chapter 7 measuring inequalities in small area life expectancy

Chapter 7 Measuring inequalities in small area life expectancy

West Midlands Key Health Data 2011/12

Launch EventMonday 18 March 2013

12.30pm – 3.30pmMichael Tippett Room, Staff House

University of Birmingham

Chapter contributions from:West Midlands Cancer Intelligence UnitHealth Protection Agency West MidlandsThe Perinatal InstituteNHS WarwickshireWarwickshire County CouncilStaffordshire County Council / NHS Staffordshire and NHS Stoke-on-TrentHeart of England Foundation TrustWest Midlands Commissioning Support Unit



Measuring inequalities in small area life expectancy

Daniel Eayres, Jane Fletcher, WMCSU

Paul Kingswell, NHS Warwickshire

Why measure life expectancy?

West Midlands Key Health Data 2011/12 Chapter 7 Measuring inequalities in small area life expectancyDaniel Eayres, Jane Fletcher, WMCSU; Paul Kingswell, NHS Warks

Longstanding and widely used measure of overall health outcome

Quantifies mortality risks in a readily understandable metric

Used in previous PSA target to reduce health inequalities between LAs

Public Health Outcomes Framework – Overarching outcomes

increased healthy life expectancy, i.e. taking account of the health quality as well as the length of life;

reduced differences in life expectancy and healthy life expectancy between communities (through greater improvements in more disadvantaged communities).

Life expectancy in the West Midlands


Male life expectancy at birth by region, England 2008-10

75

76

77

78

79

80

81

SOUTH EAST

EAST OF ENGLAND

SOUTH WEST

LONDON EAST MIDLANDS

WEST MIDLANDS

YORKSHIRE AND THE HUMBER

NORTH EAST

NORTH WEST

ENGLAND

Life

exp

ecta

ncy

year

s

Region

Source: Compendium of Population Health Indicators, NHS Information Centre.

Life expectancy in the West Midlands



Chapter 7 Measuring inequalities in small area life expectancyDaniel Eayres, Jane Fletcher, WMCSU; Paul Kingswell, NHS Warks

Female life expectancy at birth, England and the West Midlands 1991-93 to 2008-10

76

77

78

79

80

81

82

83

Life

exp

ecta

ncy

year

s

Time Period

ENGLAND WEST MIDLANDS

Source: Compendium of Population Health Indicators, NHS Information Centre.

Life expectancy by local authority


Life expectancy at birth by local authority, West Midlands 2008-10

Males Females

Life expectancy by local authority




y = -0.1378x + 81.097R² = 0.7528

75

76

77

78

79

80

81

0 5 10 15 20 25 30 35 40

Life

exp

ecta

ncy

(yea

rs)

Index of Multiple Deprivation 2010 (average score)

Source: Compendium of Population Health Indicators, NHS Information Centre; Indices of Deprivation 2010, Department for Communities and Local Government.

Male life expectancy at birth vs. Deprivation by local authority, West Midlands 2008-10

Small area geographies




Electoral Wards● Politically relevant● Frequent boundary changes● Large variation in population size

Super Output Areas - Lower (LSOA) and Middle (MSOA)● Not directly associated with admin/constiuency areas● Stable boundaries● Little variation in population size

West Midlands○ Wards n = 719, avg pop = 7,800 (LA avg 3,400 - 26,800)○ MSOAsn = 735, avg pop = 7,600 (LA avg 6,200 - 9,200)○ LSOAs n = 3,487, avg pop = 1,600 (LA avg 1,50-1,700)

Life expectancy by small area geography


Life expectancy at birth by small area, West Midlands 2008-10

By ward By MSOA



Life expectancy at birth by small area, West Midlands Metropolitan County 2008-10

By ward By MSOA





y = -0.1673x + 81.718R² = 0.6386

65

70

75

80

85

90

95

0 10 20 30 40 50 60 70 80

Life

exp

ecta

ncy

(yea

rs)

Index of Multiple Deprivation 2010 (average score)

Source: Health profiles – local health, Network of Public Health Observatories; Indices of Deprivation 2010, Department for Communities and Local Government.

Male life expectancy at birth vs. Deprivation by MSOA, West Midlands 2008-10

Slope Index of Inequality


Indicator 0.2i: Slope index of inequality (SII) in life expectancy at birth based on national deprivation deciles of Lower Super Output Areas (LSOAs) within England [National level].

Indicator 0.2ii: Number of upper tier local authorities for which the local SII in life expectancy (as defined in 0.2.iii) has decreased [National level].

Indicator 0.2iii: SII in life expectancy at birth within each English upper tier local authority, based on local deprivation deciles of LSOAs [LA level].

Public Health Outcomes Framework life expectancy inequalities





70

72

74

76

78

80

82

84

86

88

90

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Life

Expe

ctan

cy at

Birt

h (y

ears

)

Percentage of population, ranked from high to low IMD score

Life Expectancy by Deprivation Deciles, showing the Slope Index of InequalityWarwickshire, Males, 2006-10

Slope Index of Inequality = 8.3 years (95% Confidence Interval: 6.0 to 10.6)

Inequality Slope

Life Expectancy with 95% confidence limits

Source: Health Inequality Indicators, Network of Public Health Observatories.

Male life expectancy at birth by deprivation decile showing the SII, Warwickshire 2006-10





ONS Area code

LA Name Males Females

SII 95% confidence

limits

SII 95% confidence

limits Lower Upper Lower Upper

E06000019 Herefordshire, County of UA 4.8 1.1 8.4 4.1 1.0 7.2 E06000051 Shropshire UA 6.7 4.2 9.1 4.3 2.8 5.8 E06000021 Stoke-on-Trent UA 8.2 5.7 10.7 4.7 1.0 8.5 E06000020 Telford and Wrekin UA 7.0 4.3 9.6 2.8 -1.3 6.8 E10000028 Staffordshire 8.0 6.9 9.1 6.2 4.0 8.5 E10000031 Warwickshire 8.3 6.0 10.6 7.6 5.2 9.9 E10000034 Worcestershire 7.8 5.6 10.0 5.4 4.0 6.8 E08000025 Birmingham 10.8 9.2 12.5 5.9 4.3 7.5 E08000026 Coventry 11.7 9.8 13.7 7.9 5.1 10.8 E08000027 Dudley 9.9 8.7 11.0 5.7 3.4 8.1 E08000028 Sandwell 9.6 7.5 11.8 6.4 4.3 8.6 E08000029 Solihull 10.8 8.3 13.2 10.3 7.7 12.8 E08000030 Walsall 10.8 8.9 12.6 6.9 3.2 10.5 E08000031 Wolverhampton 9.7 7.4 11.9 5.8 2.8 8.8

Source: Health Inequality Indicators, Network of Public Health Observatories.

SII for life expectancy at birth by upper-tier local authority and gender West Midlands 2006-10

Summary Points




LE is a high profile outcome indicator that needs to be monitored by HWBs, including the assessment of within local authority inequality.

Life expectancy in the West Midlands is continuing to improve but has remained persistently below the national average for both men and women.

The range between the highest and lowest local authority districts LEs in the West Midlands is ~5 years for males and ~4 years for females.

Significant variation in LE at the ward, MSOA and LSOA deprivation deciles levels using 5-years of mortality data.

At all area levels there is a strong association between LE and deprivation. The association is stronger and the relationship steeper for males than for females.

Wide inequalities in life expectancy exist within even those local authorities that have high life expectancies overall.

SII values for WM upper-tier LAs range from 4.8 to 11.7 years for males and 2.8 to 10.3 years for females.

Measuring the change in the SII over time in individual LAs will be problematic as the confidence intervals are wide and long time periods are needed.



END

Daniel Eayres, Jane Fletcher, WMCSU

Paul Kingswell, NHS Warwickshire

chapter 7 measuring inequalities in small area life expectancy

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