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North-South disparities in English mortality1965-2015: longitudinal population study.

ABSTRACT: Social, economic and health disparities between northern and southern England have persisted despite Government policies to reduce them. We examine long-term trends in premature mortality in northern and southern England across age groups, and whether mortality patterns changed after the 2008-2009 Great Recession.Population-wide longitudinal (1965-2015) study of mortality in England's five northernmost versus four southernmost Government Office Regions - halves of overall population.directly age-sex adjusted mortality rates; northern excess mortality (percentage excess northern vs southern deaths, age-sex adjusted).From 1965 to 2010, premature mortality (deaths per 10 000 aged <75 years) declined from 64 to 28 in southern versus 72 to 35 in northern England. From 2010 to 2015 the rate of decline in premature mortality plateaued in northern and southern England. For most age groups, northern excess mortality remained consistent from 1965 to 2015. For 25-34 and 35-44 age groups, however, northern excess mortality increased sharply between 1995 and 2015: from 2.2% (95% CI -3.2% to 7.6%) to 29.3% (95% CI 21.0% to 37.6%); and 3.3% (95% CI -1.0% to 7.6%) to 49.4% (95% CI 42.8% to 55.9%), respectively. This was due to northern mortality increasing (ages 25-34) or plateauing (ages 35-44) from the mid-1990s while southern mortality mainly declined.England's northern excess mortality has been consistent among those aged <25 and 45+ for the past five decades but risen alarmingly among those aged 25-44 since the mid-90s, long before the Great Recession. This profound and worsening structural inequality requires more equitable economic, social and health policies, including potential reactions to the England-wide loss of improvement in premature mortality.

SUBMITTER: Buchan IE

PROVIDER: S-EPMC5561382 | biostudies-other | 2017 Sep

REPOSITORIES: biostudies-other

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Project description:BackgroundThe association of low socioeconomic status (SES) with childhood and adolescent obesity has been reported. It is unknown whether low SES affects body mass index (BMI) growth trajectory in the first 12 mo of life. Moreover, accelerated growth as a compensatory mechanism for low birth weight (LBW) during infancy, is an important predictor of later obesity. The aim of the present study was to examine the association of low SES with infancy BMI growth rate and trajectory for LBW and normal birth weight (NBW) infants.MethodsFrom September 2012 to October 2014, a total of 387 infants in this longitudinal study was subjected to repeated measures of weight and length from birth to 12 mo in Hefei. Generalized growth mixture modeling was used to classify the infancy BMI growth trajectories. Differences in infancy BMI z score (zBMI) and BMI growth rate between low SES and high SES were estimated based on linear regression after adjusting for several confounders including maternal age, pregnancy BMI, physical activity during pregnancy, paternal BMI as well as alcohol use, paternal smoking status, breastfeeding duration and delivery mode.ResultsInfancy BMI trajectories in this study were classified into three categories: rapid growth (class 1), normal growth (class 2) and slow growth (class 3). Low SES infants had the higher zBMI than high SES infants for LBW group at age 6 mo [zBMI difference with 95% CI at 6 mo: 0.28(0.03, 0.53); at 12 mo: 0.21(0.01, 0.43)]. Low SES infants had more rapid zBMI growth rate than those with high SES for low birth weight between 0 and 6 months. Controlling for the confounders, these associations remained robust. We found the lower SES in the rapid growth group.ConclusionsThese findings highlighted the impact of low SES on increasing BMI and accelerated growth during early infancy. Health care and relatively optimal family environment in the first 12 mo of life, especially for LBW infants, are benefit to shape the better infancy growth trajectory.

Project description:BackgroundIndividuals with limited English proficiency (LEP) have worse healthcare access and report lower quality of care compared to individuals who are proficient in English. Policy efforts to improve patient-provider communication for LEP individuals have been going on for decades but linguistic disparities persist.ObjectiveTo describe trends in patient-provider communication by limited English proficiency (LEP) from 2006 to 2015.DesignWe estimated interrupted time series models for three measures of patient-provider communication, testing for differences in both means (intercepts) and trends (slopes) before and after 2010 and differences in differences by English proficiency.ParticipantsA nationally representative sample of the US non-institutionalized population with at least one office-based medical visit from the 2006-2015 Medical Expenditure Panel Survey (N = 27,001).Main measuresPatient-provider communication is measured with three variables indicating whether individuals reported that their providers always explained things in a way that was easy to understand, showed respect for what they had to say, and listened carefully.Key resultsAlthough patient-provider communication improved for all groups over the study period, before 2010, it was getting worse among LEP individuals and disparities in patient-provider communication were widening. After 2010, patient-provider communication improved for LEP individuals and language disparities by English proficiency either narrowed or remained the same. For example, between 2006 and 2010, the percent of LEP individuals reporting that their provider explained things clearly declined by, on average, 1.4 percentage points per year (p value = 0.102); after 2010, it increased by 3.0 percentage points per year (p value = 0.003).ConclusionsOur study sheds light on trends in patient-provider communication before and after 2010, a year that marked substantial efforts to reform the US healthcare system. Though patient-provider communication among LEP individuals has improved since 2010, linguistic disparities persist and constitute a formidable challenge to achieving healthcare equity, a long-standing US policy goal.

Project description:BackgroundSince the mid-1990s, excess mortality has increased markedly for adults aged 25-44 years in the north compared with the south of England. We examined the underlying causes of this excess mortality and the contribution of socioeconomic deprivation.MethodsMortality data from the Office of National Statistics for adults aged 25-44 years were aggregated and compared between England's five most northern versus five most southern government office regions between Jan 1, 1981, and Dec 31, 2016. Poisson regression models, adjusted for age and sex, were used to quantify excess mortality in the north compared with the south by underlying cause of death (accidents, alcohol related, cardiovascular disease and diabetes, drug related, suicide, cancer, and other causes). The role of socioeconomic deprivation, as measured by the 2015 Index of Multiple Deprivation, in explaining the excess and regional variability was also explored.FindingsA mortality divide between the north and south appeared in the mid-1990s and rapidly expanded thereafter for deaths attributed to accidents, alcohol misuse, and drug misuse. In the 2014-16 period, the northern excess was incidence rate ratio (IRR) 1·47 (95% CI 1·39-1·54) for cardiovascular reasons, 2·09 (1·94-2·25) for alcohol misuse, and 1·60 (1·51-1·70) for drug misuse, across both men and women aged 25-44 years. National mortality rates for cardiovascular deaths declined over the study period but a longstanding gap between north and south persisted (from 33·3 [95% CI 31·8-34·8] in 1981 to 15·0 [14·0-15·9] in 2016 in the north vs from 23·5 [22·3-24·8] to 9·9 [9·2-10·5] in the south). Between 2014 and 2016, estimated excess numbers of death in the north versus the south for those aged 25-44 years were 1881 (95% CI 726-2627) for women and 3530 (2216-4511) for men. Socioeconomic deprivation explained up to two-thirds of the excess mortality in the north (IRR for northern effect reduced from 1·15 [95% CI 1·14-1·15; unadjusted] to 1·05 [1·04-1·05; adjusted for Index of Multiple Deprivation]). By 2016, in addition to the persistent north-south gap, mortality rates in London were lower than in all other regions, with IRRs ranging from IRR 1·13 (95% CI 1·12-1·15) for the East England to 1·22 (1·20-1·24) for the North East, even after adjusting for deprivation.InterpretationSharp relative rises in deaths from cardiovascular reasons, alcohol misuse and drug misuse in the north compared with the south seem to have created new health divisions between England's regions. This gap might be due to exacerbation of existing social and health inequalities that have been experienced for many years. These divisions might suggest increasing psychological distress, despair, and risk taking among young and middle-aged adults, particularly outside of London.FundingMedical Research Council and Wellcome Trust.

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North-South disparities in English mortality1965-2015: longitudinal population study.

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