Objective

To assess how effectively a routine adjustment can be made for socioeconomic confounding in small area studies of environment and health using indirect standardisation and small area deprivation indices, including analysis of the appropriate size of population unit on which to base the deprivation index and the importance of region and urban/rural status as axes of stratification.

Method

Standardised morbidity ratios were calculated for cancers in Great Britain for 1981 and standardised mortality ratios for all cause mortality in Great Britain betweeen 1982 and 1985.

Deprivation indices were calculated for enumeration districts and wards from 1981 small area census statistics.

Cancers and deaths were allocated to enumeration districts via their postcode.

Standardised morbidity and mortality ratios were calculated by quintile of enumeration district according to the deprivation index.

Standardised mortality ratios were further analysed by deprivation of ward, region, and urban/rural status.

Results

Strong relationships were found between all cause mortality and the incidence of selected cancers and deprivation quintile - there was up to a twofold difference in lung cancer incidence between the highest and lowest quintile.

The deprivation index can be used to measure gradients of deprivation according to the distance from industrial sites.

The deprivation index for enumeration districts showed similar discrimination of mortality as the index ...