Monitoring inequalities in health expectancies in England - small area analyses from the Census 2001 and General Household Survey 2001-05.

Abstract

Background: Deprivation and ill health are intimately linked. Monitoring this relationship in detail and with sufficient frequency is key in attempts to reduce health inequalities through more efficient targeting of healthcare resources. This study explores the potential of the General Household Survey (GHS) to provide an inter-censal measure of health expectancies in small areas experiencing differing degrees of deprivation.

Methods: The prevalence of health status and the health expectancy of males and females at birth and at age 65 by quintiles of small area deprivation are estimated. Comparisons are made between census 2001 and GHS 2001-05 to inform the suitability of the latter as an inter-censal measure of health expectancy across small areas. Comparisons are also made between the health expectancies of people living in more and less deprived areas.

Results: Reports of 'good' and 'fairly good' health fell and health expectancies declined as deprivation increased. Consistency between census and GHS data indicates that the latter is a suitable source for the inter-censal measurement of health expectancies across quintiles of deprivation. At birth, people living in the least deprived areas can expect more than 12 additional years of life in good or fairly good health than those in the most deprived areas, at age 65 the difference was more than four years. In terms of the proportion of life spent in favourable health states; at birth, those living in the least deprived areas could expect to spend around 91 per cent or more of their lives in good or fairly good health compared to 82 per cent for those in the most deprived areas. At age 65, people in the least deprived areas could expect to spend around 82 per cent of their remaining life in good or fairly good health compared to 69 per cent or less for those in the most deprived areas.

Conclusions: This study represents the first use of the Index of Multiple Deprivation (IMD) 2004 in the measurement of health expectancy across small areas. Both the census and GHS highlighted substantial differences in the health status and health expectancies of people experiencing differing degrees of ecological deprivation. These findings serve as a useful measure and benchmark in the targeting and assessment of interventions designed to ameliorate health inequalities.