West Midlands Key Health Data 2011/12
Launch Event
Monday 18 March 2013
Chapter 7 Measuring
in
12.30pm – inequalities
3.30pm
small area
lifeTippett
expectancy
Michael
Room, Staff House
University of Birmingham
Chapter contributions from:
West Midlands Cancer Intelligence Unit
Health Protection Agency West Midlands
The Perinatal Institute
NHS Warwickshire
Warwickshire County Council
Staffordshire County Council / NHS Staffordshire and NHS Stoke-on-Trent
Heart of England Foundation Trust
West Midlands Commissioning Support Unit
West Midlands Key Health Data 2011/12
Measuring inequalities
Chapter 7 Measuring inequalities in
small areaarea
life expectancy
in small
life expectancy
Daniel Eayres, Jane Fletcher, WMCSU
Paul Kingswell, NHS Warwickshire
Why measure life expectancy?
 Longstanding and widely used measure of overall health
outcome
 Quantifies mortality risks in a readily understandable metric
 Used in previous PSA target to reduce health inequalities
between LAs
 Public Health Outcomes Framework – Overarching
outcomes
 increased healthy life expectancy, i.e. taking account of the
health quality as well as the length of life;
 reduced differences in life expectancy and healthy life
expectancy between communities (through greater
improvements in more disadvantaged communities).
West Midlands Key Health Data 2011/12
Chapter 7 Measuring inequalities in small area life expectancy
Daniel Eayres, Jane Fletcher, WMCSU; Paul Kingswell, NHS Warks
Life expectancy in the West Midlands
Male life expectancy at birth by region, England 2008-10
81
Life expectancy years
80
79
78
77
76
75
SOUTH
EAST
EAST OF
ENGLAND
SOUTH
WEST
LONDON
EAST
WEST
YORKSHIRE
MIDLANDS MIDLANDS AND THE
HUMBER
NORTH
EAST
NORTH
WEST
ENGLAND
Region
Source: Compendium of Population Health Indicators, NHS Information Centre.
West Midlands Key Health Data 2011/12
Chapter 7 Measuring inequalities in small area life expectancy
Daniel Eayres, Jane Fletcher, WMCSU; Paul Kingswell, NHS Warks
Life expectancy in the West Midlands
Female life expectancy at birth, England and the West Midlands 1991-93 to 2008-10
ENGLAND
WEST MIDLANDS
83
Life expectancy years
82
81
80
79
Chapter 7 Measuring inequalities in
small area life expectancy
78
77
76
Time Period
Source: Compendium of Population Health Indicators, NHS Information Centre.
West Midlands Key Health Data 2011/12
Chapter 7 Measuring inequalities in small area life expectancy
Daniel Eayres, Jane Fletcher, WMCSU; Paul Kingswell, NHS Warks
Life expectancy by local authority
Life expectancy at birth by local authority, West Midlands 2008-10
Males
West Midlands Key Health Data 2011/12
Females
Chapter 7 Measuring inequalities in small area life expectancy
Daniel Eayres, Jane Fletcher, WMCSU; Paul Kingswell, NHS Warks
Life expectancy by local authority
Male life expectancy at birth vs. Deprivation by local authority, West Midlands 2008-10
81
Life expectancy (years)
80
79
78
Chapter 7 Measuring inequalities in
small area life expectancy
77
76
y = -0.1378x + 81.097
R² = 0.7528
75
0
5
10
15
20
25
30
35
40
Index of Multiple Deprivation 2010 (average score)
Source: Compendium of Population Health Indicators, NHS Information Centre;
Indices of Deprivation 2010, Department for Communities and Local Government.
West Midlands Key Health Data 2011/12
Chapter 7 Measuring inequalities in small area life expectancy
Daniel Eayres, Jane Fletcher, WMCSU; Paul Kingswell, NHS Warks
Small area geographies
 Electoral Wards
● Politically relevant
● Frequent boundary changes
● Large variation in population size
 Super Output Areas - Lower (LSOA) and Middle (MSOA)
● Not directly
associated
withinequalities
admin/constiuency
areas
Chapter
7 Measuring
in
● Stablesmall
boundaries
area life expectancy
● Little variation in population size
 West Midlands
○ Wards n = 719, avg pop = 7,800 (LA avg 3,400 - 26,800)
○ MSOAs n = 735, avg pop = 7,600 (LA avg 6,200 - 9,200)
○ LSOAs n = 3,487, avg pop = 1,600 (LA avg 1,50-1,700)
West Midlands Key Health Data 2011/12
Chapter 7 Measuring inequalities in small area life expectancy
Daniel Eayres, Jane Fletcher, WMCSU; Paul Kingswell, NHS Warks
Life expectancy by small area geography
Life expectancy at birth by small area, West Midlands 2008-10
By ward
West Midlands Key Health Data 2011/12
By MSOA
Chapter 7 Measuring inequalities in small area life expectancy
Daniel Eayres, Jane Fletcher, WMCSU; Paul Kingswell, NHS Warks
Life expectancy by small area geography
Life expectancy at birth by small area, West Midlands Metropolitan County 2008-10
By ward
West Midlands Key Health Data 2011/12
By MSOA
Chapter 7 Measuring inequalities in small area life expectancy
Daniel Eayres, Jane Fletcher, WMCSU; Paul Kingswell, NHS Warks
Life expectancy by small area geography
Male life expectancy at birth vs. Deprivation by MSOA, West Midlands 2008-10
95
y = -0.1673x + 81.718
R² = 0.6386
Life expectancy (years)
90
85
Chapter 7 Measuring inequalities in
small area life expectancy
80
75
70
65
0
10
20
30
40
50
60
70
80
Index of Multiple Deprivation 2010 (average score)
Source: Health profiles – local health, Network of Public Health Observatories;
Indices of Deprivation 2010, Department for Communities and Local Government.
West Midlands Key Health Data 2011/12
Chapter 7 Measuring inequalities in small area life expectancy
Daniel Eayres, Jane Fletcher, WMCSU; Paul Kingswell, NHS Warks
Slope Index of Inequality
Public Health Outcomes Framework life expectancy inequalities
 Indicator 0.2i:
Slope index of inequality (SII) in life expectancy at birth based on
national deprivation deciles of Lower Super Output Areas
(LSOAs) within England [National level].
 Indicator 0.2ii:
Number of upper tier local authorities for which the local SII in life
expectancy (as defined in 0.2.iii) has decreased [National level].
 Indicator 0.2iii:
SII in life expectancy at birth within each English upper tier local
authority, based on local deprivation deciles of LSOAs [LA level].
West Midlands Key Health Data 2011/12
Chapter 7 Measuring inequalities in small area life expectancy
Daniel Eayres, Jane Fletcher, WMCSU; Paul Kingswell, NHS Warks
Slope Index of Inequality
Life Expectancy
by by
Deprivation
Deciles,
showing
the Slope
Index
Inequality
Male life expectancy
at birth
deprivation
decile
showing
the
SII,ofWarwickshire
2006-10
Warwickshire, Males, 2006-10
Slope Index of Inequality = 8.3 years (95% Confidence Interval: 6.0 to 10.6)
90
88
Inequality Slope
Life Expectancy at Birth (years)
86
Life Expectancy with 95% confidence limits
84
82
Chapter 7 Measuring inequalities in
small area life expectancy
80
78
76
74
72
70
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Percentage of population, ranked from high to low IMD score
Source: Health Inequality Indicators, Network of Public Health Observatories.
West Midlands Key Health Data 2011/12
Chapter 7 Measuring inequalities in small area life expectancy
Daniel Eayres, Jane Fletcher, WMCSU; Paul Kingswell, NHS Warks
Slope Index of Inequality
SII for life expectancy at birth by upper-tier local authority and gender
West Midlands 2006-10
ONS Area
code
E06000019
E06000051
E06000021
E06000020
E10000028
E10000031
E10000034
E08000025
E08000026
E08000027
E08000028
E08000029
E08000030
E08000031
LA Name
Males
SII
Females
95%
confidence
limits
Lower Upper
1.1
8.4
Herefordshire, County of UA
4.8
4.2
9.1
Shropshire UA
6.7
ChapterUA7 Measuring8.2inequalities
5.7
10.7
Stoke-on-Trent
4.3
9.6
Telford
and Wrekin
7.0
small
areaUAlife expectancy
6.9
9.1
Staffordshire
8.0
6.0
10.6
Warwickshire
8.3
5.6
10.0
Worcestershire
7.8
9.2
12.5
Birmingham
10.8
9.8
13.7
Coventry
11.7
8.7
11.0
Dudley
9.9
7.5
11.8
Sandwell
9.6
8.3
13.2
Solihull
10.8
8.9
12.6
Walsall
10.8
7.4
11.9
Wolverhampton
9.7
SII
in
4.1
4.3
4.7
2.8
6.2
7.6
5.4
5.9
7.9
5.7
6.4
10.3
6.9
5.8
95%
confidence
limits
Lower Upper
1.0
2.8
1.0
-1.3
4.0
5.2
4.0
4.3
5.1
3.4
4.3
7.7
3.2
2.8
7.2
5.8
8.5
6.8
8.5
9.9
6.8
7.5
10.8
8.1
8.6
12.8
10.5
8.8
Source: Health Inequality Indicators, Network of Public Health Observatories.
West Midlands Key Health Data 2011/12
Chapter 7 Measuring inequalities in small area life expectancy
Daniel Eayres, Jane Fletcher, WMCSU; Paul Kingswell, NHS Warks
Summary Points
 LE is a high profile outcome indicator that needs to be monitored by HWBs,
including the assessment of within local authority inequality.
 Life expectancy in the West Midlands is continuing to improve but has remained
persistently below the national average for both men and women.
 The range between the highest and lowest local authority districts LEs in the West
Midlands is ~5 years for males and ~4 years for females.
 Significant variation in LE at the ward, MSOA and LSOA deprivation deciles levels
Measuring inequalities in
using 5-years ofChapter
mortality7data.
small area life expectancy
 At all area levels there is a strong association between LE and deprivation. The
association is stronger and the relationship steeper for males than for females.
 Wide inequalities in life expectancy exist within even those local authorities that
have high life expectancies overall.
 SII values for WM upper-tier LAs range from 4.8 to 11.7 years for males and 2.8 to
10.3 years for females.
 Measuring the change in the SII over time in individual LAs will be problematic as
the confidence intervals are wide and long time periods are needed.
West Midlands Key Health Data 2011/12
Chapter 7 Measuring inequalities in small area life expectancy
Daniel Eayres, Jane Fletcher, WMCSU; Paul Kingswell, NHS Warks
West Midlands Key Health Data 2011/12
END
Chapter 7 Measuring inequalities in
small area life expectancy
Daniel Eayres, Jane Fletcher, WMCSU
Paul Kingswell, NHS Warwickshire