White C, Edgar G. Inequalities in healthy life expectancy by social class and area type: England, 2001–03. Health Statistics Quarterly 2010; 45 (Spring): 28-56
Background: Healthy life expectancy (HLE) is an important indicator which combines longevity with health status. This article examines inequalities in HLE by socio-economic position in England, and between Local Authorities (LAs) in the deprived ‘Spearhead group’ and other LAs.
Methods: Census and vital event data available from the ONS Longitudinal Study were used to calculate estimates of HLE based on general health status for each Registrar General’s Social Class (RGSC) in 2001–03, in England as a whole and within the ‘Spearhead group’ and non-Spearhead LAs.
Results: A predominantly linear relationship was present with HLE increasing with rising social class. The differences observed in HLE at birth and at age 65 between people assigned to the professional and unskilled manual social classes were statistically significant and substantial, demonstrating a clear social inequality in the amount of life, the quality of those years lived, the absolute number of healthy life years, and thus the relative proportion of life spent in ‘Good’ or ‘Fairly Good’ health. HLEs at birth were statistically significantly higher for women than for men in the non-Spearhead LAs for all social classes; however, in the ‘Spearhead group’ of areas higher HLEs in women were only present among the skilled non-manual, skilled manual and partly skilled social classes. This suggests that an interaction effect between sex and area in the level of HLE may be operating. The magnitude of inequality in HLE between professionals and the unskilled manual class in the proportion of life spent in ‘Good’ or ‘Fairly Good’ health also varied between the ‘Spearhead group’ and non-Spearhead LAs: among men, a difference of 6.6 per cent was present in non-Spearhead LAs, compared with 10.6 per cent in the ‘Spearhead group’; among women, the equivalent differences were 5.3 per cent and 7.6 per cent.
Conclusions The within-class HLEs for men and women were lower in the ‘Spearhead group’ compared with the non-Spearhead LAs, and statistically significantly lower among the intervening social classes for men; among women they are significant for all social classes other than the professional class. The scale of inequalities shown is important for policy responses and understanding of differences in service needs.