Inequalities in mortality during and after restructuring of the
repeated cohort studies
Tony Blakely, research professor1, Martin Tobias, principal adviser2, June Atkinson, senior analyst and team leader1
1 Health Inequalities Research Programme, University of Otago, Wellington, Wellington, New Zealand , 2 Epidemiology, Public Health Intelligence, Ministry of Health, Wellington, New Zealand
BMJ, doi:10.1136/bmj.39455.596181.25 - published 24 January 2008
Available online at:
http://www.bmj.com/cgi/content/full/bmj.39455.596181.25v1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=new+zealand+and+inequalities&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
Abstract
Objectives To determine whether disparities between income and mortality changed during a period of major structural and macroeconomic reform and to estimate the changing contribution of different diseases to these disparities.
Design Repeated cohort studies Data sources 1981, 1986, 1991, 1996, and 2001 censuses linked to mortality data
Population Total New Zealand population, ages 1-74 years.
Methods Mortality rates stand ardised for age and ethnicity were calculated for each census cohort by level of household income. Standardised rate differences and rate ratios, and slope and relative indices of inequality (SII and RII), were calculated to measure disparities on both absolute and relative scales.
Results All cause mortality rates declined over the 25 year study period in all groups stratified by sex, age, and income, except for 25-44 year olds of both sexes on low incomes among whom there was little change. In all age groups pooled, relative inequalities increased from 1981-4 to 1996-9 (RIIs increased from 1.85 (95% confidence interval 1.67 to 2.04) to 2.54 (2.29 to 2.82) for males and from 1.54 (1.35 to 1.76) to 2.12 (1.88 to 2.39) for females), then stabilised in 2001-4 (RIIs of 2.60 (2.34 to 2.89) and 2.18 (1.93 to 2.45), respectively).
Absolute inequalities were stable over time, with a possible fall from 1996-9 to 2001-4. Cardiovascular disease was the major contributor to the observed disparities between income and mortality but decreased in importance from 45% in 1981-4 to 33% in 2001-4 for males and from 50% to 29% for females. The corresponding contribution of cancer increased from 16% to 22% for males and from 12% to 25% for females.
Conclusions During and after restructuring of the economy disparities in mortality between income groups in New Zealand increased in relative terms (but not in absolute terms), but it is difficult to confidently draw a causal link with structural reforms. The contribution of different causes of death to this inequality changed over time, indicating a need to re-prioritise health policy accordingly.
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