Data Insight: Is change in area-level deprivation associated with change in health outcomes?

This Data Insight examines distinct area-level deprivation trajectories within the Northern Ireland (NI) population from 2010-16; and their association with subsequent mortality, psychotropic medication, and accident and emergency (A & E) attendance from 2017-21.

Based on analysis of population-wide linked administrative data, we identified three stable, two downwardly mobile and two upwardly mobile classes. Almost half of the population were socially mobile. Upward mobility was associated with reduced risk of poor health outcomes compared to the consistently deprived. Downward mobility was associated with higher risk of poor health outcomes compared to the consistently non-deprived.

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An approximate dose-response relationship was observed across classes, whereby lower ‘endpoint’ deprivation in 2016 was associated with lower risk of adverse outcomes. The exception was the ‘substantial upward mobility’ class, with risk of poor outcomes second highest despite improved deprivation rank in 2016. Our findings demonstrate that social mobility and social immobility are present in NI, with those who continuously live in the most deprived areas having the poorest health outcomes. Upward mobility does not necessarily ameliorate this phenomenon. While current social status has an important bearing on health, patient-centred treatments should also be informed by previous social circumstances. Government policies aimed at improving health outcomes at the population level should prioritise early intervention and investment in healthcare resources, as well as education and work prospects in deprived communities.

What we found

We identified seven area-level deprivation trajectories: three stable (high, moderate and low), two downwardly mobile and two upwardly mobile.

• Around 48% of the NI population were socially mobile (upwardly or downwardly) between 2010 and 2016.
• Each social mobility class had better health outcomes (lower risk) compared to the stable high deprivation group.
• Upward mobility was associated with reduced risk (compared to stable high deprivation)., and downward mobility with increased risk (compared to stable low deprivation), across all health outcomes
• In general, ‘endpoint’ deprivation rank was associated with level of risk (i.e. higher levels of deprivation were associated with higher risk).
• The exception was the ‘substantial upward mobility’ group, which had the second-highest risk of all outcomes despite an improved deprivation rank.

 

Why it matters

NI has notably high levels of deprivation, with 37% of the population living in the most deprived fifth of the UK [4]. The most recent annual NI Health Inequalities Report indicates the persistence of wide-ranging health inequalities between the most and least deprived areas [5]. Social mobility is regarded as a major government policy goal, aiming to ensure that the circumstances of birth do not determine outcomes in life [6]. Given marked regional disparities in levels and drivers of social mobility in the UK [6,7], a ‘broad-brush’ approach to the development of policies and interventions aimed at promoting social mobility is unlikely to be effective. A more nuanced understanding of social mobility profiles in different populations, and how these relate to health outcomes, may support better targeted policies around social mobility and health.

This is the first linked administrative data study to use a data-driven technique to identify trajectories in area-level deprivation over time at the population level; and examine their associations with a range of subsequent health outcomes.