Adults in England’s most deprived areas had more than twice the premature mortality rate of those in the least deprived areas, according to a new analysis of census and death records.
The research by the Health Foundation found substantial differences linked to education, occupation and neighbourhood deprivation. Its figures cover adults aged 18 to 74 and deaths from any cause before a person’s 75th birthday.
For men living in the most deprived fifth of areas, the estimated rate was 815 deaths per 100,000 people a year, compared with 353 in the least deprived fifth. For women, the corresponding rates were 556 and 243 per 100,000.
The rates have been adjusted for age, making comparisons less dependent on differences in the age profiles of the groups. They are measures across populations, not predictions of any individual’s chances of dying.
Published on 10 November, the analysis links information from the 2021 census with records of deaths between March 2021 and December 2023. It describes patterns in that earlier period rather than a newly occurring set of deaths.
Differences by education and work
The researchers also compared groups according to qualifications and employment history. Among women with no qualifications, the estimated premature mortality rate was 564 per 100,000 a year, against 225 for women with a degree or higher qualification.
For men who had never worked or were long-term unemployed, the rate was 1,069 per 100,000, compared with 306 among men in higher managerial, administrative and professional occupations. Those categories describe differences in the groups studied; they do not establish why any particular person died.
The study found that the area where people lived was associated with differences even within groups with similar qualifications. Men with a degree or higher qualification had a rate of 556 per 100,000 in the most deprived areas, compared with 269 in the least deprived areas.
Neighbourhood deprivation was measured using an index that ranks areas, rather than a direct measure of each resident’s income. The study used the 2019 index and compared the most and least deprived fifths of areas nationally.
A regional picture
The size of the gap also varied within regions. In the North West, women who had never worked or were long-term unemployed had an estimated rate of 796 per 100,000, compared with 229 among women in higher managerial, administrative and professional occupations in the same region.
For the first of those groups, the rate in London was 462 per 100,000. The analysis found that differences between socioeconomic groups within London were smaller than in most other regions, although the authors cautioned that further work was needed to understand the reasons.
Researchers used statistical models to examine whether differences remained after taking other characteristics into account. For men in the most deprived areas, the rate remained 79% higher than for men in the least deprived areas after adjustment for other demographic and socioeconomic factors and the local authority in which they lived.
What the findings can and cannot show
The research included people who took part in the census, and some groups were less well represented. The authors noted that people experiencing homelessness may be underrepresented, that incomplete records were excluded and that delays in registering deaths may have meant some were missed.
The figures describe all deaths before 75 among the adults studied, regardless of cause. That is different from counting only deaths from causes classified as preventable or treatable. An early death in this analysis should not automatically be described as avoidable.
Nor can the comparisons isolate a single cause of the differences. The researchers noted that poor health can affect a person’s ability to work, and that factors not included in their analysis may also contribute to the gaps. The data do not capture every experience across a person’s life.
The authors called for action across government on the conditions associated with health, including education, employment and local economic circumstances. They also said local areas should be supported to reduce inequalities through prevention.
