Inequalities in mortality and illness in Trent NHS Region

Background The Department of Health is encouraging health authorities to im prove health status by tackling health inequalities. We defined ward level spatial health variations in Trent National Health Service Region, England, investigated urban and rural inequalities, and examined the relationship w ith deprivation, to identify the extent of small area health inequalities a nd to establish whether a quantifiable difference exists between urban and rural health as affected by deprivation. Method A small area ecological study design was adopted and ward level (n=5 91) standardized ratios were calculated (population aged <75, n=3900 000) f or specific causes of death and limiting long-term illness. A classificatio n was devised to assess ward health inequalities according to an urban-rura l dimension. Deprivation was measured using the Townsend Index and the rela tionship with mortality and illness was analysed using Pearson product mome nt correlation. Results Wide variations in mortality and illness were evident at ward level , being widest for accident mortality (standardized mortality range 0-508). Stroke mortality accounted for the largest proportion of wards with standa rdized mortality ratios over 125 (36.2 per cent). Relative deprivation corr elated strongly with limiting long-term illness (r=0.82) and all-cause mort ality (r=0.68) across Trent, and in both urban and rural environments. Conclusion The study set health inequalities within a regional context for Trent as an initiative to coincide with the Government's proposed health st rategy for the next few years. Wide health inequalities were evident in Tre nt and the association between deprivation and health was of a similar magn itude in urban and rural wards. This small area approach allows health auth orities access to ward level information in order to inform key debate on t ackling health inequalities and distributing resources in relation to need.