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Rural/urban mortality differences and the effect of deprivation adjustment in England and Wales

Rural/urban mortality differences and the effect of deprivation adjustment in England and Wales. Dissertation project for Masters in Public Health 2007 + HSQ article Andrea Gartner, Health information and intelligence analyst, Wales Centre for Health, Cardiff. The project.

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Rural/urban mortality differences and the effect of deprivation adjustment in England and Wales

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  1. Rural/urban mortality differences and the effect of deprivation adjustment in England and Wales Dissertation project for Masters in Public Health 2007 + HSQ article Andrea Gartner, Health information and intelligence analyst, Wales Centre for Health, Cardiff

  2. The project • ONS suggested the work (Myer Glickman and Prof. David Fone,Cardiff University) • Previous work on WCfH publication “A profile of rural health in Wales” • Supervisors: Prof. Frank Dunstan and Dr. Daniel Farewell, Cardiff University • ONS provided mortality data access and HSQ article arrangements (HSQ 39 autumn 2008) • WCfH study leave

  3. Is there a difference in mortality between rural and urban areas of England and Wales? • Investigate variation amongst rural/urban sub-classes (compare rates for all-cause mortality) • Examine differences between rural and urban areas whilst adjusting for deprivation (Logistic regression analysis for all-causes and six specific causes) (3. Investigate rural/urban differences in relationship of mortality and deprivation)

  4. Challenges with rural/urban analysis • Definition of “rural” varies in literature • Large variation in rural health outcomes – poor results hidden by averages (Haynes & Gale,2000;) • Deprivation measures thought to be more urban-centred (Farmer et al.,2001; Christie& Fone,2003) • Migration • Few published studies on the topic

  5. Rural or urban? • Six rural/urban classes of at LSOA level (2004 classification) • 20% of population in Englandlive in a rural area (35% in Wales)

  6. All-cause mortality rates 2002-2004 by rural/urban class Rural “Village and dispersed” tend to have lowest rates Source: ONS

  7. Rural/urban distribution of deprivation (WIMD 2005) -> Urban areas are classed as more deprived

  8. Regression analysis: models • Logistic regression model fitted with variables age and rurality • Second model with variables age, rurality and five deprivation measures • Townsend Index of Deprivation • Index of Multiple deprivation 2004 (IMD), Welsh Index of Multiple deprivation (WIMD) • (W)IMD excluding health domain • (W)IMD Employment domain • (W)IMD Income domain • Run separately for male/female, England/Wales, causes and deprivation measures (168 runs)

  9. Regression analysis: output • Estimated odds ratio for rurality variable relative to urban (95% confidence interval, significance value) • Interpreted as risk ratio of mortality *Statistically significant (p-value< 0.05)

  10. Rural/urban rates similar for… *Statistically significant (p-value< 0.05) ** Odds ratio rural relative to urban, Wales 2002-2004, before and after adjustment for WIMD • Rural/urban differences narrowed • Deprivation accounted for much of the difference

  11. Rural rates lower for… * Statistically significant (p-value< 0.05) ** Odds ratio rural relative to urban, Wales 2002-2004, before and after adjustment for WIMD • Largest rural/urban differences before • Deprivation accounted for some of the difference, but still substantial diff.

  12. Rural rates higher for… * Statistically significant (p-value< 0.05) ** Odds ratio rural relative to urban, Wales 2002-2004, before and after adjustment for WIMD • Rural/urban differences widened to substantial difference (accidents) • Suicides unclear/not stat. significant

  13. Conclusions • Effect of adjustment similar for five deprivation measures (Wales effect smaller) • Association between mortality and deprivation similar in rural and urban areas • Large differences for some causes are of significant public health concern • Deprivation adjustment removed many initital rural/urban mortality differences • Rural populations were not inevitably “healthier” than urban populations

  14. Any comments or questions?

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