The Ghost of Christmas Past: health effects of poverty in London in 1896 and 1991

Objectives To compare the extent to which late 20th century patterns of mor tality in London are predicted by contemporary patterns of poverty and by l ate 19th century patterns of poverty. To test the hypothesis that the patte rn of mortality from causes known to be related to deprivation in early lif e can be better predicted by the distribution of poverty in the late 19th c entury than by that in the late 20th century. Design Data from Charles Booth's survey of inner London in 1896 were digiti sed and matched to contemporary local government wards. Ward level indices of relative poverty were derived from Booth's survey and the 1991 UK census of population. AU deaths which took place within the surveyed area between 1991 and 1995 were identified and assigned to contemporary local governmen t wards. Standardised mortality ratios for various causes of death were cal culated for each ward for all ages, under age 65, and over age 65. Simple c orrelation and partial correlation analysis were used to estimate the contr ibution of the indices of poverty from 1896 and 1991 in predicting ward lev el mortality ratios in the early 1990s. Setting Inner London. Results For many causes of death in London, measures of deprivation made ar ound 1896 and 1991 both contributed strongly to predicting the current spat ial distribution. Contemporary mortality from diseases which are known to b e related to deprivation in early life (stomach cancer, stroke, lung cancer ) is predicted more strongly by the distribution of poverty in 1896 than th at in 1991. In addition, all cause mortality among people aged over 65 was slightly more strongly related to the geography of poverty in the late 19th century than to its contemporary distribution. Conclusions Contemporary patterns of some diseases have their roots in the past. The fundamental relation between spatial patterns of social deprivati on and spatial patterns of mortality is so robust that a century of change in inner London has failed to disrupt it.