Increasing inequalities in premature mortality in Great Britain

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Abstract
Study objective: To describe inequalities in all cause premature mortality between and within regions of Great Britain and how these inequalities have changed between 1979 and 1998. Design: Retrospective study using routine population and death data aggregated into five year age and sex groups for each of 20 years. Setting: All 459 local authority districts (England and Wales) and local government districts (Scotland). Participants: Estimated population and registered deaths aged 0–64. Main outcome measures: Indirectly standardised mortality ratios for all cause mortality; percentages of deaths that would be avoided if there were no inequalities between and within regions. Results: The decrease in premature mortality of 36% seen in Great Britain ranged from 42% in Wales to 33% in Scotland and 31% in London. Differences between regions led to excess mortality of about 25% in Scotland, the North East, and the North West. In London excess mortality increased from 14% to 19%. Inequalities within regions increased in most parts of Great Britain, the exceptions being Wales, London, and the South West. The largest increase was seen in Scotland where the percentage of excess deaths increased from 23% to 33%. Conclusions: A decrease in premature mortality in Great Britain was seen in all regions, although less pronounced in London, but the gap between regions remained. Inequalities between districts within regions vary from one region to another and have increased in nearly every part of Great Britain.