do you have any long-term illness, health problem or
handicap which limits your daily activities or the work
you can do?
Include problems which are due to old age.
2001 LLTI question
Do you have any long-term illness, health problem or
disability which limits your daily activities or the work
you can do?
Include problems which are due to old age
6
Changes in LLTI 1991-2001
• Increase in census rates of LLTI between 1991 and 2001
1991
Men
LLTI (census)
2001
Women
13
Men
14
Women
17
19
• Not observed in other surveys with long running
(consistently worded) LLTI questions
1991
Men
GHS
2001
Women
17
Men
18
Women
18
19
• Stigma associated with ‘handicap’ in 1991 is though to
have led to lower rates of LLTI (Bajekal et al 2004)
LLTI in 1991 and 2001 (census)
Grey = 1991, Black=2001
LLTI in 1991 and 2001 (GHS)
LLTI rates in 1991 (original and adjusted) and 2001
0
.2
.4
.6
.8
Age specific rates of LLTI (Britain, Males) – 2001, 1991 and
1991 adjusted
0
20
40
60
age
LLTI 1991 adjusted
LLTI 2001
LLTI 1991 original
80
Apply national adjustments to local LLTI rates
0
.2
.4
.6
.8
1
LLTI rates in Glasgow (females) 1991 (adjusted), 2001 and projections
for 2011 and 2021
0
20
40
60
80
age
2001
2011 - intercensal change
1991
2021 - intercensal change
Standardised illness ratios 2001 and 2021
SIRs
2001
SIR
(2001)
SIR
(2001)
SIRs
2021
SIR
(2021)
Intercensal
Local
Change
SIR
(2021)
Intercensal
Local
Change
District area classification
IH
MT
PSE
All SIRs are relative to the UK (2001) and calculated using the direct
standardisation procedure
Spatial changes in LLTI – attributable to local LLTI trends
Change in LLTI population (LLTI rates)
District area classification
Industrial
hinterlands
Manufacturing
towns
Prospering Southern England
Prospering Southern England
Manufacturing Towns
Industrial Hinterlands
Coastal and Countryside
New and Growing Towns
Prospering Smaller Towns
London Cosmopolitan
London Centre
London Suburbs
Thriving London Periphery
Centres with Industry
Regional Centres
Proportion of 2001 LLTI pop
Growth in LLTI population between 2001 and 2021 (as a
proportion of 2001 LLTI population) due to increases in LLTI
rates
0.12
0.08
0.04
0
-0.04
-0.08
-0.12
Industrial hinterlands (increasing LLTI rates)
Grey = 2001 Black = 2021
Prospering Southern England – (declining rates)
Grey = 2001. Black = 2021
Recap
Findings
• Polarisation of spatial patterns of LLTI
• Increases in Scotland
• Increases in industrial and manufacturing areas
• Exceptions – Rhonda
• Particularly hard hit districts – Barrow
• Declining LLTI rates – older ages in PSE
Explanations
• Migration
• Health expectations
• Hidden unemployment
• Health of individuals
Migration - polarisation
• Migration is an important determinant of
population health in an area, Norman et al.
(2005) demonstrate (1971-1991) that:
1.Healthy people tend to migrate away from
the most deprived areas
2.Unhealthy people migrate to the most
deprived areas
• Reflects a polarisation of wealth and other
socioeconomic characteristics (Dorling and
Rees 2003) during the 1990s
Scotland - Health expectations
• Mitchell (2005) notes that the tendency for
Scots to under report LLTI relative to levels of
mortality compared to those in England and
Wales.
• This finding held in 1991 and 2001 but was
less strong in 2001
• The increase in LLTI rates in Scotland may
reflect a convergence of health expectations
towards that of England and Wales
Hidden unemployment
• Increase in sickness benefits in some areas attributed
to ‘hidden unemployment’(Beatty et al. 2000;
Fieldhouse and Hollywood 1999).
• The expansion of ‘hidden unemployment’ in such
areas during the 1990s is likely to contribute to LLTI
rises.
• Particularly relevant to Barrow in Furness. See Beatty
and Fothergill (2002)
What about the health of individuals?
• Could people in a certain area be more/less
likely to suffer from an LLTI than their
equivalents in the recent past?
• Expansion/compression of morbidity
depending on area?
• Can we separate the roles of migration,
hidden unemployment and changing health
expectation?
Conclusions
• Polarisation of spatial patterns of LLTI (districts)
• Exceptions – Scotland (Coastal and Countryside),
Rhondda. Particularly hard hit areas
• Explanations:
1. Migration
2. Converging expectations of health,
3. Hidden unemployment
4. Trends in individual’s health
• 2011 census provides an opportunity to see if LLTI
trends (1991-01) have continued
References
Bajekal, M., Harries, T., Breman, R. and Woodfield, K. (2003). Review of
disability estimates and definitions. London, HMSO.
Beatty, C., Fothergill, S., Macmillan, R. (2000) A theory of employment,
unemployment and sickness. Regional Studies. 34(7): p617-630
Beatty, C., Fothergill, S. (2002) Hidden unemployment amongst men: a
casestudy. Regional Studies. 8(1); p811-823
Bentham. G., Eimermann, J., Haynes, R., Lovett, A. and Brainard, J. 1995.
Limiting long-term illness and its associations with mortality and indicators
of social deprivation. Journal of Epidemiology and Community Health 49:
S57-S64.
Boyle PJ (2004). The nation’s health: the picture from the 2001 census.
Census 2001: the findings. Royal Geographical Society, June 8.
Charlton, J., Wallace, M. and White, I. 1994 Long-term illness: results from the
1991 census. Population Trends 75: 18-25.
References
Dorling, D. and Thomas, B. (2004). People and Places: a 2001 census atlas of
the UK. Bristol, Policy Press.
Dorling, D. and Rees, P. (2003). A nation still dividing: the British census and
social polarisation (1971-2001). Environment and Planning A. 35. p12871313
Fieldhouse, E., Hollywood, E. (1999) Life after mining: Hidden unemployment
and changing patterns of economic activity amongst miners in England
and Wales 1981-1991. Work, Employment and Society. 13(3): 483-502.
Idler, E. and Benyamini, Y. 1997. Self-rated health and mortality: a review of
twenty-seven community studies. Journal of Health and Social Behavior
38: 21-37.
Mitchell, R. (2005). "Commentary: the decline of death--how do we measure
and interpret changes in self-reported health across cultures and time?"
International journal of Epidemiology 34(2): 306-8.
Norman, P., Boyle, P., Rees, P. (2005) Selective migration, health and
deprivation: a longitudinal analysis, Social Science & Medicine. 60(12)