title: Relative deprivation between neighbouring wards is predictive of coronary heart disease mortality after adjustment for absolute deprivation of wards.
abstract: BACKGROUND
  The aims of this study were to assess whether deprivation inequality at small area level in England is associated with coronary heart disease (CHD) mortality rates and to assess whether this provides evidence of an association between area-level and individual-level risk.
  
  
  METHODS
  Mortality rates for all wards in England were calculated using all CHD deaths between 2001 and 2006. Ward-level deprivation was measured using the Carstairs Index. Deprivation inequality within local authorities (LAs) was measured by the IQR of deprivation for wards within the LA. Relative deprivation for wards was measured as the modulus of the difference between deprivation for the ward and average deprivation for all neighbouring wards.
  
  
  RESULTS
  Deprivation inequality within LAs was positively associated with CHD mortality rates per 100000 (eg, all men β; 95% CI=2.7; 1.1 to 4.3) after adjustment for absolute deprivation (p<0.001 for all models). Relative deprivation for wards was positively associated with CHD mortality rates per 100000 (eg, all men 1.4; 0.7 to 2.1) after adjustment for absolute deprivation (p<0.001 for all models). Subgroup analyses showed that relative deprivation was independently associated with CHD mortality rates in both affluent and deprived wards.
  
  
  CONCLUSIONS
  Rich wards surrounded by poor areas have higher CHD mortality rates than rich wards surrounded by rich areas, and poor wards surrounded by rich areas have worse CHD mortality rates than poor wards surrounded by poor areas. Local deprivation inequality has a similar adverse impact on both rich and poor areas, supporting the hypothesis that income inequality of an area has an impact on individual-level health outcomes.
authors.affiliation: Division of Public Health and Primary Health Care, University of Oxford, Oxford, UK. steven.allender@dphpc.ox.ac.uk
authors.forename: Steven
authors.initials: S
authors.lastname: Allender
authors.forename: Peter
authors.initials: P
authors.lastname: Scarborough
authors.forename: Thomas
authors.initials: T
authors.lastname: Keegan
authors.forename: Mike
authors.initials: M
authors.lastname: Rayner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015986:Confounding Factors, Epidemiologic; D003327:Coronary Disease / Q000453:epidemiology / Q000401:mortality*; D004739:England / Q000453:epidemiology; D005260:Female; D054624:Health Status Disparities; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011610:Psychosocial Deprivation; D012044:Regression Analysis; D012111:Residence Characteristics; D017062:Small-Area Analysis; D012959:Socioeconomic Factors; D035862:Vulnerable Populations / Q000706:statistics & numerical data