Area effects on health variation over the life-course: analysis of the longitudinal study sample in England using new data on area of residence in childhood.

There is a growing literature which demonstrates that (a) conditions throughout the life-course are important for health outcomes in older people and (b) "contextual" conditions in the place of residence, as well as individual characteristics influence health variations. This paper contributes to this debate by presenting results of an analysis of data from the Office for National Statistics Longitudinal Study (LS) for England and Wales. The analysis makes use of a new set of variables, which have been added to the LS, describing the social and economic conditions in the 1930s in residential areas where members of the LS sample were registered as living in 1939. The analysis focuses on people who were aged 0-16 in 1939. The health outcomes considered are death between 1981 and 1991, and for those still living, whether long-term illness was reported in the 1991 census. Regression analysis is used to examine the effects of residence in 1981, and data on the registered place of residence in 1939. The analysis shows that individual characteristics and type of area of residence in 1981 were associated with health outcomes. In addition, some variables describing socio-economic conditions in the 1930s contribute independently to the regression models (notably measures of economic deprivation and unemployment). The results suggest that conditions in residential area in early life may help to explain relatively poor health experience of populations in some parts of Britain today.

Mortality from cardiovascular disease among interregional migrants in England and Wales.

OBJECTIVE: To investigate the extent to which geographical variations in mortality from ischaemic heart disease and stroke in Britain are influenced by factors in early life or in adulthood. DESIGN: Longitudinal study of migrants. SUBJECTS: 1% sample of residents in England and Wales born before October 1939 and enumerated at the 1971 census (the Office of Population Censuses and Surveys' longitudinal study). MAIN OUTCOME MEASURE: 18,221 deaths from ischaemic heart disease and 9899 deaths from stroke during 1971-88 were analysed by areas of residence in 1939 and 1971. These included 2928 deaths from ischaemic heart disease and 1608 deaths from stroke among individuals moving between 14 areas defined by the major conurbations and nine standard administrative regions of England and Wales. RESULTS: The southeast to northwest gradient in mortality from ischaemic heart disease was related significantly to both the 1939 area (chi 2 = 6.09, df = 1) and area in 1971 (chi 2 = 5.05, df = 1). Geographical variations in mortality from stroke were related significantly to the 1939 area (chi 2 = 4.09, df = 1) but the effect of area in 1971 was greater (chi 2 = 8.07, df = 1). The effect of 1971 area on mortality from stroke was largely due to a lower risk of death from stroke among individuals moving into Greater London compared with migrants to the rest of the South East region (chi 2 = 4.54, df = 1). CONCLUSIONS: Geographical variations in mortality from cardiovascular disease in Britain may be partly determined by genetic factors, environmental exposures, or lifestyle acquired early in life, but the risk of fatal ischaemic heart disease and stroke changes on migration between areas with differing mortality. The low risk of death from stroke associated with residence in Greater London is acquired by individuals who move there.