LIMITING LONG-TERM ILLNESS AND ITS ASSOCIATIONS WITH MORTALITY AND INDICATORS OF SOCIAL DEPRIVATION

Study objective - To examine geographical variation in limiting long t erm illness in England and Wales and assesses the extent of its simila rity with the distribution of mortality rates and of deprivation. Desi gn - A geographically based study using data from the 1991 census on L imiting long term illness. Maps and regression analysis are used to co mpare the distribution of standardised illness ratios with standardise d mortality ratios and indicators of social deprivation. Setting - A t otal of 401 local authority districts in England and Wales. Participan ts - The population of England and Wales enumerated in the 1991 census . Main results - The geographical pattern of limiting long term illnes s shows many similarities with that of mortality but there are also so me differences. Both are positively associated with indicators of soci al deprivation, with limiting long term illness tending to show strong er correlations, particularly in the elderly. Most of Wales and many i ndustrial areas of northern England have higher rates of long term ill ness than would be expected from their mortality rates, while much of south eastern England has lower than expected rates. Conclusions - Mov es towards using data on limiting long term illness instead of standar dised mortality rates would have important implications for NHS resour ce allocations. Further assessment of the reliability of these data on self reported morbidity is required. In particular, there is a need t o assess how much they reflect real differences in ill health rather t han the influence of socioeconomic or cultural factors affecting the l ikelihood of a positive answer to the census question on limiting long term illness.