Article Text


Socioeconomic Inequalities I
OP01 Did Health Inequality Increase in English Children and Young People between 1999 and 2009? Evidence from two Cross-Sectional Surveys and Inpatient Activity Data
  1. DS Hargreaves1,
  2. A Djafari-Marbini2
  1. 1General and Adolescent Paediatrics, University College London (UCL) Institute of Child Health, London, UK
  2. 2Speciality Services Directorate, Imperial College Healthcare NHS Trust, London, UK


Background From 1999, the English government pursued a systematic strategy to reduce health inequalities. For interventions affecting children and young people, intermediate indicators may be more useful for evaluating short/medium term impact than the mortality targets chosen. This article investigates trends in inequalities for self/parent-reported health and use of health services by children and young people between 1999 and 2009.

Methods Through the UK Data Archive (, data were accessed for the Health Survey for England 1999 (SN4365) (N=2638(0–12 years), 874(13–16), 1148(17–24), 5573(25+)) and the Health Survey for England 2009 (SN6732) (N=3022(0–12), 969(13–16), 451(17–24), 4160(25+)). Self-reported health and General Health Questionnaire data (participants aged 13+) and parent/carer report of health (participants aged 0–12) were used, with appropriate binary outcomes created. Using logistic regression in SPSS (v19), adjusted odds ratios (AORs) of poor health were calculated between the highest and lowest socio-economic tertiles, defined by occupation of household members. Analyses were stratified by age, adjusted for sex and weighted to be nationally representative. Hospital Episode Statistics on Finished Consultant Episodes were analysed by Index of Multiple Deprivation decile, derived from the patient’s postcode. Concentration indices of inpatient activity were calculated for those aged 0–12 and 13–19 in 1999/2000 (N=1843862) and 2009/2010 (N=1774139).

Results Compared to those in the highest occupations, parents/carers in the lowest tertile were more likely to report poor health in their children. The difference increased significantly from 1999 (AOR 1.7, 95% CI 1.2–2.4) to 2009 (AOR 4.1, 95% CI 2.5 to 6.7). Among adolescents, there was a non-significant increase in poor self-reported health over this time (AOR 2.3(1.2–4.3) vs. 3.2(1.6–6.4)). For young adults, there was a persistently weaker association between low socio-economic status and poor health (AOR 1.3(0.8–2.2) and 1.3(0.7–2.4)) than for older adults (AOR 3.1(2.6–3.6) and 3.2(2.6–3.9)). AORs for high General Health Questionnaire scores by age group showed a similar pattern.

The concentration index for inpatient activity in adolescents (13–19) decreased from –0.102 in 1999 to –0.082 in 2009 (Males) and –0.247 to –0.189 (Females). The changes in the concentration index for 0-12s were much smaller (Male –0.136 vs. –0.139; Female –0.136 vs. –0.142).

Conclusion Despite the policy importance given to tackling health inequalities, this decade saw inequality in parents’ reports of their children’s health widen significantly. Adolescent findings were mixed, with a non-significant increase in inequality for self-reported health but a reduction in inequality related to inpatient activity.

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