Health Expectancy at Birth by Ward
1999-2003

Introduction

Elsewhere on the Lancashire Profile there are Research Monitors on Life Expectancy at Birth by Local Authorities and Life Expectancy at Birth by Wards. The Office for National Statistics (ONS) has recently published, for the first time, estimates of life expectancy for local areas in terms of "healthy life expectancy"; (HLE) and disability-free life expectancy (DFLE). HLE and DFLE are health indicators that combine current mortality and morbidity data and thus measure both the quantity and quality of life. For example, healthy life expectancy at birth is the expected number of years a newborn baby would survive and be healthy if he or she experienced the particular area's age and sex specific mortality and health rates, as at the base date, throughout his or her life. Full downloads of all the data by district and ward for England and Wales for both indicators and for male/female/all persons separately are available from the ONS website. The data relating specifically to Lancashire can be obtained from the Lancashire Profile Data Download Centre.

Background

Life expectancy has risen strongly over the past couple of decades and substantial increases in numbers of elderly people are projected. This means that more and more people are living to ages in which they are more likely to experience chronic disease and disability. The extra years of life may be lived in good health, as age is not inevitably associated with disability though the precise trends are still unclear. Healthy life expectancy and disability-free life expectancy are valuable indicators for assessing future heath and social needs, evaluating health programmes, identifying trends and inequalities and informing long-term care and pensions, benefits and fiscal policy.

Lancashire Results

Published figures show very large geographical inequalities both in life expectancy across England and Wales and in the extent to which such life expectancy is improving. In the case of Lancashire, in the period 1999-2003, just four of the fourteen Lancashire NUTS-2 districts had higher all-person life expectancy at birth than the average for England and Wales, namely Fylde, Ribble Valley, South Ribble and (just) Wyre. With an average life expectancy of 78.9 years Ribble Valley is Lancashire's top-placed district and is the only one to lie within the top 50% of authorities in England and Wales. At the other extreme, average all-person life expectancy in Blackpool at 75.2 years is 3.7 years lower than that in Ribble Valley and 3.1 years less than the average for England and Wales. Nationally, Blackpool is ranked as third from bottom behind two other North West metropolitan districts, Manchester and Liverpool. A further seven Lancashire districts recorded rankings within the bottom 20%, including Blackburn and Burnley which alongside Blackpool were in the bottom 5%.

A very similar pattern is also apparent in terms of the "Healthy Life Expectancy"; and "Disability-free Life Expectancy"; measures. In the case of both measures, just three Lancashire districts have scores better than the national average. Effectively those districts with the highest total life expectancies also tend to have the highest HLE and DFLE scores, having fewer years of ill-health or disability concerns. The converse of this is to be found in districts with the lowest life expectancies. Such districts mainly have much lower HLE and DFLE scores and the population thus has a higher risk of spending more years in poor health or with a disability (Table 1). In Ribble Valley, for example, DFLE is about 65 years with 14 years spent with a disability. In the case of Burnley or Hyndburn the figures are 58 years and 18 years respectively.

The Lancashire and district pattern is also reflected in the geographical distribution of ward level HLE and DFLE results which reveals a quite marked skew compared with the England and Wales average with a much higher proportion of local wards exhibiting lower than average expectancies across both measures. Ranking the life expectancies from highest to lowest and dividing the results into fifths or quintiles can most readily express this. As shown in Table 2, Lancashire has relatively few of its wards in the fifth of wards with the highest national HLE and DFLE – just 18 or 6% in the case of HLE and 12 or 4% with DFLE. Lancashire also has a similarly low share of its wards in the second quintile than the national average. Conversely, in the fifth quintile (representing the 20% of wards with the poorest expectations) Lancashire has more than 100 wards represented under both measures, equivalent to 35% of all its wards.

At ward level the highest disability-free life expectancy figure was recorded for Ribby-with Wrea in Fylde district. DFLE in Ribby-with-Wrea stood at 71 years, or nearly 20 years more than Lancashire's lowest ranking ward of Daneshouse with Stoneyholme in Burnley (Table 3). It should be stressed that the rankings in this table should be regarded as illustrative rather than definitive as the difference between apparently closely space wards is not statistically significant. The pattern for Health Life Expectancy is very similar.

There is a clear cluster of poorly raking wards in Blackpool, where nearly 95% of wards are within the fourth and fifth quintiles, emphasising the district's lowly position in the national league table (Table 4). However, nearly all the larger Lancashire urban districts have a disproportionate share of their wards in the bottom two quintiles, including Blackburn, Burnley, Hyndburn, Preston and Rossendale. Even districts like Lancaster, Pendle and West Lancashire that have a reasonable representation of high performing DFLE wards contain individual wards where such life expectancy was well into the fifth quintile ranking. Rural Ribble Valley District is alone in having no wards within the firth quintile.

Figure 1 Disability-Free Life Expectancy at Birth by Ward, 1999-2003

Source ONS - Health Expectancies at Birth for 2002 Census Wards

Figure 2 Healthy Life Expectancy at Birth by Ward, 1999-2003

Source ONS - Health Expectancies at Birth for 2002 Census Wards

Not surprisingly, the poorest ranking wards (within the fifth quintile) are to be found mainly within the central urban areas and are usually the same as those known to perform poorly in terms of numerous measures of household income and general deprivation (Figures 1 and 2). Wards with the highest HLE and DFLE at birth are to be found in more rural and semi-rural locations and are characterised by the presence of higher socio-economic groupings and rate highly in terms of household incomes and other indicators of social and economic wellbeing.

Note on the Data

The local district and ward estimates of HLE and DFLE have been made possible by the availability of 2001 Census data at small area level. They have been calculated by combining experimental life expectancy data for wards (based on five years' deaths data for the period 1999-2003 and population estimates for 2001) with the 2001 Census responses to "general health"; and "limiting long-term illness"; questions, at ward level. HLE and DFLE results were calculated for all people in each of the wards in England and Wales. Separate figures for males and females were also calculated where the sex-specfic populations of wards were large enough to produce reliable results. Wards with populations of less than 1,000 males or females were excluded from the analysis when calculating the indicators by sex.

Estimates of health expectancies can be affected by local factors such as the presence of communal establishments like residential and nursing homes. People in such establishments tend to be less healthy and more likely to die than people of the same age living in private households. Wards with a relatively high proportion of residents in medical and care institutions might have lower than expected life and health expectancies. Local knowledge may be an important factor in the interpretation of results. To assist in understanding where this might occur, the data download includes an indication of the size of this institutional population in each ward.

Because of the varying sizes of individual ward populations the degree of confidence in the HLE and DFLE estimates can vary quite widely in certain instances. An indication of the precision of the estimates are given in the data downloads by providing the upper and lower 95% confidence limits so that in comparisons between areas, those differences which are statistically significant (the confidence intervals of the two areas do not overlap) can be distinguished from those which could be the result of chance (the confidence intervals do overlap).

The ONS emphasise that the status of the small area HLE and DFLE statistics is experimental, meaning that these data have not yet been shown to meet the strict National Statistics quality criteria and are still undergoing testing and evaluation with a view to becoming Nation Statistics later.

This page was compiled by Peter Kivell.

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