Age specific trends in mortality disparities by socio-economic deprivation in small geographical areas of England, 2002-2018: a retrospective registry study

Background: Disparities in mortality rates according to socioeconomic position (SEP) have been rising in England. We describe the association between recent changes in socioeconomic inequality and trends in mortality disparities for different age and sex groups at small-area level in England.

Methods: Vital registration data from the Office for National Statistics on resident population size and number of deaths in each Lower Super Output Area (LSOA) in England from 2002 to 2018 were stratified by sex and 5-year age group. We grouped LSOA into ventiles of the Index of Multiple Deprivation (IMD), our indicator of SEP. We examined time trends in smoothed mortality rates, using 3 year moving averages for the period 2003-2017, by age across the IMD distribution. We measured mortality inequalities using the ratio of mortality rates between different deprivation groups. We calculated mortality rate ratios between the most and the least deprived 10%of areas (Total Inequality) and between the median and least deprived (Lower Inequality) 10% of areas by year, gender and age group, to examine where in the distribution of deprivation trends in mortality inequality arose.

Findings: Among <1 year olds, the inequality in mortality rates between the poorest 10% of LSOAs and the rich-est 10% of LSOAs fell between 2003 and 2017 by 22•7% for men and 22•8% for women. The largest inequalities were observed among 40 to 54 year olds. This inequality increased over the study period – from 3•2 times higher mortality rates for men in the most as opposed to the least deprived 10% of LSOAs in 2003 to 3•3 times in 2017. The rise was from 2•4 to 2•6 for women. Age groups ≥65 years, who experience the highest mortality risk, had low but rising inequality. Men and women aged 65 to 79 living in the most deprived LSOAs had a mortality rate 1•9 times higher than the least deprived in 2003 but this had increased to 2•2 times higher for women and 2•3 times higher for men by 2017. This was due to rising inequality in both halves of the distribution – between the top 10% of LSOA and the middle, and between the middle and the bottom 10% of LSOA.

Interpretation: Overall mortality inequality rose in England but there were substantial differences in the trends for specific age and sex groups. Infant and child mortality inequality fell. At older ages, mortality inequality rose across cohorts, although in different ways, as each cohort's exposure to life-course to labour market inequality has differed. Policy goals of reducing mortality inequality will be best met by a focus on the risk factors that are specific to particular age and deprivation groups.