Socioeconomic inequalities in mortality: Men aged (4) Chris White Principal Research Officer Office for National Statistics LS Clearance 20105D

Introduction and context First official analysis of adult mortality by the final version of the National Statistics Socio-Economic Classification (NS-SEC), updating previous analysis by RGSC Sets benchmark for inequalities in premature death in early 21 st Century to enable future monitoring and compare impacts of different social and occupational circumstances Intend to follow-up with further analyses covering: –males and females of all ages –patterns of inequalities in mortality by cause of death –geographical area (GOR’s) –independent influence of NS-SEC adjusting for other indicators of SES

Background Examinations of social inequalities in mortality generally used one of two analytical approaches: –Unlinked records approach advantages include detailed breakdowns, precise estimates disadvantages include numerator-denominator and health selection bias –linked records follow-up approach advantages include numerator-denominator correspondence and possibility to control selection disadvantages include small numbers constraining detailed breakdowns and limiting precision

Objectives Assess the presence of biases through complementary linked record analyses Adjust unlinked records estimates to optimise validity of decennial results Measure remaining dissonance in estimates and examine potential influences Compare analyses of all-cause mortality in men aged by NS-SEC 9 analytic classes for , using unlinked records Assess conformity of the age standardised pattern by NS- SEC across the age range

National Statistics Socioeconomic Classification (1) Delineates SE structure by employment relations not occupational skill/perceived status –Service relationship: employee renders ‘service’ to employer in return for ‘compensation’ –Labour contract: employee gives discrete amounts of labour in return for a wage calculated on amount of work done or by time worked. –Intermediate: Forms of employment regulation that combine aspects of ‘service relationship’ and ‘labour contract’ No manual / non-manual divide and greater within class homogeneity and between class heterogeneity than was present in RGSC classes Distribution between classes is more even than with RGSC

National Statistics Socioeconomic Classification (2) Analytic classes 1.1Large employers and higher managers 1.2Higher professionals 2Lower managerial and professional 3Intermediate 4Small employers and own account workers 5Lower supervisory technical occupations 6Semi-routine occupations 7Routine occupations 8Never Worked and Long-term unemployed NS-SEC is derived from SOC 2000, employment status and size of organisation

Data Sources, study populations and data issues Death Occurrences and 2001 census, males aged in England and Wales ONS Longitudinal Study sample enumerated in 2001, traced and followed between census day and 31 st December 2004 Coding of occupation at census –Filter x –Reduced NS-SEC Health selection – assigned NS-SEC90 class from LS members 1991 census record if assigned to an unoccupied NS-SEC in 2001 Under-enumeration at census 2001 (MYPE 2001,2002, 2003)

Optimising cross-sectional denominator

Assessing numerator conformity Imbalance in NS-SEC allocation at census and death –Classes 1.1 and 2 had lower proportion assigned at census –Class 3 and Never worked and Long-term Unemployed had higher proportion –Other classes were within margin of sampling variation Examination of LS census and death records showed systematic misallocation of operational category L6 –occupations categorised as Intermediate distinguished by employment status –All deaths (n=18) assigned to L6 occupations at census were assigned to L7 occupations at death due to difference in reporting of employment status –age-specific adjustment factors generated and extrapolated to death occurrences for period –results in > in deaths allocated to class 2 ( 9 % ) and < in class 3 of ( 23 % )

Designation of deaths by source

Age-standardised death rates per 100,000 PYRs by NS-SEC: men aged 25-64, England and Wales, death occurrences

Age-standardised death rates per 100,000 PYRs by NS-SEC: men aged 25-64, England and Wales, LS sample

Age-standardised death rates per 100,000 PYRs by occupied NS-SEC: men aged 25-64, England and Wales, cross-sectional sources and LS sample Sources: 2001 Census, MYPE , Death occurrences , ONS LS - crown copyright

Age-specific rates per 100,000 by NS-SEC: England and Wales Sources: 2001 Census, MYPE , Death occurrences , ONS LS - crown copyright

Summary of Findings (1) A clear social gradient in mortality risk for men aged is present in contemporaneous linked and unlinked data sources (2.11 – 2.82) –Good discrimination of mortality risk between employment relations domains –Consistent pattern of decreasing mortality in each adjacent class from class implying intensity of service relationship : labour contract continuum is relevant –Mortality differences found within employment relations domains will be concealed in descriptions of inequalities using the most condensed version of NS-SEC The protective influence of class 4 reported in analyses for the period was not found in this analysis The Never worked and Long-term unemployed have clearly distinct life chances compared with men in occupied NS-SEC classes The pattern of age-standardised mortality by NS-SEC predominantly consistent across age range examined

Summary of Findings (2) Differences between sources –Linked record method produces a higher rate in class 1.1 and lower rate in class 7 resulting in a shallower gradient, but class differences only statistically significant in class 7 –May operate through differential exposure to long-term unemployed in NS-SEC and its capture at census and death registration –A lower national rate for England and Wales observed in LS sample compared with aggregate data –Unknown rate of unobserved embarkation and under-enumeration of younger men in 2001 census may be drivers of differences –Some allocations to class 3 at death suspect: adjustment for operational category L6 advised in mortality analyses by NS-SEC –Use of optimised populations recommended to adjust for known biases

Limitations of the research Restriction to men aged will weaken mortality gradient: –higher risk of death from accidental and violent causes found in low socioeconomic status younger men Health-related social mobility not examined, but necessary: –potential explanation for mortality gradient Independent influence of NS-SEC on mortality not examined: –How does it stack up against alternative socioeconomic characteristics such as tenure, area deprivation, educational attainment

Publication The article will be published in: HEALTH STATISTICS QUARTERLY NOVEMBER 2007 ISSUE Social inequalities in adult male mortality by the National Statistics Socio-Economic Classification: England and Wales