(Un-)healthy aging in local areas: England & Wales 1991 to 2011

For health, ages 50-74 are important because these ages: a) Encompass the transition between work / main career and retirement / alternative occupation; b) Start from when health inequalities can be greatest (to ~ parity in older ages) and; c) Are when there can be deviations away from a gradual increase in health rates with age
Since there are ecological correlations between health of older people in places and later life work exit, we explore, What kinds of places do people have better / worse health outcomes during ages 50 to 74?

Transcript

1. (Un-)healthy aging in local areas: England & Wales 1991 to 2011 Paul Norman School of Geography, University of Leeds Emily Murray, Nicola Shelton and Jenny Head (UCL) BSPS Conference September 2021
2. (Un-)healthy aging in local areas: England & Wales 1991 to 2011 For health, ages 50-74 are important because … These ages: • Encompass the transition between work / main career and retirement / alternative occupation • Start from when health inequalities can be greatest (to ~ parity in older ages) • Are when there can be deviations away from a gradual increase in health rates with age Since there are ecological correlations between health of older people in places and later life work exit … In what kinds of places do people have better / worse health outcomes during ages 50 to 74? DWP 2017; Marshall & Norman 2013; Norman & Boyle 2013
3. Data & Health Measure • Time frame 1991, 2001, 2011 • England & Wales, Middle Layer Super Output Areas (MSOAs) with all data converted to 2011 MSOA boundary definitions • Health Measure: Disability Free Life Expectancy • Inputs (Vital Statistics) Mortality Rates and (Census) Limiting Long-Term Illness Rates • Ages 0,1-4, 5-9 … 80-84, 85+ for males and females • Pseudo cohort: • Aged 50-54 in 1991, 60-64 in 2001 & 70-74 in 2011 Sullivan 1971; Jagger 1997; Wohland et al 2014
4. Disability Free Life Expectancy: 1991 > 2001 > 2011 Quintiles; Darker = less long Males aged 50-54 in 1991 Males aged 60-64 in 2001 Males aged 70-74 in 2011 Hot / Cold Spots
5. Disability Free Life Expectancy: 1991 > 2001 > 2011 Deprivation trajectories 1991-2011(darker = more deprived) Exeter et al 2019; Norman 2017 Males Females Deprivation Trajectory Males Females Least deprived -62.90 -65.42 Less deprived -64.73 -67.29 Middle -66.32 -68.85 More deprived -68.00 -70.76 Most deprived -68.88 -72.23 % Change 1991 to 2011
6. Disability Free Life Expectancy: 1991 > 2001 > 2011 Urban > Rural 1991-2011(darker = more urban) Males Females Density Categories Males Females Most rural -62.16 -64.99 Rural -63.99 -66.55 Urban -64.93 -67.45 Very urban -65.71 -68.26 Most urban -66.33 -68.99 % Change 1991 to 2011
7. Disability Free Life Expectancy: 1991 > 2001 > 2011 ONS Classification 1991 wards estimated for MSOA 2011 Males Females ONSCLASS Males Females Prosperous areas -61.51 -63.83 Established Owner-Occupiers -63.06 -65.40 Transient populations -63.31 -66.31 Rural Areas -62.30 -65.45 Suburbia -65.70 -67.85 Rural Fringe -64.52 -67.09 Metropolitan professionals -60.22 -63.48 Mature Populations -62.82 -65.64 Middling Britain -66.60 -69.14 Deprived City Areas -66.51 -69.63 Industrial areas -68.59 -71.03 Lower Status Owner Occupiers -67.01 -69.75 Inner city estates -67.20 -70.60 Deprived Industrial Areas -70.38 -73.48 N.B. No colour equivalence between map & graphs!
8. Disability Free Life Expectancy: 1991 > 2001 > 2011 Trajectories of DFLEs … Males Females Trajectory C3 Trajectory C2 Trajectory C5 Trajectory C1 Trajectory C4 MORECARS 1.32 AGRIC 2.59 IIIN 1.10 PCTBLACK 1.82 PCTASIAN 1.95 PCTQUAL 1.30 BIGHOUSE 1.52 DINKIES 1.05 pph 1.47 NOCAR 1.67 BIGHOUSE 1.29 MORECARS 1.44 PCTOWNER 1.05 PCTASIAN 1.40 UNEMRATE 1.65 PEOPLE12 1.28 PCTQUAL 1.26 WORKWIM 1.04 NOCAR 1.31 PCTPUB 1.59 SERVICE 1.12 PEOPLE12 1.26 pph 1.04 PCTPUB 1.27 PCTBLACK 1.55 DINKIES 1.11 DINKIES 1.11 PEOPLE12 1.02 TTWAPTE 1.27 MINEWORK 1.48 PCTOWNER 1.09 PRIVRENT 1.11 PCTQUAL 1.02 KIDSLADT 1.26 LOTSKIDS 1.44 PCTSTUDY 1.07 PCT4564 1.07 PCTOV65 1.02 PBUILT 1.25 TERRACED 1.44 IIIN 1.07 PCTSTUDY 1.07 PCT2544 1.02 PCTNOCHG 1.22 pph 1.44 WORKWIM 1.05 PCTOWNER 1.06 MORECARS 1.01 UNEMRATE 1.22 KIDSLADT 1.43 Top 10 variables (relative presence) in each cluster
9. (Un-)healthy aging in local areas: England & Wales 1991 to 2011 Summary: • Clear area relationships between deprivation and urban > rural with DFLE • Multi-variate geodemographic classification adds value • Variables distinctive by variations in DFLE? Reinforces the ‘usual suspects’ but not necessarily ‘modifiable’ • Bad news: The geography of health inequalities by area type entrenched • Good news: For a ‘levelling up’ agenda, targeting by area type can be well informed
10. Contact: Emily.murray@ucl.ac.uk @emilytmurray
11. References DW P (2017) Fuller W orking Lives https://www.gov.uk/government/publications/f uller -working-lives-a-partnership-approach Exeter DJ, Feng Z, Zhao J, Cavadino A & Norman P (2019) The geographic harmonisation of Scotland’s small area census data, 19 81 to 2011. Health & Place: 57 22 -26: https://doi.org/10.1016/j.healthplace.2019.02.003 Jagger C. (1997) Health expectancy calculation by the Sullivan method: a practical guide. Montpellier: INED -REVES [online, acces sed 06-08- 2021] https://reves.site.ined.f r/en/resources/computation_online/sullivan/ Marshall A & Norman P (2013) Geographies of the impact of retirement on health in the United Kingdom. Health & Place 30: 1 -12 http://dx.doi.org/10.1016/j.healthplace.2012.11.004 Norman P (2017) Area characteristics: Great Britain 1971 to 2011. Mendeley Data: http://dx.doi.org/10.17632/389scnndjy.1 Norman P & Boyle P (2014) Are health inequalities between dif f erently deprived areas evident at dif f erent ages? A longitudina l study of census records in England & W ales, 1991 -2001. Health & Place 26:88 -93 http://dx.doi.org/10.1016/j.healthplace.2013.12.010 Sullivan D F (1971) A single index of mortality and morbidity. HSMHA health reports, 86(4), 347. W ohland P, Rees P, Gillies C, Alvanides S, Matthews F E, O'Neill V & Jagger C (2014). Drivers of inequality in disability -f ree expectancy at birth and age 85 across space and time in Great Britain. Journal of Epidemiology & Community Health, 68(9), 826 -833Marshall A & Norman P (2013) Geographies of the impact of retirement on health in the United Kingdom. Health & Place 30: 1 -12 http://dx.doi.org/10.1016/j.healthplace.2012.11.004 Please see Health of Older People in Places (HOPE) https://www.ucl.ac.uk/epidemiology -health-care/research/epidemiology -and-public-health/research/ucl-work-and-health-research-group/health- older-people-places Acknowledgeme nts The Health Foundation f or project f unding Data suppliers particularly ONS / UKDS f or Vital Statistics, Census, Boundary f iles Charlotte Sturley & Kath Leah f or assistance in data prep of 2011 variables equivalent to 1991 ONSCLASS input variables