Modelling inequality in reported long term illness in the UK: combining individual and area characteristics.

STUDY OBJECTIVE: To assess the nature of the relation between health and social factors at both the aggregated scale of geographical areas and the individual scale. DESIGN AND SETTING: The individual data are derived from the sample of anonymised records (SAR) from the census of 1991 in Great Britain, and are combined with area data from this census. The ecological setting (context) was defined using multivariate methods to classify the 278 districts of residence identifiable in the SAR. The outcome health variable is the 1991 census long-term limiting illness question. Health variations were analysed by multilevel logistic regression to examine the compositional variation (at the level of the individual) and the contextual variation (variability operating at the level of districts) in reported illness. PARTICIPANTS: 10 per cent randomised subsample of the SAR who are aged 16+ and are resident in households. MAIN RESULTS: The multi-level modelling revealed that area factors have a significant association with individual health outcome but their effect is smaller than that of individual attributes. The results show evidence for both compositional and contextual effects in the pattern of variation in propensity to report illness. CONCLUSIONS: The results suggest generally higher levels of ill health for individuals who are older, not married, in a semi/unskilled manual social class, and socioeconomically deprived (as measured by a composite deprivation score). All individuals living in areas with high levels of illness (which tend to be more deprived areas) show greater morbidity, even after allowing for their individual characteristics. However, within affluent areas, where morbidity was generally lower, the health inequality (health gradient) between rich and poor individuals was particularly strong. We consider the implications of these findings for health and resource allocation policy.

[1]  Peter Congdon,et al.  Geographic variation in illness and mortality: the development of a relevant area typology for SAR districts , 1996 .

[2]  K. Jones,et al.  Analyzing perceived limiting long-term illness using U.K. Census Microdata. , 1996, Social science & medicine.

[3]  Peter Congdon The Impact of Area Context on Long Term Illness and Premature Mortality: An Illustration of Multi-level Analysis , 1995 .

[4]  Peter Congdon Socio-economic Structure and Health in London , 1995 .

[5]  Kelvyn Jones,et al.  Individuals and their ecologies: analysing the geography of chronic illness within a multilevel modelling framework , 1995 .

[6]  H. Joshi,et al.  Higher mortality in deprived areas: community or personal disadvantage? , 1994, BMJ.

[7]  S. Openshaw,et al.  Are multidimensional social classifications of areas useful in UK health service research? , 1994, Journal of epidemiology and community health.

[8]  T. Sheldon,et al.  Health and health care of rural populations in the UK: is it better or worse? , 1994, Journal of epidemiology and community health.

[9]  M G Marmot,et al.  Social deprivation and premature mortality: regional comparison across England. , 1993, British medical journal.

[10]  Kelvyn Jones,et al.  A Multi-level Analysis of the Variations in Domestic Property Prices: Southern England, 1980-87 , 1993 .

[11]  C Duncan,et al.  Do places matter? A multi-level analysis of regional variations in health-related behaviour in Britain. , 1993, Social science & medicine.

[12]  C. Robertson Participation in post-compulsory education in Scotland , 1993 .

[13]  S. Macintyre,et al.  Area, Class and Health: Should we be Focusing on Places or People? , 1993, Journal of Social Policy.

[14]  R. Reading,et al.  A rural advantage? Urban-rural health differences in northern England. , 1992, Journal of public health medicine.

[15]  D. Hosmer,et al.  Applied Logistic Regression , 1991 .

[16]  Harvey Goldstein,et al.  New Statistical Methods for Analysing Social Structures: an introduction to multilevel models , 1991 .

[17]  R. Carr-Hill,et al.  Area variations in health outcomes: artefact or ecology. , 1991, International journal of epidemiology.

[18]  A. G. Shaper,et al.  Self-assessment of health status and mortality in middle-aged British men. , 1991, International journal of epidemiology.

[19]  P. Östlin,et al.  Occupational history, self reported chronic illness, and mortality: a follow up of 25,586 Swedish men and women. , 1990, Journal of epidemiology and community health.

[20]  D. Black HEALTH AND DEPRIVATION: Inequality and the north , 1988 .

[21]  J. L. Grand,et al.  Inequalities in health: Some international comparisons , 1987 .

[22]  Bentham Cg Mortality rates in the more rural areas of England and Wales , 1984 .

[23]  J. Charlton,et al.  Long-term illness: results from the 1991 census. , 1994 .

[24]  C. Marsh,et al.  Samples of anonymised records from the 1991 census. , 1992 .

[25]  P. Phillimore,et al.  Discrepant legacies: premature mortality in two industrial towns. , 1991, Social science & medicine.

[26]  Kelvyn Jones,et al.  Specifying and estimating multilevel models for geographical research , 1991 .

[27]  M. Blaxter Health and lifestyles , 1990 .

[28]  J. Craig Local authority urban-rural indicators compared. , 1988 .

[29]  A. Green The North-South divide in Great-Britain : an examination of the evidence , 1988 .

[30]  D. Jones,et al.  Approaches to studying the effect of socio-economic circumstances on geographic differences in mortality in England and Wales. , 1984, British medical bulletin.

[31]  R. Webber,et al.  The national classification of residential neighbourhoods : an introduction to the classification of wards and parishes , 1977 .