RESEARCH REPORT

Is economic adversity always a killer? Disadvantaged areas with relatively low mortality rates

Helena Tunstall¹, Richard Mitchell², Julia Gibbs³, Stephen Platt⁴, Danny Dorling⁵

¹ University of Glasgow, Glasgow, UK
² Research Unit in Health, Behaviour and Change, University of Edinburgh Medical School, Edinburgh, UK
³ Blake Stevenson, Edinburgh, UK
⁴ University of Edinburgh, Edinburgh, UK
⁵ University of Sheffield, Sheffield, UK

Correspondence to:
Correspondence to:
Dr Richard Mitchell
Research Unit In Health, Behaviour and Change, University of Edinburgh Medical School, Teviot Place, Edinburgh, EH8 9AG, UK; richard.mitchell{at}ed.ac.uk

Objectives: To identify areas of Britain whose residents have relatively low age specific mortality, despite experiencing long-term economic adversity.

Methods: Longitudinal, ecological study of all residents of Britain from 1971 to 2001.

Results: 54 of Britain’s 641 parliamentary constituencies were identified as having been persistently economically disadvantaged in the period 1971–2001. Within this group, there was marked variation in age group specific mortality and in the age ranges with relatively high or low mortality. A systematic scoring process identified 18 constituencies as providing strong and consistent evidence of low mortality across a range of age groups, relative to the 54 constituencies as a whole. These 18 were labelled "resilient". Among age groups >24 years, mortality rates in the resilient areas were significantly lower than in the other economically disadvantaged areas. For example, at ages 45–59 years, the average all cause mortality rate in the resilient constituencies was 607 per 100 000 population (95% CI 574 to 641) and 728 (670 to 787) in the non-resilient constituencies (p = 0.013).

Conclusions: Areas with similar adverse economic histories do not all have similarly high mortality rates. It is unlikely that a single factor explains these results. Selective migration cannot be discounted as an explanation, but particular sociocultural features of areas (including the political, economic, ethnic and religious characteristics of their population) may also be protective.

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• Mitchell, R, Gibbs, J, Tunstall, H, Platt, S, Dorling, D (2009). Factors which nurture geographical resilience in Britain: a mixed methods study. J. Epidemiol. Community Health 63: 18-23 [Abstract] [Full Text]  
• Smyth, F. (2008). Medical geography: understanding health inequalities. Prog Hum Geogr 32: 119-127