Higher mortality in deprived areas: community or personal disadvantage?

Abstract

Objective : To investigate the association between level of social deprivation in electoral wards and premature mortality among residents, before and after allowing for levels of personal deprivation. Design : Longitudinal study of the Office of Population Censuses and Surveys. Setting : England. Subjects—Random sample of nearly 300 000 people aged between 16 and 65 at the 1981 census and followed up for nearly nine years. Main outcome measure—Death from all causes between ages of 16 and 70. Results : Without allowance for personal disadvantage, both sexes showed a clear, significant, and roughly linear positive relation between degree of deprivation of the ward of residence in 1981 and premature death before 1990. For men, this association was effectively explained away once allowance was made for individual socioeconomic circumstances. For women living in wards of above average deprivation, the association was also effectively removed, but the situation for other women was less clear. Conclusion : The excess mortality associated with residence in areas designated as deprived by census based indicators is wholly explained by the concentration in those areas of people with adverse personal or household socioeconomic factors. Health policy needs to target people as well as places.