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					About the Office for National Statistics
   The Office for National Statistics (ONS) is the Government Agency responsible for compiling, analysing and disseminating many of the
   United Kingdom’s economic, social and demographic statistics, including the retail prices index, trade figures and labour market data, as
   well as the periodic census of the population and health statistics.The Director of ONS is also the National Statistician and the
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About Health Statistics Quarterly and Population Trends
   Health Statistics Quarterly and Population Trends are journals of the Office for National Statistics. Each is published four times a year in
   February, May, August and November and March, June, September and December, respectively. In addition to bringing together articles
   on a wide range of population and health topics, Health Statistics Quarterly and Population Trends contain regular series of tables on a wide
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   political interference.




Editorial board                                                             Contact points at ONS
         Peter Goldblatt (editor)                                               People with enquiries about the statistics published regularly in
         David Pearce (editor)                                                  Health Statistics Quarterly and Population Trends can contact the
         Angela Dale                                                            following enquiry points.
         Paul Hyatt
         Azeem Majeed                                                       Topic enquiries
                                                                                Abortions: 01329 813618
         Jil Matheson
                                                                                Births: 01329 813758
         Ian R Scott                                                            Conceptions: 020 7533 5113
         Judith Walton                                                          Expectation of life: 020 7211 2622 (Government Actuary’s Department)
                                                                                Marriages and divorces: 01329 813379
                                                                                Migration: 01329 813889/813897
Contributions                                                                   Mortality: 01329 813758
         Articles: 5,000 words max.                                             Population estimates: 01329 813318
                                                                                Population projections:
                                                                                National – 020 7211 2622 (Government Actuary’s Department)
                                                                                Subnational – 01329 813474/813865
Dates for submissions
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                                                                            © Crown copyright 2003. Published with the permission of the
Please send to:
                                                                            Controller of Her Majesty’s Stationery Office (HMSO).
   Clare Parrish, executive secretary
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Health
               statistics 18                                            Quarterly
                                                                                                 Summer 2003




IN THIS ISSUE                                                                                    Page
In brief                                                                                           2

Health indicators                                                                                  4

Twentieth Century Mortality Trends in England and Wales                                            5
  Examines trends in mortality over the Twentieth Century, using data from the ONS
  Twentieth Century Mortality CD-ROM.
  Clare Griffiths and Anita Brock

Comparison of area-based inequality measures and disease morbidity in England,
1994–1998                                                                                         18
  Aims to compare the effects of using the Index of Multiple Deprivation 2000 with the
  Townsend Index of Deprivation as measures of health inequalities. Data from medical records
  supplied by 199 practices in England to the General Practice Research Database between 1994
  and 1998 are analysed using both deprivation indices.
  Jacqueline Hoare

Implications for vital statistics of the change from SOC90 to SOC2000 occupation
coding                                                                                            25
  Summarises the effect on vital statistics of the change in 2001 in the Standard Occupational
  Classification from SOC90 to SOC2000. Two dual coded data sets were analysed: births in
  2001, and deaths from 1st January to 30th June 2001, for England and Wales.
  Angela Donkin and Nanette Daniels

Recent publications                                                                               33

Tables
  List of tables                                                                                  34
  Tables 1.1–6.3                                                                                  35
  Notes to tables                                                                                 56

Report:
  Deaths registrations in England and Wales, 2002: causes                                         57




London: TSO
     Health Statistics Quar terly 18        Summer 2003




in brief                                                                                              It is planned that the marital status estimates


Census 2001 results                                                                                   for England and Wales for 2001 and final
                                                                                                      revised estimates for years prior to 2001 will
                                                                                                      be published in Summer 2003. This will
                                                                                                      complete the rebasing of the mid-year
                                                                                                      population estimates for England and Wales
                                                                                                      following the 2001 Census.

                                                                                                      Scotland
                                                                                                      Mid-year population estimates, based on the
Further detailed results from the 2001 Census for England and Wales were released                     2001 Census were published on 30 September
on 7 May by the Office for National Statistics.                                                       2002. The General Register Office for Scotland
                                                                                                      published final mid-year estimates for 1982–
Census Standard tables for local authorities        People who are providing more hours of care       2000, revised in the light of the Census, on 27
(and larger geographical areas) in England and      (that is 20–49 hours or over 50 hours per         February 2003. These revisions included
Wales were published on 7 May. These start to       week) have lower rates of good health.            estimates at the council level and provided
fill out the picture given by the Key Statistics                                                      breakdowns by sex and single year age groups.
report released on 13 February, by tabulating                                                         Revisions for health board areas will be
                                                    Further phases of Census 2001 data release
the information collected at the Census.                                                              produced in Spring 2003.
                                                    will continue throughout the summer with the
Demographic data such as age, sex, marital          National Statistics Online website
status and ethnic group are presented by                                                              Marital status estimates for Scotland for 2001
                                                    (www.statistics.gov.uk/census) becoming the
factors such as type of accommodation lived                                                           and final revised estimates for 1982–2000,
                                                    main source of Census information.
in, access to a car, occupation, level of                                                             consistent with the revised mid-year estimates
                                                                                                      published on 27 February 2003, will be
education, etc.
                                                                                                      published in Summer 2003.
The Census included two health-related              Revision of                                       Northern Ireland
questions asking people to rate their general
health and whether they had a limiting long
term illness or disability. The responses to
                                                    population                                        Mid-year population estimates for 2001, based
                                                                                                      on the 2001 Census, were published on 30
these questions have been tabulated by factors
including sex, age group, housing tenure,
                                                    estimates following                               September 2002. The Northern Ireland
                                                                                                      Statistics and Research Agency published final
                                                                                                      rebased population estimates for 1992 to 2000
economic activity and hours worked, provision
of unpaid care and NS-SEC.                          the 2001 Census                                   on 10 October. This completed the rebasing of
                                                                                                      the population estimates for Northern Ireland
                                                                                                      following the 2001 Census.
For example:                                        The rebasing of mid-year population estimates
                                                    following the 2001 Census (as reported in
A lower proportion of men aged 65–69, that is       Health Statistics Quarterly 17) is nearing
in the years immediately following retirement,
rate their health as ‘not good’ than those men
approaching retirement or later in life.
                                                    completion.
                                                                                                      Revision of life
                                                    England and Wales/United Kingdom
At ages 70–74 and above there is a lower
                                                    Mid-2001 population estimates for England and
                                                    Wales, based on the 2001 Census, were
                                                                                                      expectancy
proportion of people rating their health as
‘good’ compared to those rating their health as
                                                    published on 10 October 2002. Final mid-1991
                                                    estimates for England and Wales, revised in the
                                                                                                      estimates following
‘fairly good’. It is not until age 80–84 that the
proportion of people rating their health as
‘good’ drops below the proportion rating their
                                                    light of the Census, were published on 13
                                                    February 2003. Similarly revised figures for      the 2001 Census
                                                    1992–2000 and for 1982–1990 were published
health as ‘not good’.                               on 27 February and 27 March respectively. All     National figures
                                                    three releases included estimates at the          The figures for life expectancy at birth and at
At age 75 and above there are more people in        subnational level and provided breakdowns by      selected ages in 2000 (based on the three-year
England and Wales with a limiting long term         sex and age groups. ONS also published the        period 1999–2001) in reference tables 2.2 and
illness (including problems due to old age)         corresponding final estimates for the United
than without one.                                   Kingdom.

                   National Statistics      2
                                                                           Health Statistics Quar terly 18       Summer 2003




5.1 are taken from the interim life tables for       release, although the figures by cause relate to
1999-2001 published by the Government
Actuary’s Department (GAD) on 27 February
                                                                          Correction to
                                                     the weeks prior to the reference week, to
                                                     allow time to complete coding of cause of
2003. These use the mid-2001, and revised
mid-2000 and mid-1999, population
                                                     death.               ‘Occupation and
denominators described above. The life
expectancy figures for 1981–1999 shown in                                 cancer: the
tables 2.2 and 5.1 have been revised following
publication of the final revised population          The mental health application of a
estimates based on the 2001 Census. They are
taken from the revised interim life tables for the
United Kingdom and its constituent countries
                                                     of young people      novel graphical
for the years 1980–1982 to 1998–2000, which
were published by GAD on 15 April 2003 and
                                                     looked after by      approach to
can be found on their website http://
www.gad.gov.uk                                       local authorities in routinely collected
Local figures
Figures on life expectancy at birth for
                                                     England              registration data’
administrative areas of England and Wales
                                                     This report presents the findings of a survey
(local authorities and Government Office                                                                This article was published on the 17th
                                                     of the mental health of young people, aged 5–
Regions) were released on the National                                                                  February 2003 in pages 33–40 of Health
                                                     17, looked after by local authorities in
Statistics website in February 2003. These                                                              Statistics Quarterly 17.
                                                     England The survey was carried out between
covered three-year rolling periods from 1991–
                                                     October 2001 and June 2002. It was
1993 to 1999–2001, using three-year                                                                     There was an error on page 33 of that article.
                                                     commissioned by the Department of Health.
aggregates of mortality data and mid-year                                                               The 2nd sentence of the 1st paragraph should
population estimates based on the results of the                                                        read ‘From 2001, the National Statistics
                                                     The first part of the report focuses on the
2001 Census.                                                                                            Socio-Economic Classification (NS SEC)
                                                     prevalence rates of mental disorders
                                                                                                        replaces both SC and SEG’ not ‘From 2001,
                                                     (emotional, conduct and hyperkinetic
Results for the same period for health areas in                                                         the National Statistics Socio-Economic
                                                     disorders) among young people looked after
England and Wales (Strategic Health                                                                     Classification (SC SEG) replaces both SC and
                                                     by local authorities by socio-demographic and
Authorities in England, and Regional Offices in                                                         SEG’.
                                                     placement characteristics. The second part of
Wales) are now available on the National
                                                     the report shows the way in which children
Statistics website at http://                                                                           The corrected sentence now appears in the pdf
                                                     and adolescents with particular disorders vary
www.statistics.gov.uk/statbase/                                                                         of the article on the National Statistics
                                                     from those without that disorder on a range of
Product.asp?vlnk=8841                                                                                   website at http://www.statistics.gov.uk/
                                                     factors including their background, personal
                                                                                                        statbase/Product.asp?vlnk=6725
                                                     and familial characteristics, physical health,
Life expectancy at birth in 1999–2001 for local
                                                     use of services and social functioning.
areas of Scotland and Northern Ireland will be
published in Health Statistics Quarterly 19 in
                                                     Further information about the survey and a
August 2003.
                                                     free summary report can be obtained from:


                                                     Howard Meltzer
Weekly deaths                                        Office for National Statistics
                                                     Zone D2/03
registered in                                        1 Drummond Gate
                                                     London SW1V 2QQ

England and Wales:                                   Tel: 020 7533 5391
                                                     Email: Howard.Meltzer@ons.gov.uk
provisional
numbers
Provisional numbers of deaths registered in
England and Wales each week are now
published via a weekly web release, replacing
the monthly press release.

http://www.statistics.gov.uk/StatBase/
ssdataset.asp?vlnk=6157&Pos=&ColRank=1&Rank=272

Each new weekly estimate is normally made
available on the web on the second Tuesday
after the reference week. The release also
includes numbers of deaths in the previous 52
weeks and the number since the start of the
calendar year. Figures for previous years are
provided as a comparison. A breakdown by
selected causes of death is also included in the




                                                                                                            3   National Statistics
         Health Statistics Quar terly 18                                                           Summer 2003




Health indicators                                                                                                                                                                                                                                                   England and Wales

    Figure A                                Population change (mid-year to mid-year)1


    Thousands
    300


    200


    100


         0
                                                                                                                                                                                                                                                      Natural change                                         Total change

-100
                           72         –7
                                        3
                                              –7
                                                  4
                                                         –7
                                                            5
                                                                     –7
                                                                          6
                                                                                –7
                                                                                   7
                                                                                             –7
                                                                                               8
                                                                                                       –7
                                                                                                         9
                                                                                                               –8
                                                                                                                  0
                                                                                                                          –8
                                                                                                                              1
                                                                                                                                    –8
                                                                                                                                        2
                                                                                                                                                   –8
                                                                                                                                                      3
                                                                                                                                                               –8
                                                                                                                                                                    4
                                                                                                                                                                          –8
                                                                                                                                                                             5
                                                                                                                                                                                   –8
                                                                                                                                                                                      6
                                                                                                                                                                                            –8
                                                                                                                                                                                               7
                                                                                                                                                                                                     –8
                                                                                                                                                                                                        8
                                                                                                                                                                                                              –8
                                                                                                                                                                                                                  9
                                                                                                                                                                                                                        –9
                                                                                                                                                                                                                           0
                                                                                                                                                                                                                                 –9
                                                                                                                                                                                                                                    1
                                                                                                                                                                                                                                          –9
                                                                                                                                                                                                                                             2
                                                                                                                                                                                                                                                   –9
                                                                                                                                                                                                                                                       3
                                                                                                                                                                                                                                                             –9
                                                                                                                                                                                                                                                                4
                                                                                                                                                                                                                                                                      –9
                                                                                                                                                                                                                                                                          5
                                                                                                                                                                                                                                                                                 –9
                                                                                                                                                                                                                                                                                    6
                                                                                                                                                                                                                                                                                             –9
                                                                                                                                                                                                                                                                                                  7
                                                                                                                                                                                                                                                                                                        –9
                                                                                                                                                                                                                                                                                                           8
                                                                                                                                                                                                                                                                                                                     -9
                                                                                                                                                                                                                                                                                                                       9              00           01
                  7   1–         72         73         74       75            76         77        78        79       80          81             82       83            84       85       86       87       88        89       90       91       92        93       94         95       96            97         98          –   20       0   0–
               19                                                                                                                                                                                                                                                                                                         99           20
                                                                                                                                                                               Mid-year
    Figure B                                Age-standardised mortality rate1


Rate per million population
20,000


15,000


10,000


    5,000


              0
                       1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
                                                                                                 Year
    Figure C                                Infant mortality (under 1 year)

Rate per 1,000 live births
20


    15


    10


     5


     0
                   1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
                                                                                             Year
    Figure D                                Age-standardised quarterly abortion rates – residents1


Age standardised rate per 1,000 women 15–44
20
19
18
17
16
15
14
13
12
                                                                                                             Age-standardised abortion rate                                                                      Moving average rate
11
10
                                                                                                             Provisional age-standardised abortion rate
 9

              84                 85               86                 87              93 88    94       95
                                                                                                        89      96        97
                                                                                                                         90      98         91                 92                                                                                                         99                 00                 01                02
         19                 19               19                 19                19
                                                                                   19      19       19
                                                                                                   19        19     19 19     19       19                 19                                                                                                         19                 20                 20                20
                                                                                   Year
1
    Population estimates/denominators from 1982 to 2000 are the interim revised estimates following the results of the 2001 Census.



                                            National Statistics                                    4
                                                                             Health Statistics Quar terly 18   Summer 2003




Twentieth Century
Mortality Trends in England
and Wales


                                                                                                                Clare Griffiths and Anita
                                                                                                                Brock, Office for National
                                                                                                                Statistics




INTRODUCTION                                                                                                   This article examines trends in
                                                                                                               mortality over the Twentieth
This article examines trends in mortality during the Twentieth Century.                                        Century, using data from the ONS
We first examine changes in mortality from all causes of death                                                 Twentieth Century Mortality CD-
combined and then look at the changes by broad Chapter of the                                                  ROM. Firstly, we update analyses
International Classification of Diseases (ICD). The ninth revision of the                                      published in the Health of Adult
ICD was last used in England and Wales in 2000, so this article covers                                         Britain – changes in all-cause
all the years in which the first to ninth revisions were in use. This                                          mortality rates, and rates for
updates analysis already published1 to the end of the century. New                                             broad cause groups. These have
population estimates for 1982–2000, which take into account the results                                        been updated with new
of the 2001 Census, have been used for the first time. We then move on                                         population estimates for 1982–
to focus on selected specific causes of death. These are not exhaustive                                        2000, which take into account the
but focus on diseases which were major causes of death, either at the                                          results of the 2001 Census, and
beginning or the end of the century; diseases which had relatively                                             the analyses have been brought
comparable definitions over time; and on new analyses of ill-defined                                           up to the end of the century. The
causes of mortality, which are of particular interest currently. Potential                                     ninth revision of the International
problems in analysing mortality trends over such a long time period are                                        Classification of Diseases was last
also highlighted.                                                                                              used in England and Wales in
                                                                                                               2000, so this article covers all the
The way in which diseases have been described and classified has                                               years in which the first to ninth
changed substantially over the last 100 years. For this reason care must                                       revisions were in use. We have
be taken in interpreting trends in mortality by cause of death. They                                           also extended analyses of specific
could reflect variations over time in the incidence of disease, detection                                      diseases, focusing on diseases
or description of diseases, the case-fatality of specific diseases,                                            which were major causes of death,
statistical and classification artefacts, or new concepts of disease.2 In                                      either at the beginning or the end
particular, the coding of descriptions of causes of death from death                                           of the century; diseases which had
certificates has changed substantially over time. The ICD has been                                             relatively comparable definitions
revised nine times since 1901, to keep pace with advances in medical                                           over time; and on new analyses of
knowledge and discovery of new diseases. Annex 1 shows the revisions                                           ill-defined causes of mortality,
of the ICD, together with the periods during which each revision was                                           which are currently of particular
used in England and Wales for coding mortality. The latest revision,                                           interest.


                                                                                                           5   National Statistics
     Health Statistics Quar terly 18        Summer 2003




ICD-10, was introduced in 2001. This revision represents the largest         for 1901 to 2000,8 classified by age group, sex and underlying cause of
revision to the ICD in 50 years, and it will fundamentally affect the way    death (at the most detailed level available). Population denominators
cause of death data are analysed in the future.3–5 The analyses presented    come from mid-year population estimates based on data from decennial
here therefore cover the complete period for which the first to ninth        censuses, and take into account revisions made to these estimates
revisions were in use.                                                       following subsequent censuses. The most recent revisions to these
                                                                             estimates followed the 2001 Census, when population estimates were
With each change in ICD, the appropriate codes must be chosen in             revised for 1982–2000. We have incorporated these changes. In later
order to analyse trends in mortality for specific causes of death. The       work we will look at the effect of these changes on the mortality of
rules governing the selection of the underlying cause of death may also      population subgroups particularly affected by the latest revisions, such
change with ICD revisions or at other times. Between 1984 and 1992           as young men. Box 1 shows the main measures used in this article.
ONS (then the Office of Population Censuses and Surveys), used
different rules to select the underlying cause of death from those used
in earlier or later years of ICD-9.6 Failure to adjust for changes to the
                                                                             CHANGING TRENDS IN ALL-CAUSE MORTALITY
ICD, including the selection rules, can lead to discontinuities in the       Much of the improvement in mortality rates since the Eighteenth
data. To aid comparisons, ONS and its predecessors published factors         Century occurred in the Twentieth Century, especially in infants.9
that can be applied to data to allow for such changes. These factors are     Figure 1 shows that females had lower mortality than males throughout
generally useful in understanding trends around the time of the changes.     the Twentieth Century, after allowing for differences in the age
It is problematic to use them to take account of changes over many           structure of the population (age-standardised rate). This ‘gap’ started to
revisions of the ICD, or to be confident in interpreting trend data          widen after the Second World War but has been decreasing since the
produced in this way over long periods.                                      1970s. The rate for females was closest to that for males at the end of
                                                                             the Twentieth Century. This may be due to smoking trends, as many of
Another factor in identifying specific diseases is the detail given in the   the major causes of death in England and Wales are affected by
ICD. In ICD-9 there were over 5,000 codes, compared with under 200           smoking, for example heart disease, lung cancer and respiratory
in ICD-1. This means that many diseases cannot be identified                 diseases.
comparably, or at all, for the whole 100 years. Others have discussed
the problems in analysing data over time in more detail.7 In this article,   Figure 2 shows that the proportion of all deaths occurring in the
we have looked at a selection of causes for which we were able to            younger age groups fell throughout the Twentieth Century while an
obtain apparently comparable data over time.                                 increasing proportion were occurring in the 65 and over age group in
                                                                             both sexes. By 2000, 83 per cent of all deaths in England and Wales
                                                                             occurred at ages 65 and over compared with less than 25 per cent a
DATA AND METHODS
                                                                             century earlier. Infant mortality accounted for 25 per cent of all deaths
The data used for this article are taken from the ONS Twentieth Century      in 1901 but less than 1 per cent at the end of the century. Women had a
Mortality CD-ROM, a database of the numbers of deaths in each year           higher proportion of deaths at older ages than men throughout the
                                                                             century.



     Box one
     MAIN MEASURES USED IN THE ARTICLE
      Age-specific mortality rate
      Specific rates related to a particular group, in this case              Figure 1                          Age-standardised annual mortality rate, all causes
      defined by age and by sex. They are calculated as                                                         of death combined, by sex, 1901–2000

      age-specific mortality rate= deaths in age/sex group x100,000           England and Wales
                           mid-year population in age/sex group                                   3,000

      Infant mortality rate
                                                                                                  2,500               Males
      This is defined as Deaths under age 1 in year x1,000
                             live births in same year
                                                                               Rate per 100,000




                                                                                                  2,000
      Directly age-standardised mortality rate
      Directly age-standardised rates make allowances for
      differences in the age structure of the population, over                                    1,500
      time and between sexes. The age-standardised rate for a
                                                                                                                          Females
      particular disease is that which would have occurred if
                                                                                                  1,000
      the observed age-specific rates for the disease had
      applied in a given standard population. In this article we
      have used the European Standard Population. This is a                                        500
      hypothetical population standard, which is the same for
      both males and females allowing standardised rates to
      be compared for each sex, and between sexes.                                                   0
                                                                                                          1901 1911 1921 1931 1941 1951   1961 1971 1981 1991 2000
                                                                                                                                  Year




                   National Statistics      6
                                                                                               Health Statistics Quar terly 18                                                                   Summer 2003




 Figure 2                                   Percentage of deaths by age group, males and females, selected years


  England and Wales
                                                          Males                                                                                                                                         Females
                                    100                                                                                                                                        100




                                                                                                                                           Percentage of total female deaths
  Percentage of total male deaths




                                    80                                                                                                                                         80


                                                                                              65 and over

                                    60                                                                                                                                         60
                                                                                              45–64


                                                                                              15–44
                                    40                                                                                                                                         40
                                                                                              1–14


                                    20                                                        Under 1                                                                          20




                                     0                                                                                                                                           0
                                          1901    1926     1951     1976     2000                                                                                                     1901       1926     1951    1976     2000
                                                           Year                                                                                                                                           Year



Figure 3a shows that the infant mortality rate has fallen dramatically                               Figure 3b shows that there were increases in death rates around both the
throughout the Twentieth Century. This decline began abruptly around                                 First and Second World Wars. However, analysis of mortality,
the beginning of the century, with rates being stable before this. The                               particularly among males, during these time periods should be
early part of this decline has been attributed to rising standards of                                interpreted with caution. On the Twentieth Century Mortality CD-ROM,
living, especially improvements in nutrition, improvements in hygiene                                during the periods 1915–1920 and 1940–1949, population figures
and the decline in mortality from airborne diseases.10 Infant mortality                              correspond to the civilian resident population, so members of the armed
may have been declining as early as 1860 in some rural communities,                                  forces were excluded even if resident in England and Wales. Deaths in
but in many towns infant mortality didn’t begin to decline until well                                the military occurring in England and Wales were included in the deaths
after 1900.11                                                                                        figures for the First World War, but not the Second. Deaths in the
                                                                                                     military occurring overseas were not included in either the First or
The peaks of infant mortality in the earlier part of the century coincided                           Second World War figures.
with hot summers when diarrhoeal disease played a part in many
deaths. During the Second World War there was a peak in infant
mortality rates, mainly due to increased pneumonia and bronchitis,
which may have been due to fuel shortages during the very cold winters
of 1940 and 1941 and also to the disorganisation caused by evacuations
early in the war.12 In the later years of the War, infant mortality began to                            Figure 3a                                                               Infant mortality rate,1901–2000
decline steeply. This may be an effect of the national food policy, which
concentrated on the health of expectant mothers and infants and
children.13                                                                                            England and Wales
                                                                                                                                     160
There was a steady decline in infant mortality in the second half of the
Twentieth Century, with some exceptions. A rise in 1970 was due to an                                                                140
influenza epidemic in the winter of 1969/70. Another rise, in 1986, was
associated with exceptionally cold weather in February of that year.12
                                                                                                        Rate per 1,000 live births




                                                                                                                                     120
Infant mortality had been declining since the 1986 rise, and continued
to decline to the end of the century. However, the rate of infant                                                                    100
mortality decline was slower in the 1990s, around 2–3 per cent per year
compared with 6 per cent per year in the late 1980s.                                                                                 80

Figure 3b shows age-standardised all-cause mortality rates by sex and                                                                60
age group from 1901 to 2000 for England and Wales. A decrease in
mortality can be seen in all age groups and both sexes, with the most                                                                40
dramatic falls observed in children. Falls in adults aged 45 and over
have been confined to the second half of the century in men but
                                                                                                                                     20
happened throughout the century in women. Rates for those aged
between 15 and 44 declined earlier in the century, but tapered off in
                                                                                                                                      0
later years.                                                                                                                           1901 1911 1921 1931 1941 1951                                       1961 1971 1981 1991 2000
                                                                                                                                                               Year




                                                                                                                                                                                             7   National Statistics
                                    Health Statistics Quar terly 18      Summer 2003




 Figure 3b                                       Age-standardised all-cause mortality rate by sex and broad age group, 1901–2000



     England and Wales
                                                                      Males                                                                                             Females
                    100,000                                                                                             100,000




                                    10,000                                                 65 and over                                  10,000
     Rate per 100,000 (log scale)




                                                                                                         Rate per 100,000 (log scale)
                                                                                                                                                                                               65 and over



                                     1,000                                                    45–64                                      1,000
                                                                                                                                                                                                   45–64

                                                                                             15–44
                                      100                                                                                                 100
                                                                                                                                                                                                   15–44
                                                                                              1–14
                                                                                                                                                                                                   1–14
                                       10                                                                                                  10




                                        1                                                                                                   1
                                             1901 1911 1921 1931 1941 1951    1961 1971 1981 1991 2000                                           1901 1911 1921 1931 1941 1951    1961 1971 1981 1991 2000
                                                                     Year                                                                                                Year




Since the end of the Second World War there has been a widening gap                                                     cause of death in ONS records. Doctors may certify the deaths as due to
in mortality rates for men and women in the 15–44 age group. The age-                                                   a complication such as pneumonia, and indicate on the death certificate
standardised death rate in men (110 per 100,000) was almost double                                                      that they may be in a position to later provide further information on the
that for women (58 per 100,000) in 2000, partly as a result of the steep                                                cause of death. The late information provided in this way accounted for
falls in maternal mortality during the century.                                                                         about 32 per cent of deaths finally coded to HIV infection in ONS
                                                                                                                        records in the 1990s.18 Though the number of deaths from HIV/AIDS
                                                                                                                        undoubtedly declined sharply in the late 1990s, because of improved
TRENDS IN MORTALITY BY UNDERLYING CAUSE OF DEATH                                                                        survival on better treatment, ONS figures on these causes are
This section examines trends in mortality during the Twentieth Century                                                  incomplete.
for selected causes of death. In all cases, the figures relate to the
underlying cause of death, defined by the World Health Organisation                                                     Respiratory disease mortality also declined over the century. In the
(WHO)14,15 as:                                                                                                          years between 1984 and 1992 about 25 per cent fewer deaths were
                                                                                                                        allocated to respiratory diseases, purely as a result of a change in the
a) the disease which initiated the train of events directly leading to                                                  rules used to select the underlying cause of death. During this period
   death; or                                                                                                            deaths affected by this change were mainly assigned to diseases of the
b) the circumstances of the accident or violence which produced the                                                     nervous and endocrine systems and mental disorders. Mental disorders
   fatal injury.                                                                                                        also showed an increase from a low in the 1960s, even when this coding
                                                                                                                        change is taken account. In 1992, 92 per cent of deaths in this chapter
How the underlying cause of death is selected from all the diseases and                                                 were due to psychoses, and 72 per cent to senile and presenile organic
conditions listed on the death certificate has been described in detail                                                 psychotic conditions, largely dementia.1
elsewhere.16 The ICD codes used to select the causes examined in this
article are given in Annex 1.                                                                                           Mortality from neoplasms did not decline during the Twentieth Century.
                                                                                                                        It remained relatively stable in females, but increased slightly for males
Trends for broad disease groups                                                                                         until the early 1980s. From then it declined for both sexes to the end of
                                                                                                                        the century. Circulatory diseases have risen and fallen during the
Figure 4 shows mortality by broad cause group (Chapter of the ICD) for                                                  century. The main cancers, ischaemic heart disease and stroke are
1911– 2000. It clearly shows the dramatic decline in infectious disease                                                 discussed in more detail later in the article.
mortality that took place in the Twentieth Century. Poliomyelitis,
diphtheria, tetanus, whooping cough, measles, mumps and rubella were                                                    Diseases of the digestive and genitourinary systems declined at similar
all virtually eliminated during the second half of the century, following                                               rates during the first part of the century, but since the 1950s,
the introduction of childhood immunisation.17 Infectious disease                                                        genitourinary diseases have declined much more rapidly. In both males
mortality rates have begun to increase since the early 1990s. HIV/AIDS                                                  and females, mortality rates from digestive diseases have hardly
was included in this chapter from 1993 onwards, when automatic cause                                                    changed since the early 1950s. The lack of decline, and possibly even
coding was introduced. Before that it was coded to the endocrine                                                        an increase at the end of the century, in mortality from digestive
chapter. A clear increase in infectious disease mortality rates can be                                                  disorders is largely due to increasing mortality from cirrhosis of the
seen from 1992 to 1993, especially among males.                                                                         liver, which rose substantially between 1979 and 2000, particularly for
                                                                                                                        males.19
Due to the stigma attached to people dying from HIV and its related
conditions some deaths will not have HIV infection as the underlying


                                                   National Statistics   8
                                                                                                              Health Statistics Quar terly 18                                             Summer 2003




                 Figure 4                            Age-standardised mortality rates by ICD Chapter and sex, 1911–2000



                    England and Wales
                    10,000                                                  Males                                              10,000                                                     Females




                                                                                                               Rate per 100,000 (log scale)
    Rate per 100,000 (log scale)




                                   1,000                                                                                                           1,000




                                    100                                                                                                             100




                                     10                                                                                                              10




                                       1                                                                                                              1
                                           1911     1921    1931   1941   1951   1961   1971   1981   1991   2000                                          1911   1921    1931   1941    1951   1961   1971     1981    1991    2000
                                                                            Year                                                                                                           Year

                                                    Neoplasms               Mental disorders            Endocrine system                                                   Circulatory diseases               Injury and poisoning


                England and Wales
                10,000                                                      Males                                                  10,000                                                 Females
Rate per 100,000 (log scale)




                                                                                                                    Rate per 100,000 (log scale)




                                   1,000                                                                                                           1,000




                                    100                                                                                                             100




                                     10                                                                                                               10




                                      1                                                                                                                1
                                           1911     1921   1931    1941   1951   1961   1971   1981   1991   2000                                          1911   1921    1931   1941    1951   1961   1971      1981   1991    2000
                                                                            Year                                                                                                           Year

                                                  Infectious diseases        Respiratory diseases        Digestive diseases                                              Genitourinary diseases         Nervous system diseases



Mortality from injury and poisoning, including accidents, suicide and                                                                              Analysis has shown that accidental mortality generally declined from a
homicide, as well as deaths where the intent could not be determined,                                                                              peak in the 1930s, and that this trend was greater for men than for
declined slowly throughout the century, with peaks around both the                                                                                 women and greater for children than adults.21 Suicide rates fluctuated
First and Second World Wars for men and the Second World War for                                                                                   over the century, rates were much higher in older age groups in the
women. This was not just as a result of enemy action, for example road                                                                             earlier years, but there were substantial increases in rates for younger
traffic accidents involving pedestrians saw a sharp increase in 1939,                                                                              age groups, especially young men, since the 1950s. The most recent
due to the abolition of street lighting. In the later part of the war, as                                                                          review of suicide trends by ONS was published in 1998,22 and we plan
people became accustomed to blackouts, rates returned to their pre-war                                                                             to update this work in a future article.
levels. In contrast, suicide rates fell during the war, after high rates
during the 1930s.20




                                                                                                                                                                                     9    National Statistics
                Health Statistics Quar terly 18            Summer 2003




Trends for specific causes of death
                                                                                               Figure 5                                           Age-standardised tuberculosis mortality by sex,
We now move on to discuss trends for some specific causes of death,                                                                               1901–2000
beginning with tuberculosis and influenza, moving on to look at
                                                                                            England and Wales
ischaemic heart disease, stroke and some specific cancers. Finally we
examine trends in mortality from ill-defined conditions.                                                                          300


Tuberculosis 1901–2000                                                                                                            250
‘Consumption’ and ‘phthisis’ are terms historically used to describe
tuberculosis (TB). TB is caused by the bacterium Mycobacterium




                                                                                                               Rate per 100,000
                                                                                                                                  200
tuberculosis and mainly affects the lungs and lymph glands although
any part of the body can become infected. The disease is usually spread
through coughing and the airborne bacillus can be suspended in the                                                                                         Males
                                                                                                                                  150
atmosphere of poorly ventilated areas for several hours. Only 30 per
cent of healthy people who are exposed to the TB bacillus will become
infected and only 5–10 per cent of these will develop clinical TB,23                                                              100
although this will depend on the extent of the exposure. Overcrowding,
poor nutrition, poor health, poverty and unemployment have been
shown to have a strong association with incidence of tuberculous                                                                  50
                                                                                                                                                                 Females
disease.24,25

Figure 5 shows age-standardised mortality rates for TB by sex in                                                                      0
                                                                                                                                          1901 1911 1921 1931 1941 1951              1961 1971 1981 1991 2000
England and Wales from 1901 to 2000. There was a large increase in
                                                                                                                                                                  Year
the death rate during the First World War. This was partly due to
overcrowding and housing shortages,26 co-morbidity with influenza
during the pandemic of 1918–19 and under-nutrition.27 However, since                       decrease after 1950. This was when Bacillus Calmette-Guérin (BCG)
deaths in the military which occurred in England and Wales were                            vaccination was beginning to be introduced into the school population
included in First World War mortality figures, this could be due to a                      and effective antibiotics were becoming available to treat TB.29 It is
numerator-denominator bias, as military personnel were not included in                     generally considered that the treatment had more effect on mortality
the population estimates. The mortality rate for males during the peak                     rates than the BCG vaccine.30
in 1918 was double that for females (263 and 132 per 100,000
respectively).                                                                             Figure 6 shows age-standardised rates for TB by age group for both
                                                                                           sexes from 1901 to 2000. In males the mortality rates were usually
An increase in TB can also be seen during the Second World War,                            highest in those aged 45–64 until the early 1950s. In females, however,
which was also more marked in males than females. It could be                              those aged 15–44 had the highest rate until the same period. This
speculated that this was due to wartime conditions and circumstances,                      difference was noted in the 1921 Decennial Supplement to the Registrar
for example soldiers living in close proximity or other factors related to                 General’s Annual Reports, but an explanation was not given.27 The
active service. However, health selection could have played a part, with                   oldest age groups had the highest rate for both sexes by the end of the
only the healthier men being drafted into the armed forces.28 However,                     Twentieth Century.
the overall trend in TB mortality is one of decline with a very steep


 Figure 6                         Age-standardised mortality rate per 100,000 for tuberculosis by sex and broad age group, 1901–2000


  England and Wales
      400                                             Males                                                        400                                                     Females


                      350                                                                                          350
                                            15–44
                             45–64
                      300                                                                                          300
   Rate per 100,000




                                                                                            Rate per 100,000




                      250                                                                                          250


                      200                                                                                          200
                                                                                                                                                         15–44
                      150                                                                                          150
                              65 and over

                      100                                                                                          100
                                                                                                                                           1–14
                                                                                                                                                           45–64
                      50                                                                                                    50
                                                                                                                                           65 and over
                                            1–14
                        0                                                                                                         0
                            1901 1911 1921 1931 1941 1951       1961 1971 1981 1991 2000                                              1901 1911 1921 1931 1941 1951                  1961 1971 1981 1991 2000
                                                    Year                                                                                                      Year




                                     National Statistics   10
                                                                                       Health Statistics Quar terly 18       Summer 2003




The peaks during the First and Second World Wars can clearly be seen                      women, which may explain the difference in death rates between the
in the 15–44 year age groups, although all age groups were affected.                      sexes. The problems with numerator-denominator bias and health
During the First World War an increase in death rates can be seen in all                  selection effects during the First World War, described earlier for TB,
ages, but during the Second World War the rise was mainly seen in                         will also have had an impact on influenza mortality rates.
those aged under 45 and more so in men than women. This is consistent
with the health selection effects described above. There was a rise of                    There have been several influenza epidemics since 1918–19, but in
just over 20 per cent in the mortality rates of men aged 65 and over                      recent years they have been associated with cold winters, for example
after the Second World War but this was curtailed in the 1950s by the                     in 1969/70, 1972/73, 1976/77 and 1989/90. In the 1989/90 winter over
introduction of effective medical treatments.                                             2,500 more deaths had influenza as their underlying cause than in 1988/
                                                                                          89.33 The last epidemic in England and Wales was in winter 1996/97,
The incidence of TB is once again increasing with HIV positive                            when 375 deaths had an underlying cause of influenza. However, it is
individuals, immigrants from areas of high prevalence, and health care                    likely that influenza is frequently under-diagnosed, and it can be a
workers all at increased risk. Mortality rates, however, have been very                   contributory factor in deaths from other causes.34 It has been estimated
low. There may be some signs of an increase in mortality rates from TB                    that 1 influenza death is associated with 15 excess winter deaths from
in young men, but rates have been variable year on year.                                  other causes.35 There have been difficulties in diagnosing influenza over
                                                                                          the century, and up until 1933 it could not be confirmed diagnostically,
Influenza 1901–2000                                                                       although it was recognised as a clinical diagnosis. Even so, very few
                                                                                          people whose death is triggered by influenza have this confirmed
Figure 7 shows age-standardised mortality rates for influenza by sex in                   microbiologically, and so apparent changes in trends may simply reflect
England and Wales from 1901 to 2000. It clearly shows the influenza                       changes in diagnostic fashion.
pandemic that occurred just after the First World War in 1918–19. This
pandemic killed between 20 and 50 million people worldwide and in                         Ischaemic Heart Disease and Stroke 1950–2000
England and Wales during the 46 weeks 23rd June 1918 to 10th May
1919 there were almost 152,000 deaths for which influenza was the                         At the end of the Twentieth Century, ischaemic heart disease (IHD) and
underlying cause.31 This was the highest mortality figure for an                          stroke together accounted for 30 per cent of deaths in England and
epidemic ever recorded since registration began in England and Wales                      Wales. Stroke accounts for fewer deaths than IHD. The occurrence of
in 1837.                                                                                  stroke is strongly related to blood pressure, and can be caused by either
                                                                                          a blockage in the blood vessels in the brain (ischaemic stroke or
Unlike other strains of the influenza virus which usually strike the old                  cerebral infarct), or by a leakage of blood into the brain (haemorrhagic
and infirm or the very young, the influenza strain of the 1918–19                         stroke or cerebral haemorrhage). IHD is caused by the obstruction of
epidemic tended to attack young, healthy adults in the prime of life.32                   coronary artery blood flow by atherosclerosis. In about 20 per cent of
The age-standardised mortality rate in 1918 for men aged between 15                       cases, the first manifestation of the disease is sudden death.36
and 44 was more than twice that for women of the same age (730 and
343 per 100,000 respectively) and far exceeded that for men aged 65                       A detailed analysis of cardiovascular mortality trends can be found in
and over (438 per 100,000). This is in direct contrast with other                         The Health of Adult Britain.37 In this article, we have examined trends
influenza epidemics where those at older ages were affected to a much                     from 1950 onwards. Figure 8 shows that stroke mortality rates have
greater degree. This is generally assumed to be associated with the                       been declining since the 1960s. Trends in IHD depend on the selection
unusually high virulence of the virus, although this is not proven. In                    of ICD codes for ICD-6 and ICD-7. If both 420 (Arteriosclerotic heart
addition, a large proportion of the population may have been                              disease, including coronary disease) and 422 (Other myocardial
particularly vulnerable following the war, affecting men more than                        degeneration) are used, then the pattern was one of decline, from 1950
                                                                                          onwards. However, if 422 is excluded then rates showed a substantial
                                                                                          rise between 1950 and 1967, with a peak in the early 1970s and
 Figure 7                         Age-standardised influenza mortality by sex,            subsequent decline. It is likely that ‘other myocardial degeneration’
                                  1901–2000                                               does include some deaths that were due to ischaemic heart disease.
                                                                                          However, it is not possible to separate these out from other deaths in
 England and Wales                                                                        this category which were not. The interpretation of trends in IHD before
                      500                                                                 1968 is therefore problematic, and very much depends on the codes
                                                                       Males              used to define the condition.
                      450

                      400                                              Females            Other analysis of data from the 1930s onwards shows that IHD
                                                                                          mortality rates increased then fell, whereas stroke mortality has fallen
                      350                                                                 consistently. This is at odds with the fact that IHD and stroke share
   Rate per 100,000




                                                                                          many of the same risk factors, for example cigarette smoking and
                      300
                                                                                          increased levels of cholesterol. It has been proposed that this difference
                      250                                                                 may be due to the fact that the term stroke covers the two major sub-
                                                                                          types described above. Data from autopsy studies have been used to
                      200                                                                 obtain ratios of cerebral infarct to cerebral haemorrhage over time and
                                                                                          therefore trends for the two sub-types.38 This showed that cerebral
                      150
                                                                                          infarct trends were similar to IHD, but cerebral haemorrhage trends
                      100                                                                 were not. This suggests that the causes of cerebral infarct and IHD are
                                                                                          similar. Early-life exposures could be more important in cerebral
                      50                                                                  haemorrhage.38

                       0
                            1901 1911 1921 1931 1941 1951   1961 1971 1981 1991 2000
                                                    Year




                                                                                                                      11    National Statistics
                     Health Statistics Quar terly 18                                          Summer 2003




                                                                                                                                                        Mortality in males rose steeply from 1940 to the mid-1970s when it
      Figure 8                                 Age-standardised ischaemic heart disease (IHD)
                                                                                                                                                        peaked at 110 deaths per 100,000 but has since fallen by almost half.
                                               and stroke mortality by, sex, 1950–2000
                                                                                                                                                        Mortality in females, however, showed a four-fold increase from 1940
England and Wales
                                                                                                                                                        to 1990, peaking at about 30 deaths per 100,000 in 1991, and has since
                                                                                                                                                        very gradually declined. Mortality rates at the end of the century were
                    500
                                                                                                                                                        approaching those of breast cancer.
                    450                                    Males IHD
                                                                                                                                                        The latency period for lung cancers attributable to smoking is at least
                    400                                                                                                                                 20 years, and thus smoking patterns affect the pattern of mortality at
                                                                                                                                                        least 20 years later. The differing take-up and cessation of smoking in
                    350
 Rate per 100,000




                                                                              Males IHD excluding                                                       men and women can be clearly seen by the timing of the peaks in
                    300                                                       other myocardial                                                          mortality. Men took up smoking during the First World War.44 Earlier in
                                                                              degeneration
                                                                                                                                                        the century fewer women smoked, they started to smoke later in life
                    250                                                                                                                                 than men, tended to smoke less, and used brands of cigarettes
                                                                                                                                                        containing less tar.45 Smoking only became popular among women
                    200
                                      Males Stroke                                                                                                      during the Second World War,44 and thus the peak in female mortality
                                                                                                    Females IHD
                    150                                                                                                                                 occurred later.46

                    100                                                                                                                                 Women have also been slower to give up smoking than men.47 The
                                    Females IHD excluding                                      Females Stroke                                           impact on smoking patterns of measures designed to persuade people to
                    50              other myocardial
                                    degeneration                                                                                                        give up, or not start, smoking, such as banning of TV advertising of
                     0                                                                                                                                  cigarettes in 1965 and the introduction of a ‘National No Smoking Day’
                               50         54         58        62        66        70      74 978        82        86        90        94        98     in 1984 may have influenced smoking patterns and thus mortality
                                                                                                                                                   00




                          19         19         19        19        19        19        19    1     19        19        19        19        19
                                                                                                                                                 20




                                                                                                                                                        figures.
                                                                                        Year

                                                                                                                                                        Breast cancer 1940–2000

Cancer in the Twentieth Century                                                                                                                         Breast cancer is the most common cause of death from cancer in
                                                                                                                                                        women throughout the world41 and accounts for a quarter of all
Cancer has been known as a disease for thousands of years, for example                                                                                  malignancies in females.45 From the early 1950s it has had the highest
there are pictures on the walls in Egyptian tombs showing people with                                                                                   mortality rate of all cancers in women but there has been a decline in
tumours.39 The Second Registrar General’s Report, from 1838,                                                                                            mortality from a peak in 1988. This has been suggested to mainly result
contained the number of deaths from ‘Carcinoma’ and ‘Tumour’ by area                                                                                    from better treatment, including the use of tamoxifen, but also, to a
of England.40 These data for cancer, however, are highly unreliable and                                                                                 lesser extent, from screening.48,49
subject to doctor or certifier bias. ICD codes for cancer by site can only
be used from the Second Revision of the ICD for breast cancer and                                                                                       The major recognised risk factors for breast cancer include age (four in
from the Fifth Revision for most others. This is because these were the                                                                                 five women diagnosed with breast cancer are over 50), family history of
first occasions when separate codes were assigned to most of the                                                                                        breast cancer, hormones, age at menarche and previous radiotherapy.50
common cancer sites.                                                                                                                                    Age at first birth is also important, with risk of developing breast
                                                                                                                                                        cancer being raised for women who remain childless, or who have their
Although all-cause mortality fell over the past century for both males                                                                                  first birth late in their reproductive period, although the trends in these
and females, cancer mortality did not. Therefore deaths from cancer                                                                                     factors do not predict breast cancer trends particularly well.51
accounted for an increasing proportion of all deaths as the century
progressed. Cancer accounted for 25 per cent of all deaths in England                                                                                   Breast cancer has good survival compared with lung cancer.
and Wales in 2000, in contrast to around 15 per cent in 1950. Increases                                                                                 Consequently it is not easy to make a direct link between the mortality
in the number of deaths recorded as cancer in the early part of the                                                                                     rates presented in this article and trends in incidence. To interpret breast
century were probably due to progress in clinical diagnosis or fashions                                                                                 cancer mortality trends information on incidence and survival is also
in coding, but since the 1950s the increasing proportion of all deaths                                                                                  needed.
attributed to cancer is due to the declines seen in other diseases, for
example circulatory diseases, but not in cancer. Figure 9 shows age-                                                                                    Prostate cancer 1940–2000
standardised mortality rates by sex and major cancer site for England
and Wales from 1940 to 2000.                                                                                                                            Prostate cancer is now the second most common cancer in men in
                                                                                                                                                        England and Wales and killed over 8,000 men in 2000.52 It has had its
Lung cancer 1940–2000                                                                                                                                   own ICD code since 1940, before which there were only codes for
                                                                                                                                                        diseases of the prostate. Figure 9 shows that mortality from prostate
Lung cancer was a relatively rare disease at the beginning of the                                                                                       cancer increased from 1940 to 1950 and remained stable at just over 20
Twentieth Century and did not have its own ICD code until 1940. At the                                                                                  per 100,000. It reached a peak in the early 1990s and declined from
end of the Twentieth Century it was the most common cause of death                                                                                      then.
from cancer in the world, killing around 900,000 people every year.41
The link between lung cancer and smoking was discovered at the                                                                                          The reasons for the decline in mortality are not clear. Prostate cancer
beginning of the 1950s42 and it is now estimated that tobacco smoking                                                                                   incidence has been rising rapidly due to the widespread and increasing
causes around 90 per cent of cases.43 Other recognised risk factors for                                                                                 use of a diagnostic test (prostate specific antigen (PSA) testing),
lung cancer include passive smoking; occupational exposures,                                                                                            particularly in the early 1990s. Because of the lag between diagnosis of
especially to asbestos; and radon exposure.43                                                                                                           prostate cancer and death, we would only now expect to see any impact
                                                                                                                                                        of this screening on mortality, whereas the decline appeared to be




                                                 National Statistics                         12
                                                                                              Health Statistics Quar terly 18                           Summer 2003




  Figure 9                        Age-standardised cancer mortality by sex and site, 1940–2000


 England and Wales
                     120                               Males                                                          120                               Females



                     100                                                                                              100


                                         Lung




                                                                                                   Rate per 100,000
  Rate per 100,000




                     80                                                                                               80



                     60                                                                                               60


                                                                                                                               Colorectal                                     Breast
                     40                                                                                               40

                                        Colorectal

                     20                                                                                               20
                                                                                                                                       Stomach
                                      Prostate                               Stomach
                                                                                                                                            Lung
                      0                                                                                                0
                           1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000                                 1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000
                                                         Year                                                                                             Year


happening slowly throughout the 1990s. Research in the US has shown                              Ill-defined causes of mortality 1911–2000
that prostate cancer screening does not appear to reduce mortality when
compared with groups that have not been screened.53 This backs up the                            Doctors are required to certify the cause of death to the best of their
view that PSA testing leads to cases of prostate cancer being diagnosed                          knowledge and belief. If the doctor cannot identify a disease which
that would normally not show symptoms during life.54                                             caused the death, the death is normally referred to the coroner for
                                                                                                 investigation. However, there have been some exceptions historically,
The major risk factors for prostate cancer are age (prostate cancer has                          for example a climate of greater acceptance of Sudden Infant Death
the steepest age curve of any disease); family history of the disease;                           Syndrome (SIDS) and ‘old age’ as ‘natural causes’ of death. These have
occupational exposure to radioactive substances; and, in the USA,                                been coded to the ICD chapter for symptoms, signs and ill-defined
prostate cancer is more common in men of African descent,55 although                             conditions (referred to here as ill-defined causes of mortality).
rates in Africa are among the lowest in the world. Ethnic origin is not                          Variations in rates for this chapter often reflect changes in diagnostic
available from routine mortality data in England and Wales, so it is not                         techniques, quality of investigation and certification, and classification
possible to analyse mortality by this factor.                                                    of diseases rather than real changes in disease patterns. To an extent
                                                                                                 they can be used as an index of the quality of death certification. Figure
Stomach Cancer 1940–2000                                                                         10 shows trends in mortality from ill-defined causes.

Stomach cancer has declined substantially since the 1950s. In 1940, it                           In 1911 ill-defined causes accounted for nearly 10 per cent of all deaths
killed more men than lung and prostate cancer, and more women than                               compared to 2.5 per cent in 2000. This compares to 0.4 per cent in
lung cancer. By 2000 death rates from stomach cancer had declined by                             1976, the lowest proportion recorded. Rates started to rise from the
75 per cent in men and nearly 85 per cent in women. This appears to be                           1980s, but the increase appeared to taper off in 2000. A system of
a reversal of trends in the first part of the century, when substantial                          ‘medical enquiries’ was used by the General Register Office in most
increases were seen.51                                                                           years since 1881 until 1992.58 These enquiries allowed the follow-up of
                                                                                                 deaths where the cause of death needed further explanation, thus
The reasons for the early century rise are unclear, although there is                            allowing more deaths to be assigned to specific ICD codes, although
likely to have been some element of improvements in diagnosis. The                               most changes that resulted from medical enquiries were at the 4th digit
decline cannot be attributed to better survival, and improvements in diet                        level of ICD-9. They were stopped in 1993 when automatic cause
and nutrition probably had only a limited effect. It has been suggested                          coding was introduced, as it was not possible to generate the enquiries
that early-life influences have an impact on adult mortality from                                from the system or to deal with them in a timely way,16 and because
stomach cancer.56 Recently a link has been made between infection with                           very few led to any significant change in the underlying cause of death.
Helicobacter pylori and stomach cancer.57 This infection has been                                The cessation of this system therefore probably contributed only a
decreasing in successive cohorts born since the 1920s. This parallels the                        small amount to the increase in the number of deaths coded to the ill-
decline in stomach cancer mortality, although H. pylori infection has                            defined chapter of the ICD.
continued to decline while stomach cancer mortality has levelled off.51
This could be related to a lag time between infection with H.pylori and                          Rates do vary with age, with the highest rates being found in those aged
development of stomach cancer, with infection in childhood increasing                            75 and over. They have been rising since the mid-1980s in this age
the risk of cancer in later life, but also suggests that a proportion of                         group.1 Deaths certified as due to ‘old age’ (ICD-9 797) are included in
stomach cancers is not caused by infection with H.pylori.                                        this chapter of the ICD. The current guidance on completing the
                                                                                                 Medical Certificate of Cause of Death gives the following guidance on
                                                                                                 the use of old age as a cause of death:




                                                                                                                                                   13   National Statistics
                                  Health Statistics Quar terly 18              Summer 2003




 Figure 10                                     Age-standardised mortality rates for ill-defined               DISCUSSION
                                               causes of mortality by sex, 1911–2000
                                                                                                              We have set out to illustrate the use of the Twentieth Century Mortality
  England and Wales
                                                                                                              CD-ROM to analyse trends in mortality, both for all causes of death and
                                                                                                              by cause, using what is a very basic data set containing age, sex, cause
                 1,000
                                                                                                              and year of death. This has illustrated some of the problems that can be
                                                                                                              encountered in using these data. Care must be taken when analysing
                                                                                                              trends to take account of differences in understanding of disease
                                                                                                              processes (certification drift), terms and definitions as well as coding
  Rate per 100,000 (log scale)




                                                     Males
                                                                                                              rules and ICD codes.
                                 100
                                                                                                              Many diseases have strong cohort as well as period patterns, for
                                                       Females                                                example lung cancer which is strongly affected by the timing of
                                                                                                              smoking take-up and cessation by different groups. It is therefore useful
                                                                                                              to analyse mortality by year of birth as well as by year of death to
                                                                                                              obtain a full picture of trends. A recent analysis by the Government
                                  10                                                                          Actuary’s Department (GAD) showed that cohorts of men and women
                                                                                                              born between 1925 and 1945 appeared to have the greatest rates of
                                                                                                              mortality improvement.62 In collaboration with GAD, we plan to
                                                                                                              analyse cohort trends in all-cause mortality and in mortality by cause in
                                                                                                              future work.
                                   1
                                       1911   1921     1931      1941   1951 1961   1971   1981   1991 2000   The analysis of trends at national level masks differences across the
                                                                         Year                                 country, especially in mortality by social class and area.63, 64


                                 ‘Old age, senility – do not use ‘old age’ or ‘senility’ as the only
                                 cause of death in Part I unless a more specific cause of death cannot
                                 be given and the deceased was aged 70 or over’
                                                                                                                   Key points
                                                                                                                    q   Infant mortality and childhood mortality have fallen
The proportion of ill-defined deaths that were certified as due to ‘old
age’ has increased from about 50 per cent in 1979 to over 90 per cent in                                                most dramatically during the last 100 years. Infant
2000. Thus almost all the rise in mortality from ill-defined causes from                                                mortality rates at the beginning of the century were
                                                                                                                        nearly 30 times higher than those at the end.
the 1980s can be attributed to increases in the use of ‘old age’ or
‘senility’ (without mention of dementia) on death certificates. However,                                                Childhood mortality rates were nearly 50 times
acceptance of ‘old age’ as a cause of death is likely to change following                                               higher in males and 65 times higher in females.
the independent public inquiry into the issues arising from the case of
Harold Shipman.59 A decline in mortality from ill-defined causes was                                                q   Around 80 per cent of deaths occurred at ages over
seen in 2000, due to declines in the use by certifiers of ‘old age’ as a                                                65 in 2000 compared with around 20 per cent in
                                                                                                                        1901.
cause of death. This could signal the start of a change in attitude to the
use of ‘old age’ on death certificates.
                                                                                                                    q   Patterns of mortality by cause of death have
                                                                                                                        changed throughout the century.
Deaths certified as due to unknown cause (ICD-9 799.9) formed around
6 per cent of all deaths from ill-defined causes in 2000. These were
deaths where the coroner certified the cause of death as ‘unascertained’                                            q   Infectious diseases have declined to low levels, with
                                                                                                                        the epidemics of the early part of the century no
following an inquest or deaths in the elderly with bronchopneumonia
with a duration of over 1 year as the only condition mentioned on the                                                   longer occurring.
death certificate. Since this is not acceptable as an underlying cause
                                                                                                                    q   At the end of the century, deaths from all cancers
combination under international coding rules the cause of death is
coded as unknown.                                                                                                       combined formed around 25 per cent of all deaths
                                                                                                                        in England and Wales, compared with 15 per cent 50
                                                                                                                        years previously and less than 5 per cent in 1901.
Sudden Infant Death Syndrome was introduced into the ICD in 1969.
However, rates did not change suddenly. The gradual acceptance of                                                       This was because mortality from ischaemic heart
SIDS as a ‘natural cause’ of death led to a corresponding rise in SIDS                                                  disease and stroke declined substantially while
                                                                                                                        mortality from cancer did not.
together with a decline in respiratory diseases.60 However, rates of SIDS
fell substantially from 1988 to 1992, with a more gradual decline to
1998.61 SIDS deaths formed over 40 per cent of all deaths assigned to                                               q   There were increases in death rates from ill-defined
                                                                                                                        causes from the 1980s to 1999, although these still
the ill-defined chapter in the early 1980s. By 2000 this had fallen to less
than 2 per cent, partly due to declines in SIDS deaths, but also due to                                                 formed a small proportion of all deaths in 2000 (2.5
the rapid rise in the use of ‘old age’ as a cause of death.                                                             per cent). This was due to the increasing
                                                                                                                        certification of deaths as due to ‘old age’.




                                                     National Statistics       14
                                                                           Health Statistics Quar terly 18       Summer 2003




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55 Cancer Research UK (2002) Factsheet: Specific Cancers: prostate
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56 Davey Smith G, Hart C, Blane D, Hole D (1998) Adverse
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                  National Statistics    16
                                                                                                       Health Statistics Quar terly 18                 Summer 2003




Annex 1                 ICD codes used to examine trends by cause of death



                          Cause of death

  ICD Start      End           Infectious           All cancer         Endocrine           Mental        Nervous      Respiratory        Digestive       Genito–       Circulatory     Injury and
Revision date    date           diseases                                system            disorders      system         system            system         urinary         system        poisoning
                                                                                                                                                         system

ICD-1*    1901   1910     ==                      ==                  ==                 ==            ==             ==            ==                   ==                              ==

ICD-2† 1911      1920     1–9, 11–38, 61,         39–46, 53,          26, 27, 36,        56, 59, 68,   60, 63, 66,    10, 86–87,    99, 101–103,         119–128,    47, 64, 65,      57–58, 153,
                          62, 104, 106,           74c, 129            49–52, 74B,        74A, 154A     67, 69,        89–98, 100    104B–H, 105B–H,      130–133     72, 77–85,       155–163,
                          107, 112, 164                               88                               73–76                        108–111, 113–118                 189A             165–186

ICD-3† 1921      1930     1–10, 12–42, 71,        43–50, 65,          53–63              66, 68, 77,   70, 73, 75,    11, 97–107, 108, 110–127           128–136,    51, 74, 81,      67, 163,
                          72, 113–116,            84, 137, 139                           84, 164(1)    76, 82,        109                                138,        83, 87–96,       165–174,
                          121, 175                                                                     84–86                                             140–142     205(1)           176–199,
                                                                                                                                                                                      201–203

ICD-4† 1931      1939     1–10, 12–44, 79,        45–55, 72           58–69              75, 76, 83,   78, 81, 82c,   11, 104–114, 115(1)–(2),           130–139     56, 82a–b,       77, 163–176,
                          80, 119, 120,                                                  84, 162a      85, 87b–89     115(3)       115(4),                           87a, 90–97,      178–198
                          177                                                                                                      116–129                           99–103, 200(1)

ICD-5† 1940      1949     1–32, 34–44a,           44b, 45–57,         60–66a,            77, 84,       80–82,         33, 104–114, 115a, 116–129         130–139     58, 83a–c,      66, 78, 79,
                          44c–d, 119, 120,        74                  66b(2)–71          162b          83d–e, 85,     115b–d                                         87a, 90–97,     163–176,
                          177                                                                          87b–89                                                        99–103, 200a(1) 178–198

ICD-6     1950   1957     001–138, 571,           140–220,            250–289,           300–326       340–361,     240, 241,       530–570,             590–637,    330–334,         242–245,
                          696, 697, 764           222–239,            772                              364,         470–527         572–587              792         400–454,         365,
                                                  294                                                  366–398, 781                                                  456–468, 782     E800–E999

ICD-7     1958   1967     001–138, 571,           140–220,            250–289,           300–326       340–361, 364, 240, 241,      540–587              590–637,    330–334,         242, 245,
                          696, 764                222–239,            772                              366–398,      470–527                             792         400–454,         365,
                                                  294                                                  744, 781                                                      456–468, 782     E800–E999

ICD-8     1968   1978     000–136                 140–239             240–279            290–315       320–351,       460–519       444.2,               444.3,      390–444.1,        E800–E999
                                                                                                       354–389,                     520–577              580–629,    444.4–589,
                                                                                                       733, 781                                          792         782

ICD-9     1979   2000     001–139                 140–239             240–279            290–319       320–389        460–519       520–579              580–629     390–459          E800–E999



                          Cause of death

   ICD Start       End     Symptoms           Ischaemic               Stroke         Influenza         Tuberculosis         Lung              Breast      Prostate        Stomach        Colorectal
Revision date     date      signs and            heart                                                                     cancer             cancer       cancer          cancer         cancer
                           ill–defined          disease
                           conditions

ICD-1* 1901      1910     ==                 ==                  ==                 012.0              046.0–054.0      ==               ==             ==              ==              ==

      †
ICD-2     1911   1920     70, 71, 142,       ==                  ==                 10                 28–35            ==               43             ==              ==              ==
                          154B, 187–
                          189B–F

ICD-3† 1921      1930     79, 80, 151,       ==                  ==                 11                 31–37           ==                47             ==              ==              ==
                          164(2), 204,
                          205(2)–(3)

ICD-4† 1931      1939     86, 98, 162b,      ==                  ==                 11                 23–32           ==                50             ==               ==             ==
                          199, 200(2)
                          –(3)

ICD-5† 1940      1949     86, 98, 162a,      ==                  ==                 33                 13–22           47a,b             50             51b              46b            46c–d
                          162c, 199,
                          200a(2),
                          200b–c

ICD-6     1950   1957     450, 780, 781, 420, 422                330–334            480–483            001–019         162–163           170            177              151            153–154
                          783–791,
                          793–795

ICD-7     1958   1967     450, 780,          420, 422            330–334            480–483            001–019         162–163           170            177              151            153–154
                          783–791,                                                                                     excluding
                          793–795                                                                                      162.2

ICD-8     1968   1978     780, 783–791, 410–414                  430–438            470–474            010–019         162               174            185              151            153–154

                          793–795

ICD-9     1979   2000     780–799            410–414             430–438            487                010–018         162               174            185              151            153–154


*   An unnumbered list was used in England and Wales rather than the International classification during this period.
†   As amended for use in England and Wales.

                                                                                                                                                 17    National Statistics
   Health Statistics Quar terly 18   Summer 2003




Comparison of area-based
inequality measures and
disease morbidity in England,
1994–1998

Jacqueline Hoare,
Office for National Statistics




This article aims to compare the                   INTRODUCTION
effects of using the Index of
Multiple Deprivation 2000 with                     Tackling inequalities in health is a key aim in the Government’s health
the Townsend Index of                              strategy, as outlined in the White Paper Saving Lives: Our Healthier
Deprivation as measures of                         Nation.1 During the twentieth century there have been considerable
health inequalities. Data from                     overall improvements in the nation’s health, but these have not always
medical records supplied by 199                    been achieved at a similar rate among all social groups or in all parts of
practices in England to the                        the country. The Government’s interest in health inequalities motivated
General Practice Research                          the inclusion of deprivation-based tables in Key Health Statistics from
Database between 1994 and                          General Practice 1998 2 (KHSGP98). Further articles have been
1998 were analysed using both                      published which expand on the data in this publication, including
deprivation indices. Inequalities                  investigations into the relationship between health and deprivation for
in health were quantified by                       specific diseases. 3–9
using correlation coefficients to
describe the association                           Deprivation is a multi-dimensional concept, operationalised using
between disease morbidity and                      proxy measures that are commonly combined to form an index, and
relative deprivation. In general,                  where income is often considered of prime concern.10 In general,
the same pattern of health                         deprivation indices ‘measure the proportion of households in a defined
inequalities exist using either                    small geographical unit with a combination of circumstances indicating
the Townsend Index or the Index                    low living standards or a high need for services, or both’.11
of Multiple Deprivation 2000.
The Townsend Index remains a                       Since the 1970s numerous measures of deprivation have been
reliable measure of health                         developed. Several have been used by the Government to help target its
inequalities when compared                         regeneration policies at the most deprived areas of the country. Some of
with the more recent and                           these have also been used to investigate inequalities in health. The
complex measure of deprivation                     indices have typically been based on census data and have been
(the Index of Multiple                             produced for all local authorities and wards in England. Indices of
Deprivation 2000).                                 deprivation were produced in 199112 and 1998,13 with the latest Index of
                                                   Multiple Deprivation being published in August 2000.14

                                                   KHSGP982 used the Townsend Index of deprivation as a measure of



               National Statistics   18
                                                                             Health Statistics Quar terly 18       Summer 2003




deprivation.15 This index measures multiple deprivation by area and the         medical records. GPs are not required to document every consultation,
score is calculated by combining four census variables from 1991; the           but should record all significant morbidity events. The
higher the score, the greater the level of relative deprivation. The            comprehensiveness and accuracy of the data recorded in the GPRD has
percentage of: i) residents over 16 and unemployed; ii) households with         been documented previously.21
one person (or over) per room; iii) households with no car; and iv)
households not owning their own home, contribute to the Townsend                Practices were included in this study if they were located in England,
Index score. This index has been widely used and is considered one of           they submitted data to the GPRD throughout the five-year period 1994
the best measures of deprivation available.                                     to 1998 and these data passed quality checks. The 199 practices
                                                                                selected had a total list size of about 1.15 million in 1998, representing
In December 1998 the Department of Social Policy and Social Work at             2.3 per cent of the population of England. The published GPRD
the University of Oxford was commissioned by the Department for the             population in KHSGP98 has a similar age-sex composition to that of
Environment, Transport and the Regions to review and update the 1998            England and Wales in 1998.2, 22
Index of Local Deprivation. The Index of Multiple Deprivation 200014
(IMD 2000) measures deprivation for every ward and local authority              Although the GPRD contains data for England and Wales, this study
area in England. It combines a number of indicators that cover a range          was limited to practices in England since the IMD 2000 is a measure
of domains into a single deprivation score for each area: Income;               for English wards. A similar methodology was used to produce an
Employment; Health and disability; Education, skills and training;              analogous index for Wales (the Welsh Index of Multiple Deprivation
Housing; and Geographical access to services. Improvements in                   2000) but the indices are not comparable since the constituent
availability of data and in the methodology mean that the new index             components are different.
measures multiple deprivation in a more sophisticated way than before.
As this index is readily available at ward level and contains more up-to-       Initially, the Townsend Index of deprivation was used to classify the
date elements than those measures that rely on 1991 Census data, it was         relative deprivation status of wards in England. Scores were calculated
considered appropriate for this comparison study.                               for each of the wards in England, and a score allocated to each general
                                                                                practice according to the ward in which it was located. Wards were
However, the use of the IMD 2000 was considered cautiously within               ranked by the deprivation score and divided into 5 quintiles, each
the remit of this study because health is one of the component domains          containing approximately 20 per cent of the population of England as
of the multiple measure. In a previous study that relied on the Jarman          estimated in 1991. A range of scores describes each of these deprivation
underprivileged area score as a proxy for deprivation, criticism was            quintiles which were labelled from the least deprived (Q1) to the most
levelled at the authors for using this measure to look at the effect of         deprived (Q5). This process was repeated using the IMD 2000 but using
deprivation on GP referral rates.16 Williams et al17 commented that a           1998 population estimates and wards.
correlation between Jarman score and referral rates was to be expected
as the Jarman score was originally developed to predict workloads in            Deprivation scores were allocated to an ordinal measure (quintiles) to
primary care. Since the Health deprivation and disability domain                ensure that practices could not be identified by their Townsend score as
contributes to the IMD 2000 multiple measure, some inherent                     this is widely available. Also, this study used practice-level Townsend
correlation will arise when evaluating disease morbidity and                    scores, so plotting disease morbidity at practice-level may be
deprivation. But the Health domain contribution is just 15 per cent and         misleading as it is possible that not all patients share the level of
results in a combined measure that is a valuable estimate of deprivation.       deprivation that the practice was allocated. Data were aggregated into
As the IMD 2000 consists of individual domain indices, the effect of            quintiles to provide an overall measure of health inequalities.
using just the Income and Employment domains (both are available at
ward level) was also evaluated.                                                 One of the aspects of the recent development in measuring deprivation
                                                                                is that each of the constituent domains of the IMD 2000 can be used to
Other studies have undertaken to review and compare different                   describe types of deprivation in an area. Using scores from the Income
deprivation indices. Carstairs and Morris18 reported a high degree of           domain and also the Employment domain, the same procedure
overlap when comparing the correlation coefficients between index               described previously was used to allocate practices to deprivation
scores but concluded that both the Townsend index and the Carstairs             quintiles, again using 1998 population and ward estimates. This
and Morris Scottish deprivation score19, 20 perform well as measures of         procedure was carried out to determine or negate any potential effect of
material deprivation in explaining variations in the true health                using the IMD 2000 scores that include the Health domain.
measures.
                                                                                The ten diseases examined in this study are those which were published
This study investigates the relationship between two measures of                in KHSGP98:2 coronary heart disease (CHD), stroke, hypertension,
material deprivation (the Townsend Index and the IMD 2000) and the              raised blood pressure, schizophrenia, depression, anxiety, insulin
prevalence of treated disease. This study is limited to comparing the           treated diabetes, non-insulin treated diabetes, and asthma. Patients are
Townsend index since it was used in KHSGP98.2 The aim of this article           included in prevalence analyses if they had been registered for at least
is to compare findings based on the Townsend Index, which draws on              six months within the year of study, in addition to diagnostic criteria,
only a few dimensions of deprivation, with the more recent IMD 2000,            treatment criteria or a combination of both.2
which attempts to capture six separate domains as a multiple measure
of deprivation. Data from 199 practices in England who contributed to           Directly age-standardised rates presented with lower and upper 95 per
the General Practice Research Database (GPRD) between 1994 and                  cent confidence intervals (LCL and UCL respectively) were calculated
1998 are used. As no socio-economic data were held about the patients           using data aggregated from 1994 to 1998 and the European standard
or their place of residence, this study relies on area-based indicators of      population.
deprivation for the area in which the practice was located.
                                                                                Since the same practices contributed data throughout the study period,
                                                                                the diseases under study are chronic and data here were aggregated over
METHOD
                                                                                five years, patients were often included in more than one year under
Practices contributing to the GPRD follow agreed guidelines for                 study. As a result, data loses independence and is therefore not viable to
recording clinical data and regularly submit anonymised, patient-based          test for trend. However, correlation coefficients are appropriate so the


                                                                                                            19    National Statistics
        Health Statistics Quar terly 18       Summer 2003




Pearson Product-Moment Correlation Coefficient was determined for                   Raised blood pressure
the relationship between disease prevalence and deprivation scores for
                                                                                    These data show that for males and females age-standardised
each quintile. The significance of this relationship was tested. Where
                                                                                    prevalence of raised blood pressure decreased with increasing
graphs are presented, the line of best fit has been applied to a
                                                                                    deprivation, irrespective of which index was used. None of the
scatterplot, based on the estimate of least squares.
                                                                                    correlation coefficients for these relationships were significant.
                                                                                    However, using the Townsend Index, prevalence of raised blood
RESULTS                                                                             pressure in the least deprived quintile was significantly higher than for
                                                                                    all other quintiles (Table 3a).
Table 1 shows the distribution of practices and patients by deprivation
category using both indices. Table 2 shows how the practices were re-
allocated to the IMD 2000 measure compared with the Townsend Index                  Schizophrenia
of deprivation.                                                                     Both males and females displayed a clear trend of increasing
                                                                                    schizophrenia prevalence with increasing deprivation. Although both
Age-standardised prevalence rates with associated 95 per cent                       measures showed a significant positive correlation, greater association
confidence intervals are presented in Table 3. Health inequalities for              was seen for males and females using the Townsend index (r=0.970 and
each disease are summarised below using the Townsend and IMD 2000                   r=0.984 respectively) than using the IMD 2000 (r=0.881 and r=0.874
indices.                                                                            respectively). Males in the most deprived quintile were around three
                                                                                    times as likely to suffer from schizophrenia as those in the least
Coronary heart disease                                                              deprived quintile, using either deprivation measure (Table 3b).
According to the data presented, there was a clear trend of increasing
prevalence of CHD with increasing deprivation. Table 3a shows that for              Depression
males there was a small increase in level and significance of this                  Strong significant correlations existed between the prevalence of
association using IMD 2000 (r=0.966, p<0.01) compared with the                      treated depression and deprivation for males (r=0.943) and females
Townsend index (r=0.941, p<0.05). The pattern was similar for females,              (r=0.964) using the Townsend index. Although the association was not
with the correlation coefficient for IMD 2000 again showing a slightly              significant using the IMD 2000 measure, prevalence of treated
greater association with deprivation quintile than that for Townsend                depression for both males and females was significantly higher in the
(r=0.967 and r=0.950 respectively).                                                 most deprived quintile compared to all other quintiles (Table 3b).

Stroke                                                                              Anxiety
The prevalence of stroke increased with increasing deprivation for both             Prevalence of treated anxiety increased significantly with increasing
males and females. The association was greater and only statistically               deprivation. The two indicators, Townsend and IMD 2000, gave similar
significant using IMD 2000 (p<0.05). But whichever index was used,                  results for both males and females. Both measures showed that the risk
females in the most deprived quintile were nearly fifty per cent more               of suffering from anxiety for persons in the most deprived quintile was
likely to have a stroke than females in the least deprived quintile (Table          approximately one and a half times greater than for those in the least
3a).                                                                                deprived quintile (Table 3b).

Hypertension                                                                        Insulin dependent diabetes
According to these data, there was no clear trend in the relationship               The relationship between insulin dependent diabetes and deprivation
between hypertension and deprivation for males. The association was                 was not consistent or significant for either males or females. For
not significant for either Townsend or IMD 2000 (although it should be              females in the most deprived quintile, prevalence of insulin dependent
noted that the association was stronger for IMD 2000 than Townsend).                diabetes was significantly greater than the overall prevalence (Table
Using IMD 2000, the prevalence in the most deprived quintile was                    3c).
significantly higher than for all other quintiles (Table 3a).




  Table 1              Distribution of practices and patients by deprivation category



                                                Townsend Deprivation Index                                     Index of Multiple Deprivation 2000

                                              Number of            1991                                           Number of            1998
                                 Number of     patients in     population of     Townsend         Number of        patient in      population of    DETR 2000
Deprivation category              practices   1998 (000s)     England (000s)    score range        practices      1998 (000s)     England (000s)    score range

Least deprived Q1                    25            144           9,628         -8.7682, -2.3318       29              166             9,905          1.16, 10.16
               Q2                    40            221           9,624         -2.3313, -0.5099       40              230             9,897         10.16, 16.83
               Q3                    42            277           9,635         -0.5094, 1.6865        42              252             9,906         16.83, 26.07
               Q4                    46            254           9,624          1.6874, 4.4178        35              188             9,896         26.07, 39.97
Most deprived Q5                     46            250           9,621          4.4209, 13.6820       53              309             9,899         40.05, 83.77

Total                             0z199         1,145           48,132                               199             1,145           49,501




                        National Statistics   20
                                                                                                       Health Statistics Quar terly 18               Summer 2003




 Table 2               Comparison of deprivation category assignments                                        Asthma
                                                                                                             The relationship between prevalence of treated asthma and deprivation
                                                                                                             was not consistent or significant for either males or females. Using the
                                                   IMD 2000                                                  IMD 2000, prevalence of treated asthma in the most deprived quintile
                       Least deprived                                   Most deprived                        was significantly higher than the overall prevalence for both males and
                            Q1        Q2           Q3          Q4            Q5       Total                  females (Table 3c).
Townsend Index
Least deprived Q1           14           9           1              0          1              25             IMD 2000 domains
               Q2           12          15          11              2          0              40
               Q3            2          14          21              4          1              42             To look at the contribution made by the different domains of the IMD
               Q4            1           1           9             23         12              46             2000, variations in prevalence were examined by the two domains that
Most deprived Q5             0           1           0              6         39              46             can be used independently (Employment and Income). Using the
Total                       29          40          42             35         53             199             Employment domain produced associations with disease prevalence
                                                                                                             that displayed the same trends as the IMD 2000 (data not shown).
                                                                                                             Although the magnitude and significance of these relationships varied
                                                                                                             slightly, there was no converse trend identified in health inequalities.
Non-insulin dependent diabetes                                                                               The Income domain produced the same relationships as the IMD 2000
                                                                                                             except for the inequality in prevalence of hypertension in males (data
Increasing prevalence of non-insulin dependent diabetes was associated                                       not shown). There was a weak negative association using the Income
with increasing deprivation, at a significant level for both Townsend                                        domain, compared with a weak positive association using the IMD
and IMD 2000. Figures 1a and b show the strength of this association,                                        2000 (neither was statistically significant).
which remained significant using either deprivation measure. The risk
of non-insulin dependent diabetes was about one third higher for males
in the most deprived quintile compared with the least deprived, using
both deprivation indices (Table 3c).




Table 3a               Age-standardised prevalence of heart disease and associated risk factors per 1,000, by sex and deprivation, 1994–98


 England
                                 Coronary heart disease                                   Stroke                                Hypertension                       Raised blood pressure

                           Townsend              IMD 2000                 Townsend                   IMD 2000          Townsend            IMD 2000            Townsend            IMD 2000
                         ASR (LCL, UCL)        ASR (LCL, UCL)           ASR (LCL, UCL)             ASR (LCL, UCL)    ASR (LCL, UCL)      ASR (LCL, UCL)      ASR (LCL, UCL)      ASR (LCL, UCL)

Males
Least deprived Q1        31.1 (30.6, 31.6)     29.5 (29.0, 30.0)         1.7 (1.6, 1.9)             1.5 (1.4, 1.7)   57.5 (56.8, 58.2)   55.2 (54.6, 55.8)   33.9 (33.3, 34.4)   30.9 (30.4, 31.4)
               Q2        33.9 (33.5, 34.4)     31.6 (31.2, 32.1)         1.9 (1.8, 2.0)             1.8 (1.7, 1.9)   55.8 (55.2, 56.3)   54.7 (54.1, 55.3)   26.5 (26.0, 26.9)   31.5 (31.0, 31.9)
               Q3        34.6 (34.2, 35.0)     36.8 (36.3, 37.2)         1.9 (1.8, 2.0)             2.1 (2.0, 2.2)   54.2 (53.7, 54.7)   55.7 (55.1, 56.2)   28.6 (28.2, 29.0)   27.1 (26.7, 27.5)
               Q4        35.7 (35.2, 36.1)     36.5 (36.0, 37.0)         2.0 (1.9, 2.1)             2.0 (1.8, 2.1)   54.7 (54.2, 55.2)   54.5 (53.9, 55.1)   28.7 (28.3, 29.1)   27.9 (27.4, 28.4)
Most deprived Q5         41.0 (40.5, 41.5)     40.5 (40.0, 40.9)         2.7 (2.6, 2.8)             2.7 (2.5, 2.8)   56.8 (56.2, 57.4)   57.2 (56.7, 57.7)   27.7 (27.3, 28.2)   27.2 (26.8, 27.6)
             Total       35.5 (35.3, 35.7)     35.5 (35.3, 35.7)         2.1 (2.0, 2.1)             2.1 (2.0, 2.1)   55.6 (55.3, 55.8)   55.6 (55.3, 55.8)   28.7 (28.5, 28.9)   28.7 (28.5, 28.9)

         Correlation        r=0.941*              r=0.966**                r=0.863                    r=0.926*          r=-0.286               r=0.557          r=-0.569            r=-0.822

Females
Least deprived Q1        17.4 (17.0, 17.8)     15.9 (15.6, 16.3)         1.3 (1.2, 1.4)             1.3 (1.2, 1.4)   67.2 (66.5, 67.9)   63.3 (62.7, 64.0)   41.4 (40.8, 42.0)   37.5 (37.0, 38.1)
               Q2        18.9 (18.6, 19.2)     18.1 (17.8, 18.4)         1.5 (1.4, 1.6)             1.3 (1.2, 1.4)   63.8 (63.3, 64.4)   64.6 (64.0, 65.2)   31.4 (31.0, 31.8)   38.7 (38.2, 39.1)
               Q3        20.8 (20.5, 21.1)     21.8 (21.5, 22.1)         1.5 (1.4, 1.5)             1.6 (1.5, 1.7)   64.7 (64.2, 65.2)   65.7 (65.2, 66.2)   35.3 (34.9, 35.7)   32.3 (31.9, 32.7)
               Q4        21.4 (21.1, 21.7)     21.5 (21.1, 21.9)         1.5 (1.4, 1.6)             1.5 (1.4, 1.6)   65.9 (65.3, 66.4)   64.9 (64.2, 65.5)   36.7 (36.2, 37.1)   35.3 (34.8, 35.8)
Most deprived Q5         26.1 (25.7, 26.5)     25.7 (25.4, 26.1)         1.9 (1.8, 2.0)             1.9 (1.8, 2.0)   68.7 (68.1, 69.3)   69.4 (68.8, 69.9)   34.5 (34.0, 35.0)   34.8 (34.4, 35.2)
             Total       21.1 (20.9, 21.2)     21.1 (20.9, 21.2)         1.5 (1.5, 1.6)             1.5 (1.5, 1.6)   65.8 (65.6, 66.1)   65.8 (65.6, 66.1)   35.4 (35.2, 35.6)   35.4 (35.2, 35.6)

         Correlation        r=0.950*              r=0.967**                r=0.866                    r=0.889*           r=0.413               r=0.858          r=-0.368            r=-0.548

*    significant at p<0.05
** significant at p<0.01
ASR = Age-standardised rate.
LCL = Lower confidence limit of age-standardised rate.
UCL = Upper confidence limit of age-standardised rate.
Source: General Practice Research Database




                                                                                                                                               21   National Statistics
      Health Statistics Quar terly 18                     Summer 2003




 Table 3b                Age-standardised prevalence of mental health disorders per 1,000, by sex and deprivation, 1994–98


England
                                              Schizophrenia                                           Depression                                           Anxiety

                              Townsend                      IMD 2000               Townsend                          IMD 2000            Townsend                      IMD 2000
                            ASR (LCL, UCL)                ASR (LCL, UCL)         ASR (LCL, UCL)                    ASR (LCL, UCL)      ASR (LCL, UCL)                ASR (LCL, UCL)

Males
Least deprived Q1            1.0 (0.9, 1.1)                    1.1 (1.0, 1.2)    22.2 (21.8, 22.7)                 20.7 (20.3, 21.2)   17.8 (17.3, 18.2)             16.0 (15.6, 16.4)
               Q2            1.4 (1.3, 1.5)                    1.3 (1.2, 1.4)    23.7 (23.3, 24.1)                 20.6 (20.3, 21.0)   17.5 (17.2, 17.9)             16.5 (16.2, 16.8)
               Q3            2.1 (2.0, 2.2)                    2.4 (2.3, 2.6)    23.6 (23.2, 24.0)                 26.4 (26.0, 26.8)   20.1 (19.8, 20.4)             21.1 (20.7, 21.5)
               Q4            2.1 (2.0, 2.2)                    1.9 (1.8, 2.0)    25.7 (25.3, 26.1)                 23.8 (23.3, 24.2)   21.9 (21.6, 22.3)             21.1 (20.6, 21.5)
Most deprived Q5             3.0 (2.8, 3.1)                    2.8 (2.6, 2.9)    28.6 (28.2, 29.1)                 30.4 (30.0, 30.8)   25.5 (25.1, 25.9)             26.6 (26.2, 27.0)
             Total           2.0 (1.9, 2.0)                    2.0 (1.9, 2.0)    24.9 (24.8, 25.1)                 24.9 (24.8, 25.1)   20.8 (20.6, 21.0)             20.8 (20.6, 21.0)

        Correlation           r=0.970**                         r=0.881*             r=0.943*                            r=0.864          r=0.951*                      r=0.949*

Females
Least deprived Q1            1.1 (1.0, 1.3)                    0.9 (0.8, 1.0)    54.8 (54.0, 55.5)                 51.6 (50.9, 52.3)   39.2 (38.6, 39.8)             37.0 (36.4, 37.5)
               Q2            1.2 (1.1, 1.3)                    1.3 (1.2, 1.4)    58.6 (58.0, 59.3)                 53.3 (52.7, 53.9)   41.3 (40.8, 41.8)             39.0 (38.5, 39.5)
               Q3            1.7 (1.6, 1.8)                    2.0 (1.9, 2.1)    60.1 (59.5, 60.6)                 64.9 (64.3, 65.5)   48.6 (48.1, 49.1)             49.8 (49.2, 50.3)
               Q4            1.9 (1.8, 2.1)                    1.6 (1.5, 1.7)    62.4 (61.8, 63.0)                 57.2 (56.5, 57.8)   49.4 (48.9, 49.9)             47.9 (47.3, 48.6)
Most deprived Q5             2.3 (2.1, 2.4)                    2.2 (2.1, 2.3)    69.3 (68.6, 69.9)                 73.6 (73.0, 74.2)   58.1 (57.5, 58.7)             60.3 (59.8, 60.9)
             Total           1.7 (1.6, 1.7)                    1.7 (1.6, 1.7)    61.4 (61.1, 61.7)                 61.4 (61.1, 61.7)   47.9 (47.7, 48.2)             47.9 (47.7, 48.2)

        Correlation           r=0.984**                          r=0.874            r=0.964**                            r=0.831          r=0.969**                     r=0.939*

*    significant at p<0.05
** significant at p<0.01
ASR = Age-standardised rate.
LCL = Lower confidence limit of age-standardised rate.
UCL = Upper confidence limit of age-standardised rate.
Source: General Practice Research Database




 Table 3c                Age-standardised prevalence of diabetes and asthma per 1,000, by sex and deprivation, 1994–98


 England
                                      Insulin dependent diabetes                          Non-insulin dependent diabetes                                   Asthma

                              Townsend                          IMD 2000            Townsend                          IMD 2000           Townsend                      IMD 2000
                            ASR (LCL, UCL)                    ASR (LCL, UCL)      ASR (LCL, UCL)                    ASR (LCL, UCL)     ASR (LCL, UCL)                ASR (LCL, UCL)

Males
Least deprived Q1             5.0 (4.7, 5.2)                   4.9 (4.7, 5.1)     8.6.(8.3, 8.9)                 8.5 (8.2, 8.8)        70.3 (69.4, 71.2)             66.6 (65.8, 67.4)
               Q2             4.9 (4.8, 5.1)                   4.6 (4.4, 4.8)     9.1 (8.8, 9.3)                 8.8 (8.6, 9.1)        69.8 (69.0, 70.5)             70.7 (70.0, 71.4)
               Q3             4.9 (4.7, 5.1)                   5.5 (5.3, 5.6)     9.5 (9.2, 9.7)                 9.7 (9.5, 9.9)        71.5 (70.9, 72.2)             71.8 (71.1, 72.5)
               Q4             5.4 (5.2, 5.5)                   4.7 (4.5, 4.9)     9.8 (9.6,10.1)               10.0 (9.7, 10.3)        70.5 (69.8, 71.2)             68.5 (67.7, 69.2)
Most deprived Q5              5.0 (4.8, 5.2)                   5.3 (5.1, 5.4)   11.8 (11.5,12.1)              11.4 (11.1, 11.6)        69.8 (69.2, 70.5)             72.5 (71.9, 73.1)
             Total            5.0 (4.9, 5.1)                   5.0 (4.9, 5.1)     9.8 (9.7, 9.9)                 9.8 (9.7, 9.9)        70.4 (70.1, 70.7)             70.4 (70.1, 70.7)

           Correlation          r=0.381                           r=0.367            r=0.916*                            r=0.968**         r=-0.068                       r=0.622

Females
Least deprived Q1             4.3 (4.1, 4.5)                   3.8 (3.6, 4.0)      5.0   (4.8, 5.2)                5.3   (5.1, 5.5)    69.2 (68.3, 70.1)             64.5 (63.7, 65.3)
               Q2             4.0 (3.9, 4.2)                   4.5 (4.3, 4.7)      6.6   (6.4, 6.8)                6.2   (6.0, 6.4)    70.8 (70.1, 71.6)             75.2 (74.5, 76.0)
               Q3             4.6 (4.5, 4.8)                   4.6 (4.4, 4.8)      7.0   (6.9, 7.2)                7.0   (6.9, 7.2)    75.3 (74.6, 76.0)             74.4 (73.7, 75.1)
               Q4             4.8 (4.6, 4.9)                   4.5 (4.3, 4.7)      7.3   (7.1, 7.5)                7.5   (7.3, 7.8)    72.8 (72.1, 73.5)             68.2 (67.4, 69.0)
Most deprived Q5              4.8 (4.6, 4.9)                   4.9 (4.7, 5.1)      9.1   (8.9, 9.3)                8.8   (8.6, 9.1)    74.0 (73.3, 74.7)             77.0 (76.4, 77.6)
             Total            4.5 (4.4, 4.6)                   4.5 (4.4, 4.6)      7.1   (7.0, 7.2)                7.1   (7.0, 7.2)    72.6 (72.3, 72.9)             72.6 (72.3, 72.9)

           Correlation          r=0.822                           r=0.862                r=0.956*                        r=0.991**          r=0.750                       r=0.539

*    significant at p<0.05
** significant at p<0.01
ASR = Age-standardised rate.
LCL = Lower confidence limit of age-standardised rate.
UCL = Upper confidence limit of age-standardised rate.
Source: General Practice Research Database




                          National Statistics             22
                                                                            Health Statistics Quar terly 18           Summer 2003




 Figure 1a         Relationship between age-standardised prevalence              Figure 1b        Relationship between age-standardised prevalence
                   of treated non-insulin dependent diabetes and                                  of treated non-insulin dependent diabetes and
                   deprivation quintile in males, 1994–98                                         deprivation quintile in females, 1994–98

  Rate per 1,000                                                                Rate per 1,000
 12.0                                                                           12.0
                                                                  J
                    B       IMD 2000                                                              B      IMD 2000
 11.5
                                                                  B              11.0
                    J       Townsend                                                              J      Townsend
 11.0                                                                            10.0


                                                                                                                                                  J
 10.5                                                                             9.0
                                                                                                                                                  B
 10.0                                                  B                          8.0
                                               B       J                                                                               B
                                               J                                                                                       J
  9.5                                                                             7.0                                   J
                                                                                                                        B
                                                                                                       J
  9.0
                          J                                                       6.0
                                                                                                       B
                          B
        J
        B                                                                               B
  8.5                                                                             5.0   J
  8.0                                                                             4.0
       Q1               Q2                Q3           Q4        Q5                    Q1             Q2               Q3              Q4        Q5
 Least deprived                                             Most deprived        Least deprived                                             Most deprived
                                Deprivation quintile                                                            Deprivation quintile
 Source: General Practice Research Database.                                     Source: General Practice Research Database.




DISCUSSION                                                                     explain the association with hypertension in males. Since there was
                                                                               only one discrepancy, the IMD 2000 was determined a sufficient
In summary, the complex and methodologically refined IMD 2000                  summary measure of deprivation within this study. It was not possible
provides evidence of the same pattern of health inequalities as those          to directly correlate these measures with the IMD 2000 as both the
defined by the Townsend Index of deprivation.                                  Employment and Income domains each constitute 25 per cent of that
                                                                               index, which means there would be inherent correlation.
Eight of the ten diseases under study display the same relationship
between prevalence and deprivation using the IMD 2000 compared                 Correlating data was determined as the most appropriate method to
with the Townsend index for both males and females. Those diseases             compare the effect of using two different deprivation measures on the
with a strong, positive correlation are CHD, stroke, schizophrenia,            relationship between disease morbidity and deprivation quintile (which
depression, anxiety, insulin dependent diabetes and non-insulin                can be approximated to an interval variable). The strength of this
dependent diabetes. Of these, the relationships for CHD, schizophrenia,        statistical method is that it provides a measure of association and also
anxiety and non-insulin dependent diabetes are statistically significant       includes hypothesis testing. Since the assignment of deprivation scores
when either deprivation measure is applied. There is a strong but              to patient data are necessarily crude since only practice-level
negative association between raised blood pressure and deprivation             information was available, and also the method of allocation practices
using both deprivation measures; prevalence of raised blood pressure           to deprivation quintiles was based on population estimates, it was
decreases with increasing deprivation.                                         important to use a test which would simply describe any positive or
                                                                               negative associations, and which would also test for the significance of
Age-standardised prevalence of hypertension and asthma in females              any linear relationship that existed.
also increases with increasing deprivation, but not significantly.
However, there is no clear trend between hypertension or asthma and            In this study, the main difference between the different deprivation
deprivation in males. Using Townsend scores, the association is small          measures was how the practices are allocated to a deprivation quintile.
but negative, suggesting that prevalence decreases with increasing             The methods used were identical and looking at the distribution of
deprivation. However, using the IMD 2000 measure, the association is           practices within quintiles according to deprivation index, the majority
reversed, and it appears that prevalence of both hypertension and              remains within the same quintile. When a number of practices do
asthma in males increases with increasing deprivation, although not at a       change quintile, there is an approximately equivalent reciprocal
statistically significant level. It is not clear whether this altered          movement, except for a disproportionate amount of practices allocated
relationship is due to the IMD 2000 picking up risk factors for these          to the most deprived quintile according to the IMD 2000.
diseases more successfully than previous measures. Part of the
Geographical access to services domain does include information on             The IMD 2000 was developed in order to identify areas with high
access to a GP however, so this may have an overall influence on               deprivation. In order to ensure it included all these areas, it is possible
describing these health inequalities.                                          that the index has a relatively low threshold for severely deprived areas.
                                                                               It could also be possible that the IMD 2000 identifies higher levels of
As described, using the Employment and Income domains produced                 deprivation in rural areas than other commonly used indices, owing to
similar relationships between health and deprivation for all diseases          the use of a wide range of social and material indicators (including
compared with the IMD 2000, except when using the Income domain to             Geographical access to services). These may explain in part why
                                                                               slightly more practices are in the lowest quintile.


                                                                                                               23    National Statistics
    Health Statistics Quar terly 18       Summer 2003




However, some differences in allocation of practices to quintiles were     5. Hoare J, Bruce M and Majeed A (2003) Prevalence and
expected using the two measures in this study. In particular, areas may        management of asthma in general practice in England and Wales,
have changed in the time period since the Townsend index was                   1994 to 1998. Health Statistics Quarterly 17, 15–22.
developed and have a different level of measurable deprivation. Also,      6. Kang J, Tinto A, Higham J and Majeed A (2002) Peptic ulceration
some ward boundaries have been redefined, so practices may be                  in general practice in England and Wales 1994–98: period
assigned to a different ward.                                                  prevalence and drug management. Alimentary Pharmacology &
                                                                               Therapeutics 16(6), 1067–74 .
In general, it would seem that the same pattern of health inequalities     7. Purcell B, Gaitatzis A, Sander J W and Majeed A (2002) Epilepsy
exist when using either the Townsend score or a deprivation measure            prevalence and prescribing patterns in England and Wales. Health
based on multiple domains (IMD 2000). The relevance of the Townsend            Statistics Quarterly 15, 23–30.
index to this data from 1994 to 1998 remains intact. However, once         8. Ryan R and Majeed A (2002) Prevalence of treated hypertension in
Census 2001 data become available, the Index of Multiple Deprivation           general practice in England and Wales, 1994 to 1998. Health
will be updated and its relevance to disease prevalence in the 21st            Statistics Quarterly 16, 14-18.
Century will need to be investigated. This study provides a baseline for   9. Ryan R and Majeed A (2001) Prevalence of ischaemic heart disease
comparison with the 1990s.                                                     and its management with statins and aspirin in general practice in
                                                                               England and Wales, 1994 and 1998. Health Statistics Quarterly 12,
                                                                               34–39.
                                                                           10. Payne G, Payne J and Hyde M (1996) Refuse of all classes? Social
     Key points                                                                indicators and social deprivation. Sociological Research Online
                                                                               1(1), http:\www.socresonline.org.uk/socresonline/1/1/3.html
      q   Age-standardised prevalence of coronary heart                        (verified April 2003).
          disease, schizophrenia, anxiety and non-insulin                  11. Bartley M and Blane D (1994) Appropriateness of deprivation
          dependent diabetes increased significantly with                      indices must be ensured. BMJ 309, 1479.
          increasing deprivation. This relationship existed                12. Department of the Environment (1991) 1991 Index of Local
          when using both the Townsend Index of deprivation                    Conditions, HMSO: London.
          and the Index of Multiple Deprivation 2000.                      13. Office of the Deputy Prime Minister (1998) 1998 Index of Local
      q   Age-standardised prevalence of depression                            Deprivation. Regeneration Research Summary No.15. HMSO:
          increased significantly with increasing deprivation                  London, http://www.urban.odpm.gov.uk/research/98ild/index.htm
          using the Townsend Index of deprivation, and                         (verified April 2003).
          prevalence of stroke increased significantly with                14. Department for the Environment, Transport and the Regions (2000)
          increasing deprivation using the Index of Multiple                   Indices of Deprivation 2000. Regeneration Research Summary
          Deprivation 2000.                                                    No.31, HMSO: London, http://www.urban.odpm.gov.uk/research/
      q   There was no significant trend in age-standardised                   summaries/03100/pdf/rrs03100.pdf (verified April 2003).
          prevalence of hypertension, raised blood pressure,               15. Townsend P, Phillimore P, and Beattie A (1988) Health and
          insulin dependent diabetes or asthma using either                    deprivation: inequality and the North. Croom Helm: London.
          the Townsend Index of deprivation or the Index of                16. Hippisley-Cox J, Hardy C, Pringle M, Fielding K, Carlisle R and
          Multiple Deprivation 2000.                                           Chilvers C (1997) The effect of deprivation on variations in general
      q   In general, the same pattern of health inequalities                  practitioners’ referral rates: a cross-sectional study of computerised
          exist using either the Townsend Index or a                           data on new medical and surgical outpatient referrals in
          deprivation measure based on multiple domains (the                   Nottinghamshire. BMJ 314, 1458–61.
          Index of Multiple Deprivation 2000).                             17. Williams T, Jackson A and Turbitt D (1997) Letter: Effect of
                                                                               deprivation on general practitioners’ referral rates. BMJ 315, 882–3.
                                                                           18. Carstairs V and Morris R (1991) Which deprivation index? A
ACKNOWLEDGEMENTS                                                               comparison of selected deprivation indexes. Journal of Public
                                                                               Health Medicine 13(4), 318–26.
I would like to acknowledge the work of David Dix in extracting and        19. Carstairs V and Morris R (1989) Deprivation and mortality: an
categorising data and also Cathy Hodgson and Sue Davies for their              alternative to social class? Community Med 11, 210–9.
advice.                                                                    20. Carstairs V and Morris R (1989) Deprivation: explaining difference
                                                                               in mortality between Scotland and England and Wales. BMJ 299,
REFERENCES                                                                     886–90.
                                                                           21. Hollowell J (1997) The General Practice Research Database:
1. Department of Health (1999). Saving Lives: Our Healthier Nation.            quality of morbidity data. Population Trends 87, 36–40.
   White Paper. The Stationery Office. http://www.archive.official-        22. Lawson D H, Sherman V and Hollowell J (1998) The General
   documents.co.uk/document/cm43/4386/4386.htm (verified April                 Practice Research Database. Quarterly Journal of Medicine 91,
   2003).                                                                      445–52.
2. Office for National Statistics (2000) Key Health Statistics from
   General Practice 1998. Series MB6 No.2, HMSO: London.
3. Moser K (2001) Inequalities in treated heart disease and mental
   illness in England and Wales, 1994–1998. British Journal of
   General Practice 51, 438–44.
4. Bailey K, Ellis C and Majeed A (2002) Trends in the treatment of
   osteoporosis and types of drug treatments prescribed in general
   practice in England and Wales, 1994 to 1998. Health Statistics
   Quarterly 16, 5–13.




                  National Statistics     24
                                                                           Health Statistics Quar terly 18   Summer 2003




Implications for vital statistics
of the change from SOC90
to SOC2000 occupation
coding

                                                                                                              Angela Donkin and Nanette
                                                                                                              Daniels,
                                                                                                              Office for National Statistics




INTRODUCTION                                                                                                  This article summarises the
                                                                                                              effect on vital statistics of the
Revision of the Standard Occupational Classification (SOC) takes place                                        change in 2001 in the Standard
at decennial intervals, and the latest version – SOC20001 ,2 – was                                            Occupational Classification from
introduced in 2001. SOC2000 replaced the previous version of the                                              SOC90 to SOC2000. Two dual
occupational classification, referred to as SOC90,3 which had been in                                         coded data sets were analysed:
use since 1991. The main features of the revision of SOC90 to                                                 births in 2001, and deaths from
SOC2000 include: a tighter definition of managerial occupations;                                              1st January to 30th June 2001, for
expansion in the field of computing and related occupations; the                                              England and Wales. Overall, 80
introduction of specific occupations associated with the environment                                          per cent of deaths and 75 per
and conservation; changes linked to the up-grading of skills but the de-                                      cent of births were allocated to
skilling of manufacturing processes; and the recognition of the                                               the equivalent SOC90 and
development of customer service occupations and the emergence of                                              SOC2000 major group. However,
remote service provision through the operation of call centres. Most of                                       the number of events allocated
the major groups of occupations were renamed, and the composition of                                          to the equivalent major group
all major groups changed.4                                                                                    varied considerably depending
                                                                                                              on the major group, the
A change in occupational classification also impacts on interrelated                                          direction of comparison (from
classification systems, such as the National Statistics Socio-Economic                                        SOC90 to SOC2000 or vice
Classification (NS SEC).5 An article in Population Trends 107                                                 versa), the data source and the
described the degree to which changes in occupation and employment                                            sex of the individual.
status coding in 2001 influenced comparability between NS SEC (based
on SOC2000) and NS SEC90 (an approximation of NS SEC based on
SOC90) in deaths data.6 A subsequent short report repeated the analysis
for births and infant deaths.7 The analysis of dual coded data for 2001
showed that 9 per cent of deaths and 16 per cent of births were assigned
to different NS SEC and NS SEC90 categories due to the influence of
the change in the occupational classification. The percentage agreement
varied according to sex, age and NS SEC class, and was particularly
low for those in managerial and professional occupations. Further
mismatching occurred due to changes in employment status coding.



                                                                                                       25    National Statistics
     Health Statistics Quar terly 18                   Summer 2003




This article reports on a detailed investigation into the relationship                       The number of births and deaths that were coded to the equivalent
between SOC90 and SOC2000 codes on two dual coded data sets:                                 SOC90 and SOC2000 code are expressed as percentages. A percentage
deaths by occupation, 2001, and births by father’s occupation, 2001, for                     of 80% means that 80 out of a hundred deaths or births are allocated to
England and Wales. This has two purposes. Firstly, it provides                               the equivalent SOC90 and SOC2000 code. The percentage of cases
background information for the interpretation of changes over time in                        assigned to the equivalent SOC90 or SOC2000 code differs according
occupational health. Secondly, it provides additional information to                         to the direction of comparison (SOC90 to SOC2000 or SOC2000 to
help understand differences in allocation to NS SEC and NS SEC90, for                        SOC90), reflecting the different sizes of the groups in each version of
the analysis of time trends in socio-economic inequalities in mortality                      the classification.
and fertility.
                                                                                             COMPARABILITY
METHODS                                                                                      Tables 1a and 1b contain two sets of figures for deaths and births
                                                                                             respectively. In each table, the first column of figures shows the
SOC90 has 9 major groups, 22 sub-major groups, 77 minor groups and
                                                                                             percentage of births or deaths allocated to each SOC2000 major group
371 unit groups. SOC2000 has 9 major groups, 25 sub-major groups, 81
                                                                                             that were previously allocated to the equivalent SOC90 major group. The
minor groups and 353 unit groups. The two classification systems differ
                                                                                             second column shows the percentage of births or deaths allocated to a
in structure and group definition so no exact correspondence exists.
                                                                                             SOC90 major group that have been allocated to the equivalent SOC2000
It is important to note that a SOC2000 major group that bears the same
                                                                                             major group. SOC2000 composition in terms of SOC90 is illustrated in
title as a SOC90 major group is not necessarily composed of the same
                                                                                             Figure 1a for deaths and Figure 1b for births. SOC90 composition in
occupations.                                                                                 terms of SOC2000 is illustrated in Figure 2a for deaths and 2b for births.

In order to examine the effect of the change from SOC90 to SOC2000,                          The overall agreement percentage between SOC90 and SOC2000 for all
a sample of deaths registered between 1st January and 30th June 2001,                        major groups was 79.5 per cent for deaths and 75.4 per cent for births.
and all births registered in 2001 and coded for occupation, were                             That is, SOC90 and SOC2000 classified approximately 80 out of every
analysed. For death registrations, occupation is coded where the age of                      100 deaths and 75 out of every 100 births to the equivalent (same
the deceased is less than 75 years. A 10 per cent sample of birth                            numbered) major group. Agreement varied by major group: for example
registrations is coded. Coding is carried out clerically. The 2001 data                      only 13 per cent of births classified to SOC90 major group 6 were also
were coded to SOC2000 throughout the year, in the course of routine                          classified to SOC2000 major group 6 (Table 1b last column), while 63
processing. Coding to SOC90 was added subsequently, by substantially                         per cent of births classified to SOC2000 major group 6 were classified
the same group of coders. The main analysis for births used the father’s                     to SOC90 major group 6 (Personal and Protective Occupations)
occupation, but comparisons were made between the coding of father’s                         (previous column). The other births had, in the main, been categorised
and mother’s occupation to highlight specific differences by sex in                          to SOC90 major groups 1 (Managers and Administrators) and 3
comparability between SOC90 and SOC2000.                                                     (Associate Professional and Technical Occupations).

Table 1a            SOC major group comparability, analyses of deaths, 2001



SOC2000 Major Group                                         SOC90 Major Group                                 Percentage of deaths in          Percentage of deaths in
                                                                                                              SOC2000 major group               SOC90 major group
                                                                                                              allocated to equivalent          allocated to equivalent
                                                                                                               SOC90 major group               SOC2000 major group
1   Managers and Senior Officials                           1   Managers and Administrators                            92.0                              75.0
2   Professional Occupations                                2   Professional Occupations                               86.8                              93.8
3   Associate Professional and Technical Occupations        3   Associate Professional and Technical                   59.5                              78.3
4   Administrative and Secretarial Occupations              4   Clerical and Secretarial Occupations                   89.8                              78.8
5   Skilled Trades Occupations                              5   Craft and Related Occupations                          84.4                              88.3
6   Personal Service Occupations                            6   Personal and Protective Occupations                    82.4                              42.9
7   Sales and Customer Service Occupations                  7   Selling Occupations                                    87.6                              70.5
8   Process, Plant and Machine Operatives                   8   Plant and Machine Operatives                           76.5                              87.0
9   Elementary Occupations                                  9   Other Occupations                                      67.4                              84.8



Table 1b            SOC major group comparability, analyses of births, 2001



SOC2000 Major Group                                         SOC90 Major Group                                 Percentage of births in           Percentage of births in
                                                                                                              SOC2000 major group                SOC90 major group
                                                                                                              allocated to equivalent           allocated to equivalent
                                                                                                               SOC90 major group                SOC2000 major group
1   Managers and Senior Officials                           1   Managers and Administrators                            94.1                              81.4
2   Professional Occupations                                2   Professional Occupations                               75.7                              90.1
3   Associate Professional and Technical Occupations        3   Associate Professional and Technical                   47.0                              64.8
4   Administrative and Secretarial Occupations              4   Clerical and Secretarial Occupations                   77.4                              51.5
5   Skilled Trades Occupations                              5   Craft and Related Occupations                          83.1                              90.1
6   Personal Service Occupations                            6   Personal and Protective Occupations                    63.0                              12.7
7   Sales and Customer Service Occupations                  7   Selling Occupations                                    78.5                              55.6
8   Process, Plant and Machine Operatives                   8   Plant and Machine Operatives                           82.3                              86.0
9   Elementary Occupations                                  9   Other Occupations                                      53.7                              86.8




                      National Statistics              26
                                                                                  Health Statistics Quar terly 18             Summer 2003




Figures 1a and 1b show, for deaths and births respectively, the                      SOC90 major group, while the shading of the bar segments indicates
proportion of events in each SOC2000 major group and their allocation                the SOC2000 major group. For example, in Figure 2a the first bar
to each SOC90 major group. The height of each bar shows the                          represents the composition of SOC90 major group 1 (Managers and
percentage of all events in the relevant SOC2000 major group; the                    Administrators). 75 per cent of deaths classified to SOC90 major group
largest number of both deaths and births were in major group 5 (Skilled              1 were also classified to SOC2000 major group 1 (Managers and Senior
Trades Occupations). The shading of the bar segments indicates the                   Officials), as indicated by the dark green portion of the bar. It is also
SOC90 major group; thus for both deaths and births the majority of                   possible to see that deaths, now assigned to SOC2000 major group 1,
events in SOC2000 major group 5 were also in SOC90 major group 5                     were formerly distributed in significant numbers to other SOC90 major
(Craft and Related Occupations) – light green shading - but some                     groups. A significant number of deaths previously allocated to SOC90
events in this SOC90 major group were in SOC2000 groups 8, 2 and 9.                  major groups 1, 3, 6, and 7 have been reassigned to SOC2000 major
                                                                                     group 1, as shown by the dark green segments of each of these bars.
Ninety-two per cent of deaths and 94 per cent of births classified to
SOC2000 major group 1 (Managers and Senior Officials) were                           The percentages of SOC2000 births previously assigned to the
previously classified to SOC90 major group 1 (Managers and                           equivalent SOC90 major group were generally lower than for deaths.
Administrators), as indicated by the dark green segment of the first bar             However there was a close resemblance in the way in which ‘non-
in both figures. It is also possible to see that births and deaths                   matching’ births and deaths – those not allocated to the corresponding
previously assigned to SOC90 major group 1 were redistributed, in                    SOC90 major group – were previously distributed under SOC90. For
significant numbers, to many other SOC2000 major groups. SOC2000                     example, the non-matching births under SOC2000 major group 1
major groups 1, 3, 4, 5, and 6 all received a significant number of                  (Managers and Senior Officials) had, in the main, previously been
events from SOC90 major group 1, as shown by the dark green                          classified to the equivalent SOC90 major groups (3, 6 and 7) as those
segments of each of these bars. In contrast, deaths previously allocated             non-matching deaths under SOC2000 major group 1.
to SOC90 major group 2 (Professional Occupations) were only
distributed in significant numbers to SOC2000 major groups 2 and 3.                  The difference in the percentage comparability between SOC90 to
                                                                                     SOC2000, and SOC2000 to SOC90, is due to the difference in the total
Figures 2a and 2b are similar to the preceding figures, but show, for                number of deaths allocated to major group 1 under SOC90 and SOC2000.
deaths and births respectively, the proportion of events in each SOC90               In total 8,073 deaths were assigned to SOC2000 major group 1, in contrast
major group and their allocation to each SOC2000 major group. The                    to 9,894 deaths assigned to SOC90 major group 1, while 7,424 deaths were
height of each bar shows the percentage of all events in the relevant                allocated to major group 1 in both SOC90 and SOC2000.


 Figure 1a            Percentage of deaths classified to each                          Figure 1b          Percentage of births classified to each
                      combination of SOC2000 and SOC90 major                                              combination of SOC2000 and SOC90 major
                      groups: showing SOC90 figures within SOC2000                                        groups: showing SOC90 figures within SOC2000
                      totals                                                                              totals

 England and Wales                                                                     England and Wales
 Percentage of all deaths                                                              Percentage of all births

 25                                                                                    25




 20                                                                                    20




 15                                                                                    15




 10                                                                                    10




  5                                                                                     5




  0                                                                                     0
         1        2       3     4     5      6         7      8       9                         1       2        3     4     5      6          7         8        9
                              SOC2000 major group                                                                    SOC2000 major group

      SOC90 Major Group                                                                     SOC90 Major Group
      1 Managers and                  5 Craft and related         9 Other                   1 Managers and                    5 Craft and related            9 Other
        administrators                  occupations                 occupations               administrators                    occupations                    occupations
      2 Professional occupations      6 Personal and                                        2 Professional occupations        6 Personal and
                                        protective occupations                                                                  protective occupations
      3 Associate professional and    7 Selling occupations                                 3 Associate professional and      7 Selling occupations
        technical occupations                                                                 technical occupations
                                      8 Plant and machine                                                                     8 Plant and machine
      4 Clerical and secretarial                                                            4 Clerical and secretarial
                                        operatives                                                                              operatives
        occupations                                                                           occupations




                                                                                                                         27   National Statistics
      Health Statistics Quar terly 18               Summer 2003




 Figure 2a           Percentage of deaths classified to each                          Figure 2b                  Percentage of births classified to each combination
                     combination of SOC90 and SOC2000 major                                                      of SOC90 and SOC2000 major groups: showing
                     groups: showing SOC2000 figures within SOC90                                                SOC2000 figures within SOC90 totals
                     totals
 England and Wales                                                                    England and Wales
 Percentage of all deaths
                                                                                       Percentage of all births
 25                                                                                   25




 20                                                                                   20




 15                                                                                   15




 10                                                                                   10




  5                                                                                     5




  0                                                                                     0
         1       2        3         4    5      6           7    8       9                      1            2           3     4    5      6                 7        8           9
                                  SOC90 major group                                                                          SOC90 major group

      SOC2000 Major Group                                                                   SOC2000 Major Group
      1 Managers and senior              5 Skilled trades            9 Elementary           1 Managers and senior                        5 Skilled trades                 9 Elementary
        officials                          occupations                 occupations            officials                                    occupations                      occupations
      2 Professional occupations         6 Personal service                                 2 Professional occupations                   6 Personal service
                                           occupations                                                                                     occupations
      3 Associate professional and       7 Sales and customer                               3 Associate professional and                 7 Sales and customer
        technical occupations              service occupations                                technical occupations                        service occupations
                                         8 Process, plant and                                                                            8 Process, plant and
      4 Administrative and                                                                  4 Administrative and
                                           machine operatives                                                                              machine operatives
        secretarial occupations                                                               secretarial occupations




The revision of SOC90 had no effect on the general shape of the                      births were assigned to major group 6 under SOC90, but just 5 per cent
distribution of deaths across major groups. For example, both                        of deaths and 2 per cent of births under SOC2000.
classifications allocated the greatest proportion of deaths to major
group 5, that is, Skilled Trades Occupations under SOC2000, and Craft
and Related Occupations under SOC90. Unlike the distribution for
deaths, the general shape of the distribution for births changed under
the revision. Both classifications allocated the largest number of births
                                                                                      Figure 3                   Net effect of the classification revision on the sizes
to major group 5, that is Craft and Related Occupations under SOC90
                                                                                                                 of major groups
and Skilled Trades Occupations under SOC2000. However, the smallest
proportion of births was assigned to major group 7 (Selling
Occupations) under SOC90, but major group 6 (Personal Service                                                                                                                 4       6
Occupations) under SOC2000. For deaths, both SOC90 and SOC2000                                                                                                            1       7
major group 7 received the smallest proportion of deaths. The drop in
                                                                                                                                                                      v




the proportion of births assigned to major group 6 is likely to be
                                                                                                                                                            smaller
                                                                                                                                                       v




because a significant proportion of new fathers were employed in                     SOC90                                               SOC2000
occupations categorised to the minor group Protective Service                                   1
                                                                                                         2           3       4       5
                                                                                        v




                                                                                                                                                 v




Occupations, which has moved to SOC2000 major group 3 (Associate                                                 7               9
                                                                                                     6                   8
Professional and Technical Occupations).                                                                                                                    larger
                                                                                                                                                       v




For both births and deaths, the net effect of the revision on the sizes of                                                                                       v
                                                                                                                                                                          2
groups has been similar. There has been a reduction in the proportion of                                                                                                                  3
births and deaths classified to major groups 1, 4, 6 and 7 and a                                                                                                 5
corresponding increase in the size of major groups 2, 3, 5, 8 and 9, as                                                                                                   8
                                                                                                                                                                                              9
illustrated in Figure 3. The greatest change occurs for major group 6
(‘Personal and Protective Occupations’ in SOC90 and ‘Personal Service
Occupations’ in SOC2000). 9 per cent of all deaths and 8 per cent of all




                       National Statistics          28
                                                                                    Health Statistics Quar terly 18           Summer 2003




Main changes to each SOC Major Group                                                   than on the classification of male and female deaths. That is, births data
                                                                                       are subject to more movement under the SOC revision than deaths data.
The revision of the occupational classification has affected the size and              New fathers are more frequently employed in the occupations that have
composition of each major group. Tables 2a and 2b list the most                        been subject to major group movement under the revision. The
common occupations to move into and out of each group in the deaths                    occupational areas subject to major changes under the SOC revision
data set, and Tables 3a and 3b list the same for the births data set.                  included the newer rapidly expanding industries such as information
Percentages are given as a proportion of the total number of births or                 technology and managerial occupations.4 It is also possible to identify
deaths sampled. Since occupational titles under SOC90 and SOC2000                      the movement of Protective Service Occupations from SOC90 major
may differ, the SOC90 occupational title is given when the movement is                 group 6 (Personal and Protective Occupations), as the main reason for
out of a major group (i.e. where there is a decrease), and the SOC2000                 the low agreement rates for this major group.
occupational title is given for movements into a group (where there is
an increase).
                                                                                       Distribution of deaths by sex
Table 2a shows that, for example, although many administrative                         Table 4a shows that more female deaths were assigned to major group 4
occupations previously classified to SOC90 major group 4 are also now                  (‘Clerical and Secretarial Occupations’ under SOC2000 and
classified to SOC2000 major group 4, the overall effect of the revision                ‘Administrative and Secretarial Occupations’ under SOC90) than any
has been a decrease of 2 per cent in the size of this group. The deaths of             other group. For male deaths, this occurred for major group 5 (‘Craft
those in occupations such as storekeepers and warehousemen/women                       and Related Occupations’ under SOC90 and ‘Skilled Trades
are now classified to SOC2000 major group 9 (Elementary                                Occupations’ under SOC2000).
Occupations).
                                                                                       For both sexes, the direction of net movement was the same, except in
Table 2b shows that, for example, the SOC revision has resulted in an                  the case of major group 7 (‘Selling Occupations’ under SOC90 and
increase of deaths allocated to major group 3, by 2 per cent. One                      ‘Sales and Customer Service Occupations’ under SOC2000). There has
explanation for this is the movement into the group of those in                        been an increase in the number of female deaths allocated to this group,
Protective Service Occupations, such as police officers (sergeant and                  but a decrease in male deaths. The number of male deaths allocated has
below) and NCOs and other ranks from SOC90 major group 6                               almost halved, due to reallocation to SOC2000 major group 3
(Personal and Protective Occupations) and sales representatives from                   (Associate Professional and Technical Occupations).
SOC90 major group 7 (Selling Occupations).
                                                                                       In order to provide a comparison for births, we looked at the differences
As noted above, the agreement rates for births are generally lower than                in the distribution of births by mother’s SOC code and father’s SOC
for deaths. The lower agreement rates for births indicate that the SOC                 code. Table 4b shows that, using the mother’s SOC2000 code, more
revision has had a greater impact on the classification of new fathers                 births were assigned to major group 4 (‘Clerical and Secretarial


 Table 2a            The most frequently occurring occupations to                       Table 2b            The most frequently occurring occupations to
                     move out of SOC2000 major groups: deaths, 2001                                         move into SOC2000 major groups: deaths, 2001

England and Wales                                                                      England and Wales

SOC2000 Major           % decrease     Most Frequently            Reallocated          SOC2000 Major          % Increase      Most Frequently            Previously Allocated
Group                                Occurring Occupations       to SOC2000            Group                                Occurring Occupations             to SOC90
                                         to Move Out             Major Group                                                     to Move In                 Major Group
1 Managers and              3          farm owners,          5     Skilled Trades      2 Professional              1             software                  3   Associate
  Senior Officials                     farm managers,              Occupations           Occupations                             professionals                 Professional
                                       horticulturists                                                                                                         and
                                                                                                                                                               Technical
4 Administrative and        2          storekeepers,         9     Elementary
                                                                                                                                                               Occupations
  Secretarial                          warehousemen/               Occupations
  Occupations                          women                                           3 Associate                2              Protective                6   Personal
                                                                                         Professional and                        Service Occupations           and
6 Personal Service          4          security guards,      9     Elementary
                                                                                         Technical                               such as police                Protective
  Occupations                          chefs and cooks             Occupations
                                                                                         Occupations                             officers (sergeant            Occupations
                                                             5     Skilled Trades
                                                                                                                                 and below), NCOs          7   Selling
                                                                   Occupations
                                                                                                                                 and other ranks               Occupations
7 Sales and Customer        1          technical and         3     Associate                                                     sales representatives
  Service Occupations                  wholesale sales             Professional
                                                                                       5 Skilled Trades           1              farmers, chefs and cooks 1    Managers and
                                       representatives             and
                                                                                         Occupations                                                           Administrators
                                                                   Technical
                                                                                                                                                           6   Personal and
                                                                   Occupations
                                                                                                                                                               Protective
                                                                                                                                                               Occupations
                                                                                       8 Process, Plant and       2              coal mine labourers,      5   Craft and
                                                                                         Machine operatives                      sewing machinists             Related
                                                                                                                                                               Occupations
                                                                                                                                                           9   Other
                                                                                                                                                               Occupations
                                                                                       9 Elementary                4             other goods handling      4   Clerical and
                                                                                         Occupations                             and storage                   Secretarial
                                                                                                                                 occupations nec               Occupations
                                                                                                                                 (not elsewhere            6   Personal and
                                                                                                                                 classified), security         Protective
                                                                                                                                 guards                        Occupations




                                                                                                                       29    National Statistics
        Health Statistics Quar terly 18               Summer 2003




 Table 3a            The most frequently occurring occupations to                                      Table 3b               The most frequently occurring occupations to
                     move out of SOC2000 major groups: births, 2001                                                           move into SOC2000 major groups: births, 2001

England and Wales                                                                                     England and Wales

SOC2000 Major            % decrease        Most Frequently                     Reallocated            SOC2000 Major               % Increase         Most Frequently           Previously Allocated
Group                                    Occurring Occupations                to SOC2000              Group                                        Occurring Occupations            to SOC90
                                             to Move Out                      Major Group                                                               to Move In                Major Group

1 Managers and               3              farm owners,                  5       Skilled Trades      2 Professional                   2             software                   3 Associate
  Senior Officials                          farm managers,                        Occupations           Occupations                                  professionals                Professional
                                            marketing and                 3       Associate                                                                                       and
                                            sales managers,                       Professional                                                                                    Technical
                                            property and                          and                                                                                             Occupations
                                            estate managers                       Technical
                                                                                  Occupations         3 Associate                     4              protective                 6 Personal
                                                                                                        Professional and                             Service Occupations          and Protective
4 Administrative and         2              storekeepers,                 9       Elementary            Technical                                    such as police               Occupations
  Secretarial                               warehousemen/                         Occupations           Occupations                                  officers (sergeant
  Occupations                               women                                                                                                    and below), NCOs
                                                                                                                                                     and other ranks
6 Personal Service           6              chefs, police officers        9       Elementary
  Occupations                               (sergeant and below),                 Occupations         5 Skilled Trades                2              chefs, cooks                6 Personal and
                                            security guards               3       Associate             Occupations                                                                Protective
                                                                                  Professional                                                                                     Occupations
                                                                                  and
                                                                                  Technical           8 Process, Plant and            1              scaffolders, stagers,      5 Craft and
                                                                                  Occupations           Machine operatives                           riggers                      Related
                                                                          5       Skilled Trades                                                                                  Occupations
                                                                                  Occupations                                                                                   9 Other
                                                                                                                                                                                  Occupations
7 Sales and Customer         1              sales assistants,             3       Associate
  Service Occupations                       technical and                         Professional        9 Elementary                    4              other goods handling       4 Clerical and
                                            wholesale sales                       and                   Occupations                                  and storage                  Secretarial
                                            representatives                       Technical                                                          occupations nec              Occupations
                                                                                  Occupations                                                        (not elsewhere
                                                                                                                                                     classified)


 Table 4a              Distribution of deaths by sex and major occupational group, 2001


England and Wales

                                                                         Male                               Female
                                                                 SOC90          SOC2000             SOC90            SOC2000
                                                                Percentage      Percentage         Percentage        Percentage

SOC90 Major Groups                                                                                                                         SOC2000 Major Groups
1  Managers and Administrators                                    14.5               12.1            10.7               8.2                1  Managers and Senior Officials
2  Professional Occupations                                        6.3                6.8             6.7               7.2                2  Professional Occupations
3  Associate Professional and Technical Occupations                5.4                8.3             9.3               9.3                3  Associate Professional and Technical Occupations
4  Clerical and Secretarial Occupations                            6.5                4.7            24.4              23.9                4  Administrative and Secretarial Occupations
5  Craft and Related Occupations                                  25.4               26.6             5.5               5.8                5  Skilled Trades Occupations
6  Personal and Protective Occupations                             6.7                2.4            15.0              10.6                6  Personal Service Occupations
7  Selling Occupations                                             2.8                1.6             7.7               7.8                7  Sales and Customer Service Occupations
8  Plant and Machine Operatives                                   18.5               20.8             7.3               8.6                8  Process, Plant and Machine Operatives
9  Other Occupations                                              14.0               16.6            13.4              18.7                9  Elementary Occupations

Total                                                              100               100              100               100                Total


 Table 4b              Distribution of births by father’s and mother’s major occupational group, 2001


England and Wales

                                                                         Father                             Mother
                                                                 SOC90          SOC2000             SOC90            SOC2000
                                                                Percentage      Percentage         Percentage        Percentage

SOC90 Major Groups                                                                                                                         SOC2000 Major Groups
1  Managers and Administrators                                    20.2               17.5            16.6              10.9                1  Managers and Senior Officials
2  Professional Occupations                                       10.0               11.9            11.8              12.3                2  Professional Occupations
3  Associate Professional and Technical Occupations                9.2               12.7            14.3              16.9                3  Associate Professional and Technical Occupations
4  Clerical and Secretarial Occupations                            6.6                4.4            24.4              23.4                4  Administrative and Secretarial Occupations
5  Craft and Related Occupations                                  22.3               24.2             1.7               2.3                5  Skilled Trades Occupations
6  Personal and Protective Occupations                             7.8                1.6            16.1              15.5                6  Personal Service Occupations
7  Selling Occupations                                             3.7                2.6             9.3              10.0                7  Sales and Customer Service Occupations
8  Plant and Machine Operatives                                   13.1               13.7             2.8               3.0                8  Process, Plant and Machine Operatives
9  Other Occupations                                               7.1               11.5             2.9               5.8                9  Elementary Occupations

Total                                                              100               100              100               100                Total



                        National Statistics           30
                                                                             Health Statistics Quar terly 18      Summer 2003




Occupations’ under SOC90 and ‘Administrative and Secretarial                    while some reference has been made to individual occupations, this
Occupations’ under SOC2000) than any other group. For births using              might not provide enough detail for all users. More information about
father’s SOC2000 code, this occurred for major group 5 (‘Craft and              the SOC90 and SOC2000 classifications can be found on the National
Related Occupations’ under SOC90 and ‘Skilled Trades Occupations’               Statistics website.
under SOC2000). This pattern was the same as for male and female
deaths.                                                                         Occupational classifications have to be revised periodically because of
                                                                                changes in the jobs people do, reflecting changes in the labour market,
For both mothers and fathers, the direction of net movement was the             technological innovation and wider economic and social factors. The
same, except in the case of major group 7 (‘Selling Occupations’ under          proportion of individuals whose occupation can be accurately coded
SOC90 and ‘Sales and Customer Service Occupations’ under                        will tend to be highest when a new classification is introduced, and then
SOC2000). There has been an increase in the number of births allocated          gradually decline as change continues. Similarly, the accuracy with
to this group using the mother’s SOC2000 code, but a decrease in births         which a new classification can be applied retrospectively decreases, the
using the father’s SOC2000 code. A similar difference occurs for male           further back in time it is applied. The reported agreement rates between
and female deaths.                                                              SOC90 and SOC2000, based on dual coded data for 2001, cannot be
                                                                                expected to have been constant over the whole period 1991 to 2001.
The distribution for births using the mother’s SOC code was similar to
that for female deaths. The main difference is that a greater percentage        Differences between deaths and births data in the pattern and extent of
of births were allocated to major group 1 (‘Managers and                        agreement between classifications can be expected, since the
Administrators’ under SOC90 and ‘Managers and Senior Officials’                 occupations coded relate to different sections of the population. Deaths
under SOC2000) than to major group 9 (‘Other Occupations’ under                 occur primarily to older people, and in many cases the occupation
SOC90, ‘Elementary Occupations’ under SOC2000). The opposite was                recorded is the last employment before retirement rather than a current
true for female deaths. This indicates that a higher proportion of new          job. Both of these factors are likely to increase the probability of the
mothers were employed in occupations classified to major group 1,               occupation coded being an ‘older’ one which was included in SOC 90,
compared to females deaths.                                                     though possibly reclassified in SOC2000. The parents of new-born
                                                                                babies naturally tend to be younger people and more likely to be in
                                                                                ‘new’ occupations, such as in the information technology sector, for
EFFECT OF REVISION TO SOC ON NS SEC
                                                                                which codes were introduced for the first time in SOC2000.
Issues concerning analyses of trends in socio-economic inequalities
following the introduction of the National Statistics Socio-Economic            These results are specific to births and deaths data and should not be
Classification (NS SEC) were examined in a previous article.6 Deaths            extrapolated to other sources. It is important to be aware that inter-
data from the first quarter of 2001 were dual coded to NS SEC and NS            classification comparability will vary between data sets, depending on
SEC90 (a method for coding data prior to 2001) and agreement rates              the exact approach taken to recording and coding occupation, and the
given. The agreement rates for NS SEC based on SOC changes alone                age and sex distribution of the populations concerned.
(there has been one other change affecting NS SEC) are generally
higher. For example, the overall NS SEC agreement rate is 89 per cent
for males and 94 per cent for females.6 In contrast, SOC agreement
rates at major group level are lower – 79 per cent and 81 per cent for
                                                                                       Key findings
males and females respectively. The difference in the agreement rates of               •   Comparison of vital events data for 2001 dual
the two systems indicates that deaths are more likely to be reclassified                   coded to the Standard Occupational Classification
to the equivalent category under NS SEC than under SOC. For                                1990 (SOC90) and the new SOC2000 showed that
example, a company secretary previously allocated to SOC90 major                           80 per cent of deaths and 75 per cent of births are
group 1 (Managers and Administrators) and reassigned to SOC2000                            assigned to the equivalent major groups in the two
major group 4 (Administrative and Secretarial Occupations) is still                        classifications.
classified to the same NS SEC category. However, several unit groups
have undergone a change in definition in SOC2000. For example,                         •   The number of births and deaths allocated to major
SOC90 unit group local government officers (administrative and                             groups 2, 3, 5, 8 and 9 increased while the number
executive functions) has been split into several separate SOC2000 unit                     assigned to major groups 1, 4, 6, and 7 decreased.
groups, including Local government clerical officers and assistants.
Local government clerical officers and assistants are now classified to                •   The greatest change occurred in major group 6
SOC2000 major group 4 (Administrative and Secretarial Occupations),                        (‘Personal and Protective Occupation’ in SOC90
and assigned to a different NS SEC category than previously.                               and ‘Personal and Service Occupations’ in
                                                                                           SOC2000): 9 per cent of deaths and 8 per cent of
                                                                                           births were assigned to this group under SOC90
DISCUSSION
                                                                                           but only 5 per cent of deaths and 2 per cent of
New occupational classifications are introduced to reflect the changing                    births under SOC2000.
nature of employment. By restructuring the occupational classification
some occupations have moved from one category to another and the                       •   The number of births and male deaths allocated to
category names have changed. This paper provides a summary of these                        major group 7 in SOC2000 (Sales and Customer
changes and the effect that they have had on vital statistics data.                        Service Occupations) was almost half that allocated
                                                                                           to SOC 90 major group 7 (Selling Occupations),
Those interested in trends in occupational or socio-economic mortality                     because of reallocation of occupations to SOC2000
and fertility rates need to take into consideration the fact that no exact                 major group 3 (Associate Professional and Technical
correspondence exists between SOC90 and SOC2000. The figures                               Occupations).
shown in this paper are for comparability at the major group level and




                                                                                                           31    National Statistics
     Health Statistics Quar terly 18    Summer 2003




REFERENCES

1. Office for National Statistics (2000) Standard Occupational
   Classification 2000: Volume 1. Structure and descriptions of unit
   groups, TSO: London.
2. Office for National Statistics (2000) Standard Occupational
   Classification 2000: Volume 2. The coding index, TSO: London.
3. Office of Population Censuses and Surveys (1990) Standard
   Occupational Classification: Volumes 1–3, HMSO: London.
4. Beerten R, Rainford L and Jones A (2001) Changing to Standard
   Occupational Classification (SOC) 2000 - dual coding on the
   Labour Force Survey. Labour Market Trends July, 357–366.
5. Rose D and O’Reilly K (1998) The ESRC Review of Government
   Social Classifications, Economic & Social Research Council:
   Swindon and Office for National Statistics: London.
6. Donkin A, Lee Y H and Toson B (2002) Implications of changes in
   the UK social and occupational classifications in 2001 for vital
   statistics. Population Trends 107, 23–29.
7. Office for National Statistics (2002) In Brief: NS SEC
   comparability over time: births and infant deaths. Population
   Trends 109, 3–5.




                  National Statistics   32
                                                                 Health Statistics Quar terly 18       Summer 2003




Recent Publications
Census 2001 National report for England and Wales                    The mental health of young people looked after by local
(TSO, £65, May, ISBN 0-11-621654-9)                                  authorities in England (TSO, £45, May, ISBN 0-11-621651-4)

Contraception and Sexual Health, 2001 (March, available on the       Mortality statistics: childhood, infant and perinatal, England
National Statistics website at www.statistics.gov.uk/statbase/       and Wales, 2001, Series DH3 no.34 (March, available on the National
Product.asp?vlnk=6988)                                               Statistics website at www.statistics.gov.uk/statbase/Product.asp?vlnk=6305)

Key Population and Vital Statistics: Local and Health                Population Trends 111 (TSO, £20, April, ISBN 0-11-621633-6)
Authority Areas, United Kingdom, 2001, Series VS No.28, PP1
No. 24 (TSO, £35, April, ISBN 0-11-621649-2)                         All of the above publications from TSO can be ordered on 0870 600 5522 or
                                                                     online at www.tso.co.uk/bookshop.They can also be downloaded free of
                                                                     charge from the National Statistics website.




                                                                                                 33    National Statistics
                                                                              Tables
                                                                                                                                                    Page

                      Population
           1.1        International ................................................................................. Selected countries             35
           1.2        National ........................................................................................ Constituent countries of
                                                                                                                        the United Kingdom           37
           1.3        Subnational                                                                                       Government Office Regions
                                                                                                                        of England                   38
           1.4        Age and sex .................................................................................. Constituent countries of
                                                                                                                        the United Kingdom           39
           1.5        Age, sex and legal marital status .................................................. England and Wales                         42

                      Vital statistics
           2.1        Summary ...................................................................................... Constituent countries of
                                                                                                                     the United Kingdom              44
           2.2        Key demographic and health indicators ....................................... Constituent countries of
                                                                                                                     the United Kingdom              46
                      Live births
           3.1        Age of mother ............................................................................... England and Wales                47
           3.2        Outside marriage: age of mother and type of registration ............ England and Wales                                        48

                      Conceptions and abortions
           4.1        Age of women at conception ........................................................ England and Wales (residents)              49
           4.2        Abortions: age and gestation. ....................................................... England and Wales                        50

                      Expectation of life
           5.1        (In years) at birth and selected age ............................................... Constituent countries of
                                                                                                           the United Kingdom                        51
                      Deaths
           6.1        Age and sex                                                                            England and Wales                       52
           6.2        Subnational                                                                            Health Regional Office areas
                                                                                                             of England                              53
           6.3        Selected causes and sex                                                                England and Wales                       54


                      Notes to tables                                                                                                                56




                      StatBase®
                      Health Statistics Quarterly tables are now available on StatBase® which can be accessed
                      via our website www.statistics.gov.uk


                      Symbols
                            ..    not available
                             :    not applicable
                            -     nil or less than half the final digit shown
                            blank not yet available




National Statistics   34
                                                                                              Health Statistics Quarterly 18                 Summer 2003




 Table 1.1             Population and vital rates: international

Selected countries                                                                                                                                       Numbers (thousands)/Rates per thousand
                                                                                                          1
Year           United         Austria     Belgium     Denmark        Finland      France      Germany         Greece       Irish            Italy             Luxem-      Nether-      Portugal
              Kingdom i         ii           ii          ii             ii           ii          ii             ii       Republic ii          ii              bourg ii    lands ii        ii

Population (thousands)
1971          55,928          7,501        9,673        4,963        4,612        51,251       78,313          8,831       2,992           54,073               342       13,194         8,644
1976          56,216          7,566        9,818        5,073        4,726        52,909       78,337          9,167       3,238           55,718               361       13,774         9,356
1981          56,357          7,569        9,859        5,121        4,800        54,182       78,408          9,729       3,443           56,502               365       14,247         9,851
1986          56,684          7,588        9,862        5,120        4,918        55,547       77,720          9,967       3,543           56,596               368       14,572        10,011
1991          57,439          7,813       10,004        5,154        5,014        57,055       80,014         10,247       3,534           56,751               387       15,070         9,871

1993            57,672        7,992       10,084        5,189        5,066        57,654       81,190         10,379       3,576           57,049               398       15,290         9,881
1994            57,797        8,030       10,116        5,206        5,088        57,900       81,420         10,426       3,590           57,204               404       15,383         9,902
1995            57,928        8,050       10,137        5,230        5,110        58,140       81,660         10,450       3,598           57,269               407       15,460         9,920
1996            58,043        8,059       10,157        5,263        5,120        58,370       81,900         10,476       3,636           57,397               416       15,530         9,927
1997            58,167        8,072       10,181        5,280        5,140        58,610       82,060         10,499       3,673           57,520               421       15,611         9,946

1998            58,305        8,078       10,210        5,304        5,153        58,850       82,020         10,516       3,700           57,588               426       15,707         9,968
1999            58,481        8.090       10,230        5,330        5,170        59,100       82,090         10,522       3,750           57,650               429       15,810         9,890
2000            58,643        8,110       10,250        5,340        5,180        58,890       82,180         10,010       3,790           57,760               436       15,910        10,010
2001            58,837        8,080       10,263        5,330        5,190        59,190       82,360         10,020       3,840           57,950               441       16,040        10,020

Population changes (per 1,000 per annum)
1971–76         1.0        1.7        3.0                  4.4          4.9           6.5         0.1            7.6         16.4             6.1               10.7          8.8         16.5
1976–81         0.5        0.1        0.8                  1.9          3.1           4.8         0.2           12.3         12.7             2.8                2.5          6.9         10.6
1981–86         1.2        0.5        0.1                  0.0          4.9           5.0        –1.8            4.9          5.8             0.3                1.8          4.6          3.2
1986–91         2.6        5.9        2.9                  1.3          3.9           5.4         5.9            5.6         –0.5             0.5               10.2          6.8         –2.8
1991–96         2.1        6.3        3.1                  4.2          3.8           4.6         4.7            4.5          3.6             2.3               14.9          6.1          1.1

1997–98               2.5       0.7           2.8          4.5          2.5           4.1         0.5            1.6          7.4             1.2               11.9          6.1          2.2
1998–99               3.2       1.5           2.0          4.9          3.3           4.2         0.9            0.6         13.5            –1.5                7.0          6.6         –7.8
1999–2000             2.1       2.5           2.0          1.9          1.9         – 3.6         1.1          –48.7         10.7             4.5               16.3          6.3         12.1
2000–01               3.1      –3.7           1.3         –1.9          1.9           5.1         2.2            1.0         13.2             3.3               11.5          8.2          1.0

Live birth rate (per 1,000 per annum)
1971–75          14.1       13.3            13.4          14.6        13.1           16.0        10.5           15.8         22.2            16.0               11.6        14.9          20.3
1976–80          12.5       11.5            12.5          12.0        13.6           14.1        10.5           15.6         21.3            12.6               11.2        12.6          17.9
1981–85          12.9       12.0            12.0          10.2        13.4           14.2        10.7           13.3         19.2            10.6               11.6        12.2          14.5
1986–90          13.7       11.6            12.1          11.5        12.7           13.8         9.8           10.6         15.8             9.8               12.2        12.8          11.9
1991–95          13.2       11.8            12.0          13.1        12.9           12.7        10.9            9.9         14.0             9.6               13.3        12.8          11.4

1996                 12.6      11.0         11.2          12.9        11.8           12.6         9.7            9.6         13.9             9.2               13.7        12.2          11.1
1997                 12.5      10.4         11.3          12.8        11.5           12.4         9.9            9.7         14.4             9.3               13.1        12.3          11.4
1998                 12.3      10.1         11.3          12.5        11.1           12.6         9.7            9.6         14.5             9.0               12.6        12.7          11.4
1999                 12.0       9.7         11.1          12.4        11.2           12.7         9.4           11.0         14.2             9.1               13.0        12.7          11.6
2000                 11.6       9.6         11.2          12.6        11.0           13.2         9.4           11.7         14.3             9.3               13.1        13.0          11.8
2001                 11.4       9.2         11.3             ..       10.8              ..        9.1              ..        15.1               ..              12.4        12.6          10.8

Death rate (per 1,000 per annum)
1971–75        11.8        12.6             12.1          10.1          9.5          10.7        12.3            8.6         11.0             9.8               12.2          8.3         11.0
1976–80        11.9        12.3             11.6          10.5          9.3          10.2        12.2            8.8         10.2             9.7               11.5          8.1         10.1
1981–85        11.7        12.0             11.4          11.1          9.3          10.1        12.0            9.0          9.4             9.5               11.2          8.3          9.6
1986–90        11.4        11.1             10.8          11.5          9.8           9.5        11.6            9.3          9.1             9.4               10.5          8.5          9.6
1991–95        11.1        10.4             10.4          11.9          9.8           9.1        10.8            9.5          8.8             9.7                9.8          8.8         10.4

1996                 11.0      10.0         10.3          11.6          9.6           9.2        10.8            9.6          8.7             9.6                9.4          8.9         10.8
1997                 10.8       9.8         10.2          11.3          9.6           9.0        10.5            9.5          8.6             9.8                9.4          8.7         10.6
1998                 10.8       9.7         10.2          11.0          9.6           9.2        10.4            9.5          8.5            10.0                9.1          8.8         10.7
1999                 10.8       9.7         10.3          11.1          9.5           9.2        10.4            9.8          8.5             9.8                8.8          8.9         10.8
2000                 10.4       9.3         10.2          10.9          9.5           9.1        10.2           10.5          8.2             9.7                8.6          8.8         10.6
2001                 10.2       9.1         10.2             ..         9.3             ..       10.0              ..         7.8               ..               7.2          8.8         10.4
2002                 10.3 p        ..           ..            ..          ..             ..          ..             ..           ..                 ..              ..          ..            ..


Note: Figures may not add exactly due to rounding.                                                             1 Including former GDR throughout.
Population estimated as follows:                                                                               2 Estimates prepared by the Population Division of the United Nations –
   i     At 30 June.                                                                                               excludes Hong Kong.
   ii    Estimated mid-year population at latest available date, as given in Council of Europe report:         3 Rates are based on births to, or deaths of, Japanese nationals only.
         Recent Demographic Developments in Europe.                                                            4 Rates are for 1990–1995.
   iii The European Union consists of 15 member countries (EU15); live birth rates and death rates as          5 Estimates prepared by Eurostat.
         given in Eurostat report, Demographic Statistics.                                                     6 Including Hong Kong.
   iv At 1 July as given in the United Nations Demographic Yearbook or United Nations Monthly Bulletin of      7 Including the Indian held part of Jammu and Kashmir, the final status of
         Statistics.                                                                                               which has not yet been determined.
                                                                                                               . . Figures not available.
                                                                                                               p Provisional




                                                                                                                                      35    National Statistics
        Health Statistics Quarterly 18               Summer 2003




 Table 1.1           Population and vital rates: international
 continued
Selected countries                                                                                                                          Numbers (thousands)/Rates per thousand
Year                  Spain         Sweden        European           Russian       Australia     Canada       New            China            India7        Japan3          USA
                        ii            ii          Union iii        Federation ii      iv           iv       Zealand iv        iv                iv            iv             iv

Population (thousands)
1971               34,216            8,098         342,631           130,934        13,067       22,026       2,899          852,290         551,311        105,145        207,661
                                                                                                                                        2
1976               36,118            8,222         350,598           135,027        14,033       23,517       3,163          937,170         617,248        113,094        218,035
                                                                                                                                        2
1981               37,741            8,320         356,494           139,225        14,923       24,900       3,195        1,008,460         675,185        117,902        229,958
                                                                                                                                        2
1986               38,536            8,370         359,418           144,154        16,018       26,204       3,317        1,086,733         767,199        121,672        240,680
                                                                                                                                        2
1991               38,920            8,617         365,923           147,885        17,284       28,030       3,480        1,170,100         851,900        123,964        252,618
                                                                                                                                        2
1993                  39,086         8,719         369,254           148,146        17,667       28,700       3,550        1,195,660         886,250        124,829        258,080
                                                                                                                                        2
1994                  39,149         8,781         370,424           147,968        17,855       29,040       3,600        1,207,580         903,940        125,178        260,602
                                                                                                                                        2
1995                  39,210         8,830         371,429           147,939        18,072       29,350       3,660        1,236,700         921,990        125,472        263,040
                                                                                                                                        2
1996                  39,270         8,841         372,438           147,373        18,311       29,670       3,710        1,246,240         939,540        127,761        265,460
                                                                                                                                        2
1997                  39,323         8,846         373,386           146,938        18,520       29,990       3,760        1,242,800         955,220        126,070        268,010
                                                                                                                                        2
1998                  39,371         8,851         374,091           146,534        18,730       30,250       3,790        1,253,900          970,930       126,410        270,300
                                                                                                                                        2                              2
1999                  39,420         8,854         374,720           146,328        18,970       30,490       3,810        1,264,770          986,610       126,650        272,690
2000                  39,470         8,862         374,852           145,560        19,160       30,770       3,830        1,275,130        1,002,140       126,870        275,260 2
2001                  40,270         8,833         376,714           144,819        19,490       31,110       3,850        1,284,970        1,017,540       127,340        284,800

Population changes (per 1,000 per annum)
1971–76              11.1          3.1                  4.7               6.3         14.8          13.5        18.2            19.9             23.9          15.1           10.0
1976–81               9.0          2.1                  3.4               6.2         12.7          11.8         2.0            15.2             18.8           8.5           10.9
1981–86               4.2          1.2                  1.6               7.1         14.7          10.5         7.6            15.5             27.3           6.4            9.3
1986–91               2.0          5.9                  3.6               5.2         15.8          13.9         9.8            15.3             22.1           3.8            9.9
1991–96               1.8          5.2                  3.6               0.7         11.9          11.7        13.2            13.0             20.6           6.1           10.2

1997–98                  1.2           0.6              1.9             –2.7          11.3           8.7         8.0             8.9           –24.4            2.7            8.5
1998–99                  1.2           0.3              1.7             –1.4          12.8           7.9         5.3             8.7            16.1            0.7            8.8
1999–2000                1.3           0.9              0.4             –5.2          10.0           8.5         5.2             8.2            15.7            2.9            9.4
2000–01                 20.3           2.4              5.0             –5.1          17.2          11.0         5.2             7.7            15.4            3.7           34.7

Live birth rate (per 1,000 per annum)
1971–75                19.2        13.5                14.7                ..         18.8          15.9        20.4            27.2             35.6          18.6           15.3
1976–80                17.1        11.6                13.1                ..         15.7          15.5        16.8            18.6             33.4          14.9           15.2
1981–85                12.8        11.3                12.2                ..         15.6          15.1        15.8            19.2                ..         12.6           15.7
1986–90                10.8        13.2                12.0                ..         15.1          14.8        17.1               ..               ..         10.6           16.0
                                                                                                                                        4
1991–95                 9.8        13.3                 9.7             10.2             ..            ..          ..           18.5                ..            ..             ..

1996                     9.2          10.8             10.8               8.8         13.9          12.2        15.4             9.8             27.3           9.6           14.7
                                                                                                                                        6
1997                     9.4          10.2             10.8               8.6         13.6          11.9        15.4             9.1                ..          9.5           14.5
                                                               5                                                                        6
1998                     9.3          10.1             10.7               8.8         13.3             ..       14.6             8.1                ..          9.5           14.6
                                                                                                                                        6
1999                     9.6          10.0                ..              8.3         13.1             ..       15.0             7.8                ..          9.3           14.5
                                                                                                                                        6
2000                     9.9          10.2                ..              8.7         13.0             ..       14.8             8.1                ..          9.4           14.7
                                                                                                                                        6
2001                       ..            ..               ..              9.1         12.6             ..          ..            7.2                ..            ..             ..

Death rate (per 1,000 per annum)
1971–75                8.5            10.5             10.8                ..           8.2          7.4         8.4             7.3             15.5           6.4            9.1
1976–80                8.0            10.9             10.6                ..           7.6          7.2         8.2             6.6             13.8           6.1            8.7
1981–85                7.7            11.0             10.4                ..           7.3          7.0         8.1             6.7                ..          6.1            8.6
1986–90                8.2            11.1             10.2                ..           7.2          7.3         8.2               ..               ..          6.4            8.7
1991–95                8.7            10.9             10.0             13.7              ..           ..          ..              ..               ..            ..             ..

1996                     8.9          10.6             10.0             14.1            7.0          7.1         7.6             5.0              8.9           7.1            8.7
                                                                                                                                        6
1997                     8.9          10.5              9.8             13.7            7.0          7.2         7.3             4.9                ..          7.2            8.6
                                                               5                                                                        6
1998                     9.1          10.5              9.9             13.6            6.8            ..        6.9             5.0                ..          7.4            8.6
                                                                                                                                        6
1999                     9.1          10.7                ..            14.7            6.8            ..        7.4             5.0                ..          7.8            8.8
                                                                                                                                        6
2000                     9.3          10.5                ..            15.3            6.7            ..        7.0             5.0                ..          7.6            8.7
                                                                                                                                        6
2001                       ..            ..               ..            15.6            6.6            ..          ..            4.8                              ..             ..
2002                       ..            ..               ..               ..             ..           ..          ..              ..                  ..         ..             ..

Note: Figures may not add exactly due to rounding.                                                          1 Including former GDR throughout.
Population estimated as follows:                                                                            2 Estimates prepared by the Population Division of the United Nations –
   i    At 30 June.                                                                                             excludes Hong Kong.
   ii   Estimated mid-year population at latest available date, as given in Council of Europe report:       3 Rates are based on births to, or deaths of, Japanese nationals only.
        Recent Demographic Developments in Europe.                                                          4 Rates are for 1990–1995.
   iii The European Union consists of 15 member countries (EU15); live birth rates and death rates as       5 Estimates prepared by Eurostat.
        given in Eurostat report, Demographic Statistics.                                                   6 Including Hong Kong.
   iv At 1 July as given in the United Nations Demographic Yearbook or United Nations Monthly Bulletin of   7 Including the Indian held part of Jammu and Kashmir, the final status of
        Statistics.                                                                                             which has not yet been determined.
                                                                                                            . . Figures not available.
                                                                                                            p Provisional




                       National Statistics          36
                                                                                           Health Statistics Quarterly 18                 Summer 2003




 Table 1.2          Population: national

Constituent countries of the United Kingdom                                                                                          Numbers (thousands) and percentage age distribution
Mid-year                                       United              Great              England             England              Wales                 Scotland           Northern
                                              Kingdom              Britain           and Wales                                                                           Ireland

Estimates
1971                                          55,928              54,388              49,152               46,412               2,740                  5,236               1,540
1976                                          56,216              54,693              49,459               46,660               2,799                  5,233               1,524
1981                                          56,357              54,815              49,634               46,821               2,813                  5,180               1,543
1986                                          56,684              55,110              49,999               47,188               2,811                  5,112               1,574
1991                                          57,439              55,831              50,748               47,875               2,873                  5,083               1,607

1993                                          57,672              56,037              50,944               48,063               2,882                  5,092               1,636
1994                                          57,797              56,154              51,051               48,166               2,885                  5,102               1,644
1995                                          57,928              56,279              51,175               48,290               2,885                  5,104               1,649
1996                                          58,043              56,381              51,289               48,402               2,887                  5,092               1,662

1997                                          58,167              56,496              51,413               48,523               2,890                  5,083               1,671
1998                                          58,305              56,627              51,550               48,658               2,893                  5,077               1,678
1999                                          58,481              56,802              51,730               48,836               2,894                  5,072               1,679
2000                                          58,643              56,960              51,897               48,997               2,900                  5,063               1,683
2001                                          58,837              57,149              52,084               49,181               2,903                  5,064               1,689

           of which (percentages)
           0–4                                    5.9                 5.9                 5.9                 5.9                 5.8                    5.5                 6.8
           5–15                                  14.2                14.2                14.2                14.2                14.5                   13.7                16.7
           16–44                                 40.1                40.1                40.0                40.2                37.4                   40.4                41.7
           45–64M/59F                            21.3                21.4                21.4                21.3                22.3                   21.8                19.3
           65M/60F–74                            10.9                10.9                10.9                10.8                11.8                   11.5                 9.6
           75 and over                            7.5                 7.6                 7.6                 7.6                 8.3                    7.1                 6.0

Projections1
2006                                          59,657              57,943              52,920               49,994               2,926                  5,023               1,714
2011                                          60,524              58,789              53,806               50,859               2,947                  4,983               1,735
2016                                          61,459              59,705              54,762               51,790               2,972                  4,943               1,754
2021                                          62,386              60,617              55,722               52,725               2,997                  4,895               1,769

           of which (percentages)
           0–4                                    5.7                 5.7                 5.7                 5.7                 5.5                    5.1                 5.9
           5–15                                  12.3                12.3                12.3                12.3                12.3                   11.3                13.3
           16–44                                 36.2                36.2                36.3                36.4                34.5                   35.0                36.5
           45–642                                26.3                26.3                26.2                26.2                25.9                   28.1                26.5
           65–742                                10.5                10.5                10.4                10.4                11.6                   11.4                 9.8
           75 and over                            9.0                 9.0                 9.0                 9.0                10.0                    9.2                 8.1

Note: Figures may not add exactly due to rounding.
1 ’Interim‘ national projections based on the mid-2001 population estimates.
2 Between 2010 and 2020, state retirement age will change from 65 years for men and 60 years for women to 65 years for both sexes.




                                                                                                                               37        National Statistics
           Health Statistics Quarterly 18             Summer 2003




 Table 1.3            Population: subnational

Government Office Regions of England1                                                                                                  Numbers (thousands) and percentage age distribution
Mid-year                                           North           North          Yorkshire         East          West             East          London           South           South
                                                    East           West            and the        Midlands       Midlands                                          East           West
                                                                                  Humber


Estimates
1971                                                2,679           7,108           4,902          3,652          5,146            4,454          7,529            6,830          4,112
1976                                                2,671           7,043           4,924          3,774          5,178            4,672          7,089            7,029          4,280
1981                                                2,636           6,940           4,918          3,853          5,187            4,854          6,806            7,245          4,381
1986                                                2,594           6,833           4,884          3,908          5,180            4,999          6,774            7,468          4,548
1991                                                2,587           6,843           4,936          4,011          5,230            5,121          6,829            7,629          4,688

1992                                                2,589           6,835           4,948          4,035          5,237            5,142          6,823            7,656          4,711
1993                                                2,589           6,836           4,955          4,053          5,246            5,152          6,832            7,672          4,729
1994                                                2,582           6,823           4,958          4,070          5,248            5,177          6,844            7,711          4,753
1995                                                2,573           6,809           4,957          4,089          5,255            5,205          6,860            7,764          4,778
1996                                                2,564           6,787           4,954          4,105          5,260            5,236          6,901            7,805          4,789

1997                                                2,554           6,769           4,951          4,116          5,261            5,270          6,928            7,857          4,819
1998                                                2,544           6,762           4,950          4,125          5,267            5,306          6,969            7,891          4,843
1999                                                2,531           6,738           4,947          4,144          5,265            5,341          7,041            7,955          4,874
2000                                                2,523           6,737           4,950          4,157          5,260            5,375          7,104            7,982          4,909
2001                                                2,517           6,732           4,967          4,175          5,267            5,395          7,188            8,007          4,934

            of which (percentages)
            0–4                                       5.5             5.8             5.9            5.7            6.0              6.0             6.7             5.9            5.5
            5–15                                     14.2            14.8            14.6           14.3           14.8             14.1            13.5            14.0           13.6
            16–44                                    39.1            39.2            39.5           39.2           39.0             38.9            47.4            39.4           37.1
            45–64M/59F                               21.9            21.6            21.4           22.1           21.6             22.1            18.0            21.9           22.6
            65M/60F–74                               11.8            11.2            11.1           11.0           11.1             11.1             8.5            10.8           12.1
            75 and over                               7.5             7.4             7.6            7.6            7.4              7.8             5.9             8.0            9.3

Projections2
2001                                                2,579           6,871           5,071          4,234          5,343            5,448          7,215            8,134          4,977
2006                                                2,555           6,843           5,098          4,312          5,358            5,582          7,337            8,344          5,098
2011                                                2,536           6,820           5,130          4,384          5,372            5,702          7,470            8,534          5,213
2016                                                2,521           6,813           5,165          4,455          5,391            5,823          7,609            8,722          5,333
2021                                                2,509           6,808           5,200          4,523          5,411            5,941          7,736            8,905          5,452

            of which (percentages)4
            0–4                                       5.4             5.7             5.6            5.4            5.7              5.5             6.4             5.4            4.9
            5–15                                     12.1            12.4            12.2           12.0           12.5             12.1            12.5            12.1           11.2
            16–44                                    35.1            35.4            35.9           35.1           34.9             34.5            41.5            34.9           32.8
            45–643                                   27.7            27.5            27.3           27.4           27.3             27.2            26.3            27.4           27.8
            65–743                                   11.2            10.6            10.6           11.1           10.7             11.2             7.7            10.9           12.4
            75 and over                               8.4             8.4             8.4            9.0            8.9              9.5             5.6             9.3           10.8

Note: Figures may not add exactly due to rounding.
1 From 1 April 2002 there are four Directorates of Health and Social Care (DHSCs) within the Department of Health. The GORs sit within the DHSCs as follows: North East, North West,
  Yorkshire and The Humber GORs are within North DHSC, East Midlands, West Midlands and East GORs are within Midlands and Eastern DHSC, London GOR equates to London DHSC
  and South East and South West GORs are within South DHSC. See ‘In brief’ Health Statistics Quarterly number 15 for further details of changes to Health Areas.
2 These projections are based on the mid-1996 population estimates and are consistent with the 1996-based national projections produced by the Government Actuary’s Department.
3 Between 2010 and 2020, state retirement age will change from 65 years for men and 60 years for women to 65 years for both sexes.
4 The percentages shown in this table are correct and show the proportion in each age group for 2021. These replace the percentage figures shown in Health Statistics Quarterly numbers 01,
  02 and 03, and Population Trends 95 and 96, which were miscalculated.
       See Notes to tables on page 56




                         National Statistics         38
                                                                                     Health Statistics Quarterly 18      Summer 2003




 Table 1.4          Population: age and sex

Constituent countries of the United Kingdom                                                                                                      Numbers (thousands)
                                                                                          Age group
Mid-year             All ages   Under 1     1–4      5–14    15–24   25–34   35–44    45–59   60–64   65–74   75–84    85–89   90 and    Under      16–     65/60
                                                                                                                                over      16       64/59   and over

United Kingdom
Persons
1971                55,928      899        3,654     8,916   8,144   6,971   6,512   10,202   3,222   4,764   2,159     358     127     14,257   32,548      9,123
1976                56,216      677        3,043     9.176   8.126   7,868   6,361    9,836   3,131   5,112   2,348     390     147     13,797   32,757      9,663
1981                56,357      730        2,726     8,147   9,019   8,010   6,774    9,540   2,935   5,195   2,677       ..      ..    12,543   33,780     10,035
1986                56,684      748        2,886     7,143   9,200   8,007   7,711    9,212   3,069   5,020   2,971     716       ..    11,645   34,725     10,313
1991                57,439      790        3,077     7,141   8,168   8,898   7,918    9,500   2,888   5,067   3,119     626     248     11,685   35,197     10,557
1996                58,043      719        3,020     7,524   7,182   9,094   7,956   10,551   2,782   5,061   3,127     710     317     11,996   35,408     10,639

1997                58,167      734        2,954     7,604   7,064   9,014   8,115   10,655   2,795   5,009   3,178     720     328     11,996   35,508     10,663
1998                58,305      713        2,929     7,654   6,993   8,878   8,284   10,762   2,833   4,973   3,209     735     344     12,008   35,591     10,706
1999                58,481      704        2,896     7,687   7,019   8,697   8,464   10,875   2,874   4,941   3,226     745     353     12,012   35,736     10,733
2000                58,643      681        2,867     7,653   7,080   8,523   8,655   10,992   2,897   4,933   3,244     755     363     11,955   35,914     10,774
2001                58,837      662        2,815     7,614   7,228   8,332   8,804   11,144   2,880   4,940   3,290     753     376     11,855   36,154     10,828
Males
1971                27,167      461        1,874     4,576   4,137   3,530   3,271    4,970   1,507   1,999     716      97      29      7,318   17,008      2,841
1976                27,360      348        1,564     4,711   4,145   3,981   3,214    4,820   1,466   2,204     775     101      31      7,083   17.167      3,111
1981                27.412      374        1,400     4,184   4,596   4,035   3,409    4,711   1,376   2,264     922       ..      ..     6,439   17,646      3,327
1986                27,542      384        1,478     3,664   4,663   4,022   3,864    4,572   1,463   2,206   1,060     166       ..     5,968   18,142      3,432
1991                27,909      403        1,572     3,655   4,146   4,432   3,949    4,732   1,390   2,272   1,146     166      46      5,976   18,303      3,768
1996                28,182      369        1,548     3,843   3,601   4,505   3,953    5,243   1,358   2,309   1,187     201      65      6,130   18,290      3,762

1997                28,244      376        1,515     3,887   3,535   4,455   4,029    5,291   1,366   2,297   1,217     207      68      6,136   18,319      3,789
1998                28,310      365        1,502     3,915   3,500   4,376   4,108    5,340   1,387   2,291   1,239     215      73      6,145   18,348      3,818
1999                28,406      361        1,485     3,934   3,518   4,275   4,192    5,393   1,408   2,286   1,257     220      77      6,150   18,415      3,840
2000                28,491      349        1,468     3,920   3,559   4,179   4,279    5,446   1,418   2,291   1,276     225      80      6,124   18,901      3,872
2001                28,611      338        1,443     3,901   3,648   4,083   4,347    5,520   1,409   2,304   1,306     227      85      6,073   18,616      3,922
Females
1971                28,761      437        1,779     4,340   4,008   3,441   3,241    5,231   1,715   2,765   1,443     261      97      6,938   15,540      6,282
1976                28,856      330        1,479     4,465   3,980   3,887   3,147    5,015   1,665   2,908   1,573     289     116      6,714   15,590      6,552
1981                28,946      356        1,327     3,963   4,423   3,975   3,365    4,829   1,559   2,931   1,756       ..      ..     6,104   16,134      6,708
1986                29,142      364        1,408     3,480   4,538   3,985   3,847    4,639   1,606   2,814   1,911     550       ..     5,678   16,583      6,881
1991                29,530      387        1,505     3,487   4,021   4,466   3,968    4,769   1,498   2,795   1,972     460     202      5,709   16,894      6,927
1996                29,861      350        1,473     3,681   3,581   4,589   4,003    5,307   1,424   2,751   1,941     509     252      5,866   17,118      6,877

1997                29,924      358        1,439     3,716   3,528   4,559   4,086    5,364   1,429   2,712   1,961     513     260      5,860   17,190      6,874
1998                29,995      348        1,427     3,739   3,493   4,502   4,177    5,422   1,446   2,682   1,969     520     271      5,863   17,244      6,888
1999                30,075      343        1,411     3,753   3,501   4,422   4,271    5,482   1,467   2,655   1,969     525     277      5,862   17,321      6,892
2000                30,153      332        1,398     3,733   3,521   4,344   4,376    5,546   1,479   2,643   1,968     529     283      5,831   17,419      6,902
2001                30,225      324        1,372     3,713   3,579   4,249   4,457    5,624   1,470   2,636   1,983     525     291      5,781   17,538      6,906
England and Wales
Persons
1971             49,152         782        3,170     7,705   7,117   6,164   5,736    9,034   2,853   4,228   1,926     323     115     12,334   28,710      8,108
1976             49,459         585        2,642     7,967   7,077   6,979   5,608    8,707   2,777   4,540   2,093     351     135     11,973   28,894      8,593
1981             49,634         634        2,372     7,085   7,873   7,086   5,996    8,433   2,607   4,619   2,388     383     157     10,910   29,796      8,928
1986             49,999         654        2,522     6,226   8,061   7,052   6,856    8,136   2,725   4,470   2,655     461     182     10,161   30,647      9,190
1991             50,748         698        2,713     6,248   7,165   7,862   7,022    8,407   2,553   4,506   2,790     561     223     10,247   31,101      9,400
1996             51,289         636        2,670     6,616   6,287   8,038   7,015    9,360   2,454   4,490   2,799     638     285     10,562   31,263      9,464

1997                51,413      650        2,613     6,694   6,184   7,971   7,153    9,453   2,467   4,440   2,845     647     296     10,572   31,357      9,483
1998                51,550      632        2,593     6,745   6,125   7,855   7,304    9,547   2,501   4,406   2,872     660     310     10,594   31,436      9,520
1999                51,730      625        2,565     6,782   6,157   7,702   7,464    9,644   2,539   4,375   2,887     670     319     10,609   31,579      9,542
2000                51,897      606        2,542     6,758   6,216   7,559   7,637    9,746   2,561   4,365   2,902     679     328     10,567   31,753      9,578
2001                52,084      589        2,497     6,730   6,355   7,394   7,775    9,874   2,544   4,370   2,941     677     339     10,487   31,976      9,622
Males
1971                23,897      402        1,626     3,957   3,615   3,129   2,891    4,414   1,337   1,778     637      86      26      6,334   15,036      2,527
1976                24,089      300        1,358     4,091   3,610   3,532   2,843    4,280   1,304   1,963     690      91      29      6,148   15,169      2,773
1981                24,160      324        1,218     3,639   4,011   3,569   3,024    4,178   1,227   2,020     825      94      32      5,601   15,589      2,970
1986                24,311      335        1,292     3,194   4,083   3,542   3,438    4,053   1,302   1,972     951     115      35      5,208   16,031      3,072
1991                24,681      356        1,385     3,198   3,638   3,920   3,504    4,199   1,234   2,027   1,029     150      42      5,240   16,193      3,248
1996                24,924      327        1,369     3,379   3,150   3,985   3,489    4,658   1,203   2,058   1,067     182      59      5,397   16,162      3,365
1997                24,986      333        1,341     3,422   3,093   3,943   3,555    4,700   1,211   2,045   1,094     187      62      5,408   16,189      3,389
1998                25,052      323        1,330     3,450   3,064   3,875   3,626    4,742   1,229   2,039   1,115     194      66      5,421   16,217      3,414
1999                25,151      320        1,315     3,471   3,086   3,789   3,703    4,786   1,248   2,033   1,131     199      70      5,432   16,286      3,433
2000                25,238      310        1,302     3,462   3,125   3,709   3,783    4,831   1,257   2,037   1,147     204      73      5,413   16,365      3,460
2001                25,355      301        1,279     3,448   3,208   3,627   3,847    4,893   1,249   2,048   1,173     206      77      5,372   16,479      3,503
Females
1971                25,255      380        1,544     3,749   3,502   3,036   2,845    4,620   1,516   2,450   1,289     236      89      6,000   13,673      5,581
1976                25,370      285        1,284     3,876   3,467   3,447   2,765    4,428   1,473   2,577   1,403     261     106      5,826   13,725      5,820
1981                25,474      310        1,154     3,446   3,863   3,517   2,972    4,255   1,380   2,599   1,564     289     126      5,309   14,207      5,958
1986                25,687      319        1,231     3,032   3,978   3,509   3,418    4,083   1,422   2,498   1,704     346     148      4,953   14,616      6,118
1991                26,067      342        1,328     3,050   3,527   3,943   3,517    4,208   1,319   2,479   1,761     411     181      5,007   14,908      6,152
1996                26,365      310        1,301     3,237   3,137   4,054   3,526    4,701   1,251   2,433   1,732     456     227      5,165   15,101      6,099

1997                26,427      317        1,273     3,272   3,091   4,029   3,598    4,753   1,256   2,395   1,750     460     234      5,164   15,168      6,094
1998                26,498      308        1,263     3,295   3,062   3,981   3,677    4,805   1,272   2,367   1,758     466     244      5,173   15,219      6,107
1999                26,579      305        1,250     3,311   3,072   3,914   3,761    4,858   1,291   2,341   1,756     471     249      5,177   15,293      6,109
2000                26,659      295        1,240     3,296   3,091   3,850   3,854    4,915   1,303   2,329   1,755     475     255      5,154   15,387      6,117
2001                26,730      288        1,218     3,282   3,146   3,767   3,928    4,982   1,295   2,322   1,767     471     262      5,115   15,497      6,118

.. Figures not available.
Note: Figures may not add exactly due to rounding.




                                                                                                                  39    National Statistics
           Health Statistics Quarterly 18            Summer 2003




Table 1.4           Population: age and sex
continued
Constituent countries of the United Kingdom                                                                                                    Numbers (thousands)
                                                                                         Age group
Mid-year            All ages   Under 1      1–4      5–14    15–24   25–34   35–44   45–59   60–64   65–74   75–84   85–89   90 and   Under      16–      65/60
                                                                                                                              over     16       64/59    and over

England
Persons
1971               46,412       739        2,996     7,272   6,731   5,840   5,421   8,515   2,690   3,976   1,816    416        ..   11,648    27,127    7,636
1981               46,821       598        2,235     6,678   7,440   6,703   5,663   7,948   2,449   4,347   2,249    362      149    10,285    28,133    8,403
1986               47,188       618        2,380     5,869   7,623   6,682   6,478   7,672   2,559   4,199   2,501    435      172     9,583    28,962    8,643
1991               47,875       660        2,560     5,885   6,772   7,460   6,633   7,920   2,399   4,222   2,626    529      210     9,658    29,390    8,827
1996               48,402       603        2,524     6,236   5,937   7,630   6,636   8,819   2,307   4,212   2,629    601      269     9,966    29,551    8,885

1997               48,523       614        2,472     6,311   5,840   7,567   6,769   8,907   2,319   4,166   2,671    609      278     9,977    29,642    8,904
1998               48,658       598        2,452     6,360   5,785   7,458   6,914   8,994   2,352   4,134   2,696    622      292     9,998    29,719    8,940
1999               48,836       592        2,426     6,397   5,813   7,316   7,069   9,086   2,388   4,107   2,709    632      300    10,015    29,859    8,963
2000               48,997       574        2,404     6,375   5,866   7,183   7,234   9,181   2,408   4,100   2,722    640      309     9,976    30,024    8,997
2001               49,181       557        2,362     6,349   6,000   7,031   7,366   9,304   2,391   4,106   2,758    638      319     9,900    30,243    9,038

Males
1971               22,569       380        1,537     3,734   3,421   2,965   2,733   4,161   1,261   1,671     599    107       25     5,982    14,209    2,377
1976               22,728       283        1,280     3,858   3,413   3,339   2,686   4,031   1,228   1,849     649     85       27     5,798    14,320    2,610
1981               22,795       306        1,147     3,430   3,790   3,377   2,856   3,938   1,154   1,902     777     89       30     5,280    14,717    2,798
1986               22,949       317        1,219     3,010   3,862   3,357   3,249   3,822   1,224   1,853     897    108       33     4,911    15,147    2,891
1991               23,291       336        1,307     3,011   3,439   3,721   3,311   3,957   1,159   1,900     970    141       39     4,938    15,302    3,050
1996               23,527       309        1,294     3,185   2,974   3,783   3,302   4,390   1,132   1,930   1,002    172       55     5,093    15,275    3,159
1997               23,586       315        1,268     3,226   2,920   3,742   3,366   4,428   1,139   1,919   1,028    177       58     5,103    15,301    3,182
1998               23,650       306        1,257     3,253   2,892   3,678   3,435   4,467   1,156   1,914   1,047    183       62     5,116    15,328    3,206
1999               23,748       303        1,244     3,274   2,912   3,599   3,509   4,509   1,174   1,910   1,061    188       66     5,128    15,396    3,225
2000               23,835       294        1,231     3,265   2,950   3,525   3,585   4,551   1,182   1,913   1,076    192       69     5,109    15,475    3,251
2001               23,951       285        1,210     3,252   3,030   3,451   3,647   4,611   1,174   1,924   1,101    194       72     5,071    15,588    3,291
Females
1971               23,843       359        1,459     3,538   3,310   2,875   2,688   4,354   1,429   2,305   1,217    309       85     5,666    12,918    5,259
1976               23,932       269        1,211     3,656   3,275   3,260   2,612   4,168   1,387   2,425   1,323    246      100     5,495    14,968    5,481
1981               24,026       292        1,088     3,248   3,650   3,327   2,807   4,009   1,295   2,445   1,472    273      119     5,004    13,416    5,605
1986               24,239       301        1,161     2,859   3,761   3,325   3,229   3,850   1,335   2,346   1,604    326      140     4,672    13,815    5,752
1991               24,584       324        1,253     2,873   3,333   3,739   3,322   3,964   1,239   2,323   1,656    388      171     4,720    14,088    5,777
1996               24,875       293        1,230     3,052   2,963   3,848   3,334   4,430   1,175   2,282   1,626    429      214     4,873    14,276    5,726

1997               24,937       300        1,203     3,085   2,920   3,825   3,403   4,479   1,180   2,247   1,643    432      220     4,873    14,341    5,722
1998               25,007       292        1,195     3,107   2,893   3,780   3,480   4,527   1,196   2,221   1,649    439      230     4,882    14,391    5,734
1999               25,088       288        1,183     3,124   2,901   3,718   3,560   4,576   1,214   2,198   1,648    444      235     4,888    14,463    5,738
2000               25,163       280        1,173     3,110   2,917   3,658   3,649   4,630   1,226   2,187   1,646    448      240     4,866    14,550    5,746
2001               25,231       273        1,152     3,097   2,970   3,580   3,719   4,693   1,217   2,182   1,657    444      247     4,829    14,655    5,747

Wales
Persons
1971                2,740         43          173     433     386     325     315     519     164     252     110      16        6      686      1,582      472
1976                2,799         33          151     453     388     379     309     509     161     267     121      19        7      680      1,618      501
1981                2,813         36          136     407     434     383     333     485     158     272     139      21        8      626      1,663      525
1986                2,811         37          143     357     438     369     378     464     166     271     154      26       10      578      1,686      547
1991                2,873         38          153     363     393     402     389     486     154     284     164      32       13      589      1,711      573
1996                2,887         34          146     380     351     408     379     540     147     279     170      37       17      596      1,713      578

1997                2,890         35          142     383     344     404     384     546     148     274     174      38       17      595      1,715      579
1998                2,893         34          141     385     341     397     389     553     149     271     176      38       18      596      1,717      580
1999                2,894         33          139     385     344     386     395     558     151     267     178      38       19      594      1,720      579
2000                2,900         32          138     383     349     375     403     564     152     265     180      39       19      591      1,728      581
2001                2,903         32          135     381     355     362     408     571     153     264     183      39       20      587      1,733      583
Males
1971                1,329         22           89     222     194     164     158     253      76     107      38       6        1      352       827       150
1976                1,361         17           78     233     197     193     157     249      75     114      41       5        2      350       849       162
1981                1,365         18           70     209     221     193     168     240      73     118      48       5        2      321       871       173
1986                1,362         19           73     184     221     186     190     231      79     119      54       7        2      297       885       181
1991                1,391         20           78     186     199     199     194     242      74     128      60       8        2      302       891       198
1996                1,398         17           74     194     177     202     187     269      72     128      64      10        3      304       887       206
1997                1,400         18           73     196     173     200     189     271      72     126      66      10        4      305       888       207
1998                1,402         17           72     197     172     196     192     274      73     125      68      11        4      305       889       208
1999                1,403         17           71     198     173     190     194     277      74     124      69      11        4      305       890       208
2000                1,403         16           71     196     175     183     197     279      75     124      70      12        4      303       891       210
2001                1,404         16           69     196     178     176     200     282      75     124      72      12        4      301       891       212
Females
1971                1,412         21           85     211     191     161     157     265      88     146      73      16        4      335       755       322
1976                1,438         16           73     220     191     187     153     260      86     152      80      14        6      330       770       339
1981                1,448         18           66     199     213     190     165     246      85     154      91      16        6      305       791       352
1986                1,449         18           70     173     217     184     188     233      87     152     100      20        8      282       801       366
1991                1,482         19           75     177     194     203     195     244      80     156     104      24       10      288       820       375
1996                1,490         16           71     186     174     206     192     272      75     151     106      27       13      292       825       373

1997                1,490         17           69     187     171     204     195     275      76     148     108      27       14      291       827       372
1998                1,491         17           69     188     169     201     198     278      76     146     109      27       14      291       828       372
1999                1,491         16           68     188     171     196     201     281      77     144     109      27       15      289       831       371
2000                1,497         15           67     187     174     192     205     285      77     142     109      28       15      288       838       371
2001                1,499         15           66     185     177     187     209     289      78     140     110      27       15      286       842       371
Note: Figures may not add exactly due to rounding.




                       National Statistics           40
                                                                                 Health Statistics Quarterly 18          Summer 2003




 Table 1.4            Population: age and sex
 continued
Constituent countries of the United Kingdom                                                                                                     Numbers (thousands)
                                                                                        Age group
Mid-year               All ages   Under 1   1–4   5–14   15–24   25–34   35–44   45–59      60–64   65–74   75–84      85–89   90 and   Under     16–     65/60
                                                                                                                                over     16      64/59   and over
Scotland
Persons
1971                  5,236        86       358   912    781      617     612     926       294     430     183         29       9      1,440    2,986     810
1976                  5,233        67       291   904    806      692     591     897       282     460     202         31      11      1,352    3,023     858
1981                  5,180        69       249   780    875      724     603     880       260     460     232         35      14      1,188    3,110     882
1986                  5,112        66       257   656    863      739     665     849       273     435     252         42      15      1,061    3,161     890
1991                  5,083        66       258   634    746      795     696     853       265     441     259         51      19      1,021    3,151     912
1996                  5,092        59       252   643    651      798     722     925       259     448     256         57      24      1,019    3,151     922

1997                  5,083        60       243   644    637      785     736     932       258     446     260         58      25      1,010    3,148     925
1998                  5,077        58       239   644    628      766     749     941       261     445     262         59      26      1,003    3,145     929
1999                  5,072        56       234   643    625      743     762     951       262     444     265         59      27        995    3,144     933
2000                  5,063        53       230   636    628      717     774     962       263     445     267         59      28        985    3,141     937
2001                  5,064        52       224   629    633      696     782     979       262     447     272         59      29        970    3,150     944
Males
1971                  2,516        44       184   467    394      306     299     440       134     176      60          8       2       738     1,530     247
1976                  2,517        34       149   463    408      347     290     429       128     193      65          8       2       693     1,556     269
1981                  2,495        35       128   400    445      364     298     424       118     194      77          8       3       610     1,603     282
1986                  2,462        34       131   336    438      371     331     410       127     184      86         10       3       543     1,636     283
1991                  2,445        34       132   324    377      394     345     415       124     192      91         13       3       522     1,623     299
1996                  2,447        30       128   328    327      392     355     454       122     198      93         15       5       521     1,616     310

1997                  2,442        31       124   329    320      384     362     458       122     197     95          16       5       516     1,613     313
1998                  2,439        30       122   329    315      374     367     463       124     198     96          16       5       513     1,610     316
1999                  2,437        29       120   329    313      362     372     469       125     198     98          16       6       510     1,609     318
2000                  2,432        28       118   326    315      347     377     474       125     199     100         17       6       505     1,606     322
2001                  2,434        26       115   322    319      337     379     483       125     200     103         17       6       497     1,610     327
Females
1971                  2,720        42       174   445    387      311     313     485       160     254     122         20       7       701     1,455     563
1976                  2,716        32       142   440    398      345     301     468       154     267     137         23       8       659     1,468     589
1981                  2,685        33       121   380    430      359     305     456       142     265     155         27      11       579     1,506     600
1986                  2,649        32       126   320    424      368     334     439       146     250     166         32      12       518     1,525     606
1991                  2,639        32       126   309    369      402     351     437       141     249     168         38      16       499     1,528     612
1996                  2,645        28       123   315    324      406     367     470       137     250     164         42      20       498     1,535     612

1997                  2,641        29       119   315    318      401     374     473       136     249     165         42      20       494     1,535     612
1998                  2,638        28       116   315    313      392     382     478       137     248     166         43      21       490     1,535     614
1999                  2,635        27       114   314    312      381     390     483       138     246     166         43      22       486     1,535     614
2000                  2,631        26       112   310    313      369     397     488       138     246     166         43      22       480     1,535     616
2001                  2,630        26       109   307    314      359     403     496       137     246     169         43      23       473     1,540     617
Northern Ireland
Persons
1971             1,540             31       126   299    247      189     165     243        74     106      51          7       2       483     853       205
1976             1,524             26       111   306    243      198     163     231        73     111      53          8       2       471     840       212
1981             1,543             27       106   282    271      200     175     227        68     116      57          ..      ..      444     874       224
1986             1,574             28       107   261    277      217     190     227        71     115      64         16       ..      423     917       234
1991             1,607             26       106   260    256      240     200     241        70     120      69         14       6       417     945       246
1996             1,662             24        99   266    244      257     220     266        70     123      72         15       7       415     993       253

1997                  1,671        24       97    266    242      258     226     270        71     122      73         16       7       413     1,003     255
1998                  1,678        24       97    264    239      257     231     275        71     122      74         16       7       411     1,010     257
1999                  1,679        23       96    262    237      252     237     279        73     122      75         16       7       408     1,014     258
2000                  1,683        22       95    259    237      247     243     284        73     123      75         16       7       403     1,020     259
2001                  1,689        22       93    255    240      243     248     290        74     123      77         16       7       397     1,030     262
Males
1971                  755          16       64    152    127       95      81     116        36      45      19         2        1       246     441       67
1976                  754          13       58    157    127      102      81     111        34      47      19         3        0       242     442       70
1981                  757          14       54    145    140      102      87     109        32      50      21         ..       ..      228     454       75
1986                  768          14       55    134    142      109      95     110        33      50      23         4        ..      217     474       77
1991                  783          13       54    133    131      119     100     118        32      53      26         4        1       213     487       83
1996                  810          12       51    136    124      128     109     131        33      54      27         4        1       212     511       87
1997                  816          12       50    136    123      129     112     133        34      54      28         4        1       211     516       88
1998                  819          12       50    135    121      128     114     135        34      54      28         5        2       211     520       89
1999                  818          12       49    134    119      125     117     138        35      54      29         5        2       209     521       89
2000                  820          11       49    133    120      122     119     141        35      55      29         5        2       207     524       90
2001                  824          11       48    131    122      120     122     144        35      56      30         5        2       204     529       92
Females
1971                  786          15       62    147    119       95      84     126        39      61      32          5       2       237     411       138
1976                  769          13       53    149    116       96      81     120        38      64      33          6       2       229     398       143
1981                  786          13       52    137    130       98      88     118        37      66      37          ..      ..      216     420       150
1986                  805          13       52    127    135      107      96     118        38      65      41         12       ..      206     442       157
1991                  824          13       52    127    125      121     100     123        38      67      44         10       4       203     458       163
1996                  851          11       49    130    120      129     110     135        37      69      45         11       6       203     482       167

1997                  856          12       47    130    119      129     114     137        37      68      45         11       6       202     486       167
1998                  859          12       47    129    118      129     117     139        37      68      46         11       6       201     490       168
1999                  861          11       47    128    117      127     120     141        38      68      46         11       6       199     493       169
2000                  862          11       46    126    118      125     124     143        38      68      46         11       6       196     497       169
2001                  865          10       45    124    119      123     126     146        38      68      47         11       6       193     501       170

See notes opposite.




                                                                                                                  41    National Statistics
           Health Statistics Quarterly 18               Summer 2003




 Table 1.5            Population: age, sex and legal marital status

England and Wales                                                                                                                                                          Numbers (thousands)
                        Total                                          Males                                                                          Females
                      population
Mid-year                                  Single      Married         Divorced       Widowed            Total           Single         Married        Divorced        Widowed            Total

Aged

16 and over
1971                   36,818              4,173       12,522             187              682        17,563            3,583          12,566             296             2,810         19,255
1976                   37,486              4,369       12,511             376              686        17,941            3,597          12,538             533             2,877         19,545
1981                   38,724              5,013       12,238             611              698        18,559            4,114          12,284             828             2,939         20,165
19862                  39,887              5,673       11,886             919              695        19,173            4,613          11,994           1,164             2,943         20,714
19912                  40,796              6,024       11,745           1,200              731        19,699            4,822          11,838           1,459             2,978         21,097

19942                  41,003              6,221       11,492           1,413              730        19,855            4,958          11,583           1,684             2,922         21,147
19952                  41,167              6,345       11,415           1,480              729        19,968            5,058          11,488           1,754             2,898         21,199
19962                  41,356              6,482       11,339           1,543              728        20,091            5,171          11,406           1,819             2,870         21,265
19972                  41,540              6,622       11,256           1,604              726        20,209            5,292          11,319           1,882             2,838         21,331
19982                  41,746              6,768       11,185           1,659              725        20,338            5,415          11,244           1,940             2,808         21,408

19992                  41,996              6,936       11,128           1,716              721        20,501            5,539          11,185           2,001             2,771         21,495
20002                  42,275              7,109       11,074           1,770              718        20,672            5,667          11,136           2,063             2,737         21,604

16–19
1971                     2,666             1,327            34              0                0          1,362           1,163             142               0                  0         1,305
1976                     2,901             1,454            28              0                0          1,482           1,289             129               0                  0         1,419
1981                     3,310             1,675            20              0                0          1,694           1,523              93               0                  0         1,616
19862                    3,144             1,601            10              0                0          1,611           1,483              49               1                  0         1,533
19912                    2,680             1,372             8              0                0          1,380           1,267              32               0                  0         1,300

19942                    2,360             1,212              3             0                0          1,215           1,131              14               0                  0         1,145
19952                    2,374             1,220              3             0                0          1,222           1,139              13               0                  0         1,152
19962                    2,436             1,251              2             0                0          1,253           1,171              12               0                  0         1,183
19972                    2,517             1,291              2             0                0          1,293           1,212              11               0                  0         1,224
19982                    2,578             1,322              2             0                0          1,324           1,242              11               0                  0         1,254

19992                    2,595             1,332              2             0                0          1,334           1,250              11               0                  0         1,261
20002                    2,571             1,322              2             0                0          1,324           1,237               9               0                  0         1,246

20–24
1971                     3,773             1,211            689             3                0          1,904             745           1,113               9                  2         1,869
1976                     3,395             1,167            557             4                0          1,728             725             925              16                  2         1,667
1981                     3,744             1,420            466            10                1          1,896           1,007             811              27                  2         1,847
19862                    4,203             1,794            322            14                0          2,130           1,382             658              32                  1         2,072
19912                    3,966             1,764            249            12                0          2,025           1,421             490              29                  1         1,941

19942                    3,625             1,699            152             7                0          1,858           1,416             330              20                  1         1,767
19952                    3,495             1,658            127             6                0          1,791           1,404             282              17                  0         1,703
19962                    3,329             1,597            105             5                0          1,707           1,369             238              15                  0         1,622
19972                    3,177             1,536             87             4                0          1,628           1,333             204              12                  0         1,549
19982                    3,084             1,500             76             3                0          1,579           1,314             180              10                  0         1,505

19992                    3,085             1,511            68              3                0          1,582           1,328             165               9                  0         1,503
20002                    3,132             1,541            63              2                0          1,606           1,363             154               8                  0         1,525

25–29
1971                     3,267               431         1,206             16                1          1,654            215            1,367              29                  4         1,614
1976                     3,758               533         1,326             39                2          1,900            267            1,522              65                  5         1,859
1981                     3,372               588         1,057             54                1          1,700            331            1,247              89                  4         1,671
19862                    3,724               841           956             79                1          1,877            527            1,204             113                  4         1,847
19912                    4,246             1,183           894             85                1          2,163            800            1,158             123                  2         2,083

19942                    4,168             1,293            754            76                1          2,124             908           1,011             122                  2         2,044
19952                    4,094             1,326            696            70                1          2,092             936             947             116                  2         2,002
19962                    4,045             1,368            639            64                1          2,071             977             887             109                  2         1,975
19972                    3,972             1,401            577            58                1          2,037           1,014             818             101                  2         1,935
19982                    3,883             1,422            520            51                0          1,994           1,047             750              91                  2         1,889

19992                    3,774             1,426            469            45                0          1,941           1,062             686              84                  2         1,833
20001,2                  3,685             1,429            426            39                0          1,895           1,080             632              75                  2         1,790

Note: Figures may not add exactly due to rounding.
      Population estimates by marital status for 1971 and 1976 are based on the 1971 Census; those for 1981 and 1986 are based on the 1981 Census and have not been rebased using
      the 1991 Census. Estimates for 1991 onwards are based on the 1991 Census.
1.    There was an error in the mid-2000 marital status estimates by gender that were published in this table in Population Trends 106. The error was due to the incorrect use of deaths data
      by gender in the processing. Total populations including totals by gender and the estimates of the number of single and divorced people are not affected by the error. There is an
      apparent difference in single females aged 25–29 but this is small and is purely due to rounding of the recompiled estimates by marital status. The figures supplied in this table are now
      correct.––
2.    These are original marital status estimates; rebased marital status estimates will not be available until Summer 2003 (See ‘in brief’).

        See Notes to tables on page 56.




                         National Statistics           42
                                                                                Health Statistics Quarterly 18       Summer 2003




 Table 1.5            Population: age, sex and legal marital status                                                                    England and Wales
 continued
England and Wales                                                                                                                          Numbers (thousands)
                        Total                             Males                                                           Females
                      population
Mid-year                           Single     Married    Divorced     Widowed        Total      Single     Married        Divorced   Widowed          Total



30–34
1971                    2,897         206       1,244        23            3         1,475        111       1,269             34              8        1,422
1976                    3,220         236       1,338        55            3         1,632        118       1,388             75              8        1,588
1981                    3,715         318       1,451        97            3         1,869        165       1,544            129              9        1,846
19862                   3,341         356       1,200       125            2         1,683        206       1,292            154              6        1,658
19912                   3,762         535       1,206       160            2         1,903        335       1,330            189              5        1,859

19942                   4,126         732       1,187       179            2         2,100        467       1,340            213              5        2,025
19952                   4,235         799       1,177       182            2         2,160        518       1,333            218              5        2,075
19962                   4,296         855       1,155       181            2         2,194        560       1,316            221              5        2,103
19972                   4,318         903       1,125       177            3         2,207        598       1,287            222              5        2,111
19982                   4,294         938       1,085       171            3         2,196        627       1,247            219              5        2,098

19992                   4,260         976       1,041       163            2         2,182        652       1,205            216              5        2,078
20002                   4,211       1,016         993       153            2         2,164        675       1,158            209              5        2,047

35–44
1971                    5,736         317       2,513        48           13         2,891        201       2,529             66             48        2,845
1976                    5,608         286       2,442       104           12         2,843        167       2,427            129             42        2,765
1981                    5,996         316       2,519       178           12         3,024        170       2,540            222             41        2,972
19862                   6,863         397       2,743       293           12         3,444        213       2,816            350             39        3,419
19912                   7,056         482       2,658       388           12         3,539        280       2,760            444             34        3,517

19942                   6,925         556       2,463       444           12         3,475        343       2,587            491             29        3,449
19952                   7,003         601       2,446       464           12         3,523        374       2,568            509             29        3,480
19962                   7,146         657       2,449       483           13         3,602        414       2,575            527             28        3,544
19972                   7,325         725       2,458       503           13         3,700        459       2,593            545             28        3,625
19982                   7,515         802       2,467       520           14         3,803        510       2,612            563             27        3,712

19992                   7,734         890       2,483       537           14         3,923        570       2,634            579             27        3,811
20002                   7,970         981       2,503       552           14         4,050        635       2,659            600             27        3,920

45–64
1971                   11,887         502       4,995        81          173         5,751        569       4,709            125            733        6,136
1976                   11,484         496       4,787       141          160         5,583        462       4,568            188            683        5,901
1981                   11,040         480       4,560       218          147         5,405        386       4,358            271            620        5,635
19862                  10,860         461       4,423       332          141         5,356        326       4,221            388            569        5,504
19912                  10,960         456       4,394       456          127         5,433        292       4,211            521            503        5,527

19942                  11,596         489       4,564       587          120         5,759        300       4,422            659            456        5,837
19952                  11,730         500       4,581       630          119         5,830        305       4,452            703            440        5,900
19962                  11,844         512       4,587       673          118         5,890        310       4,473            746            425        5,954
19972                  11,959         524       4,590       715          117         5,946        318       4,494            789            412        6,013
19982                  12,103         541       4,604       758          117         6,019        328       4,523            832            401        6,085

19992                  12,259         560       4,618       802          117         6,097        340       4,554            875            392        6,162
20002                  12,398         579       4,621       846          117         6,164        353       4,577            920            384        6,234

65 and over
1971                    6,592         179       1,840        17          492         2,527        580       1,437             32           2,016       4,065
1976                    7,119         197       2,033        33          510         2,773        569       1,579             60           2,138       4,347
1981                    7,548         216       2,167        54          534         2,971        533       1,692             90           2,263       4,578
19862                   7,752         223       2,233        76          539         3,070        475       1,754            127           2,325       4,681
19912                   8,127         231       2,337        99          589         3,257        427       1,858            153           2,433       4,870

19942                   8,203         239       2,368       121          595         3,323        393       1,879            179           2,429       4,880
19952                   8,237         241       2,385       128          595         3,349        382       1,893            190           2,422       4,887
19962                   8,259         242       2,401       137          594         3,375        370       1,904            201           2,410       4,884
19972                   8,272         242       2,417       147          593         3,399        358       1,912            213           2,390       4,873
19982                   8,288         242       2,432       156          592         3,422        347       1,921            225           2,372       4,866

19992                   8,288         241       2,446       166          587         3,441        336       1,930            237           2,344       4,847
20002                   8,308         240       2,466       177          585         3,468        324       1,948            251           2,318       4,841

See notes opposite.




                                                                                                           43        National Statistics
           Health Statistics Quarterly 18              Summer 2003




 Table 2.1           Vital statistics summary

Constituent countries of the United Kingdom                                                                                                                    Numbers (thousands) and rates
Year and                   All live           Live births         Marriages             Divorces               Deaths               Infant             Neonatal                Perinatal
quarter                    births          outside marriage                                                                        mortality5          mortality6              mortality7

                     Number       Rate1    Number     Rate2   Number       Rate3    Number      Rate4     Number      Rate1    Number      Rate2   Number       Rate2   Number         Rate8

United Kingdom
1976                  675.5       12.0      61.1       90      406.0         ..     135.4         ..       680.8     12.1         9.79     14.5        6.68      9.9       12.3       18.0
1981                  730.7       13.0      91.3      125      397.8       49.4     156.4       11.3       658.0     11.7         8.16     11.2        4.93      6.7        8.79      12.0
1986                  754.8       13.3     154.3      204      393.9         ..     168.2         ..       660.7     11.7         7.18      9.5        4.00      5.3        7.31       9.6
1991                  792.3       13.8     236.1      298      349.7         ..     173.5         ..       646.2     11.2         5.82      7.4        3.46      4.4        6.45       8.1
1996                  733.2       12.6     260.4      355      317.5         ..     171.7         ..       636.0     11.0         4.50      6.1        3.00      4.1        6.41       8.7

1998                  716.9       12.3     269.7      376      304.8         ..     160.1          ..      629.2     10.8         4.08      5.7        2.72      3.8        5.94        8.2
1999                  700.0       12.0     271.6      388      301.1         ..     158.7          ..      632.1     10.8         4.05      5.8        2.73      3.9        5.79        8.2
2000                  679.0       11.6     268.1      395      305.9         ..     154.6          ..      608.4     10.4         3.79      5.6        2.63      3.9        5.56        8.1
2001                  669.1       11.4     268.0      401      286.1         ..     156.8P         ..      602.3     10.2         3.66      5.5        2.43      3.6p       5.39p       8.0p
2002                     ..         ..        ..         ..       ..         ..        ..          ..      608.0
                                                                                                                 p
                                                                                                                     10.3p        3.54p     5.3p       2.37p     3.5        5.53        8.2
                                                                       p
2001 March            164.9       11.4      65.9      400       33.0         ..       39.3P        ..      165.0     11.3         0.98      5.9        0.64      3.9        1.38        8.3
     June             167.0       11.4      65.2      391       81.1p        ..       39.3P        ..      145.6     10.0         0.86      5.1        0.58      3.5        1.33        7.9
                                                                     p
     Sept             171.7       11.6      69.2      403      120.4         ..       38.5P        ..      138.8      9.4         0.90      5.3        0.62      3.6        1.31        7.6
     Dec              165.6       11.2      67.7      409       51.6p        ..       39.7P        ..      152.9     10.3         0.93      5.6        0.60      3.6        1.37        8.2
2002 March            161.0p      11.1p     65.3p     406p        ..         ..        ..          ..      164.0p    11.3p        0.88p     5.5p       0.58p     3.6p       1.35p       8.4p
                            p          p         p        p
     June             165.2       11.3      65.5      396         ..         ..        ..          ..      146.3P    10.0P        0.89P     5.4P       0.60P     3.6P       1.40P       8.4P
     Sept             173.6P      11.7P     71.0P     403P        ..         ..        ..          ..      141.1Pp
                                                                                                                      9.5Pp
                                                                                                                                  0.84Pp
                                                                                                                                            4.8P
                                                                                                                                               p
                                                                                                                                                       0.57P
                                                                                                                                                           p
                                                                                                                                                                 3.3P
                                                                                                                                                                    p
                                                                                                                                                                            1.40Pp
                                                                                                                                                                                        7.8P
                                                                                                                                                                                           p
     Dec                 ..         ..        ..         ..       ..         ..        ..          ..      156.5     10.6         0.92      5.5        0.62      3.7        1.41        8.3

England and Wales
1976             584.3            11.8      53.8       92      358.6       57.7     126.7       10.1       598.5     12.1         8.34     14.3        5.66      9.7       10.5       17.7
1981             634.5            12.8      81.0      128      352.0       49.6     145.7       11.9       577.9     11.6         7.02     11.1        4.23      6.7        7.56      11.8
1986             661.0            13.2     141.3      214      347.9       43.5     153.9       12.9       581.2     11.6         6.31      9.6        3.49      5.3        6.37       9.6
1991             699.2            13.8     211.3      302      306.8       35.6     158.7       13.5       570.0     11.2         5.16      7.4        3.05      4.4        5.65       8.0
1996             649.5            12.7     232.7      358      279.0       30.0     157.1       13.8       560.1     10.9         3.99      6.1        2.68      4.1        5.62       8.6

1998                  635.9       12.3     240.6      378      267.3       27.7     145.2       12.9       555.0     10.8         3.63      5.7        2.42      3.8        5.26        8.2
1999                  621.9       12.0     241.9      389      263.5       26.8     144.6       13.0       556.1     10.8         3.62      5.8        2.44      3.9        5.14        8.2
2000                  604.4       11.6     238.6      395      268.0       26.7     141.1       12.7       535.7     10.3         3.38      5.6        2.34      3.9        4.96        8.2
                                                                     p          p
2001                  594.6       11.4     238.1      400      249.2       24.8     143.8P      13.0P      530.4p    10.2p        3.24p     5.4p       2.14p     3.6p       4.75p       8.0p
2002                     ..         ..        ..         ..       ..         ..        ..         ..       535.4     10.3         3.17      5.3        2.14      3.6        4.96        8.3

2001 March            145.5       11.3      58.0      398       28.8p      11.7p      36.1p     13.2p      145.1     11.2         0.85      5.8        0.54      3.7        1.19        8.2
     June             148.8       11.5      58.1      391       70.9p      28.3p      36.0p     13.0p      128.3      9.9         0.75      5.0        0.50      3.4        1.18        7.9
     Sept             153.0       11.7      61.8      404      105.3p      41.7p      35.4p     12.7p      122.2      9.3         0.82      5.3        0.56      3.6        1.17        7.6
     Dec              147.4       11.2      60.2      409       44.2p      17.5p      36.3p     13.0p      134.8     10.3         0.83      5.6        0.54      3.6        1.21        8.2
2002 March            143.3p      11.2p     58.0p     405p        ..         ..       35.8P     13.1P      144.9p    11.3p        0.81p     5.7p       0.54p     3.8p       1.22p       8.5p
     June             147.2p      11.3p     58.3p     396p        ..         ..       37.3P     13.5P      128.8p     9.9p        0.78p     5.3p       0.54p     3.7p       1.25p       8.5p
     Sept             155.0p      11.8p     63.4p     409p        ..         ..       37.9P     13.5P      124.0P     9.4P        0.75P     4.8P       0.51P     3.3P       1.23P       7.9P
                                                                                                                 p        p            p       p           p        p            p         p
     Dec                 ..         ..        ..         ..       ..         ..       33.6p     12.0p      137.7     10.5         8.30      5.5        0.56      3.7        1.26        8.3
England
1976                  550.4       11.8      50.8       92      339.0         ..        ..          ..      560.3     12.0         7.83     14.2        5.32      9.7        9.81      17.6
1981                  598.2       12.8      76.9      129      332.2         ..        ..          ..      541.0     11.6         6.50     10.9        3.93      6.6        7.04      11.7
1986                  623.6       13.2     133.5      214      328.4         ..     146.0          ..      544.5     11.6         5.92      9.5        3.27      5.2        5.98       9.5
1991                  660.8       13.7     198.9      301      290.1         ..     150.1          ..      534.0     11.2         4.86      7.3        2.87      4.3        5.33       8.0
1996                  614.2       12.5     218.2      355      264.2         ..     148.7          ..      524.0     10.8         3.74      6.1        2.53      4.1        5.36       8.7

1998                  602.1       12.2     225.7      375      253.1         ..     137.3          ..      519.6     10.7         3.39      5.6        2.29      3.8        4.97        8.2
1999                  589.5       11.8     226.7      385      249.5         ..     137.0          ..      519.6     10.6         3.38      5.7        2.29      3.9        4.86        8.2
2000                  572.8       11.7     223.8      391      253.8         ..     133.9          ..      501.0     10.2         3.18      5.6        2.21      3.9        4.69        8.2
2001                  563.7       11.5     223.3      396      236.2p        ..     136.4P         ..      496.1     10.1         3.04      5.4        2.02      3.6        4.51        8.0
                                                                                                                          p                    p           p        p            p         p
2002                     ..         ..        ..         ..       ..         ..        ..          ..      500.8p    10.2         3.00p     5.3        2.03      3.6        4.71        8.3
                                                                       p                    p
2001 March            137.8       11.4      54.3      394       27.5         ..       34.2         ..      135.7     11.1         0.79      5.7        0.51      3.7        1.13        8.1
                                                                     p                    p
     June             141.1       11.5      54.5      386       67.1         ..       34.2         ..      119.9      9.3         0.72      5.1        0.48      3.4        1.12        7.9
     Sept             145.1       11.7      58.0      400       99.6p        ..       33.6p        ..      114.2      8.7         0.76      5.3        0.53      3.6        1.12        7.6
                                                                     p                    p
     Dec              139.6       11.3      56.4      404       42.0         ..       34.5         ..      126.2      9.6         0.77      5.5        0.50      3.6        1.15        8.2

2002 March            135.9p      11.2P     54.3p     400p        ..         ..       34.0P        ..      135.6p    11.2p        0.77p     5.7p       0.52p     3.8p       1.18p       8.6p
     June             139.8p      11.4p     54.7p     391p        ..         ..       35.4P        ..      120.5p     9.8p        0.74p     5.3p       0.51p     3.7p       1.19p       8.5p
                            p          p         p
     Sept             147.1       11.7      59.4      404P        ..         ..       36.0P        ..      115.8Pp
                                                                                                                      9.3Pp
                                                                                                                                  0.70Pp
                                                                                                                                            4.8P
                                                                                                                                               p
                                                                                                                                                       0.48P
                                                                                                                                                           p
                                                                                                                                                                 3.2P
                                                                                                                                                                    p
                                                                                                                                                                            1.15Pp
                                                                                                                                                                                        7.8P
                                                                                                                                                                                           p
     Dec                 ..         ..        ..         ..       ..         ..       32.0p        ..      128.9     10.4         0.79      5.5        0.53      3.7        1.19        8.3

Notes: Quarters for 2002 are based on the mid-2001 population estimate.                             From 1972 figures for England and figures for Wales each exclude events for persons usually
       Rates for the most recent quarters will be particularly subject to revision, even            resident outside England and Wales. These events are however included in the totals for
       when standard detail is given, as they are based on provisional numbers or on                England and Wales combined, and for the United Kingdom.
       estimates derived from events registered in the period.                                      From 1981 births to non-resident mothers in Northern Ireland are excluded from the
       Figures for England and Wales represent the numbers of deaths registered in each             figures for Northern Ireland, and for the United Kingdom.
       year up to 1992, and the number of deaths occurring in each year from 1993.                  Figures may not add exactly due to rounding.
       Marriage and divorce rates are based on original marital status estimates; rebased
       marital estimates will be available in mid 2003.
       Provisional figures are registrations.
       See Notes to tables on page 56.




                         National Statistics          44
                                                                                                Health Statistics Quarterly 18                          Summer 2003




 Table 2.1           Vital statistics summary
 continued
Constituent countries of the United Kingdom                                                                                                                            Numbers (thousands) and rates

Year and                  All live           Live births             Marriages           Divorces                   Deaths               Infant               Neonatal                Perinatal
quarter                   births          outside marriage                                                                              mortality5            mortality6              mortality7

                    Number       Rate1    Number      Rate2    Number       Rate3     Number   Rate4          Number       Rate1    Number          Rate2   Number      Rate2   Number        Rate8

Wales
1976                   33.4      11.9        2.9       86           19.5     ..          ..         ..           36.3     13.0          0.46        13.7      0.32       9.6       0.64       19.0
1981                   35.8      12.7        4.0      112           19.8     ..          ..         ..           35.0     12.4          0.45        12.6      0.29       8.1       0.51       14.1
1986                   37.0      13.1        7.8      211           19.5     ..         7.9         ..           34.7     12.3          0.35         9.5      0.21       5.6       0.38       10.3
1991                   38.1      13.3       12.3      323           16.6     ..         8.6         ..           34.1     11.9          0.25         6.6      0.16       4.1       0.30        7.9
1996                   34.9      11.9       14.4      412           14.8     ..         8.4         ..           34.6     12.0          0.20         5.6      0.13       3.6       0.26        7.5

1998                   33.4      11.4       14.8      444           14.2     ..         7.9         ..           34.0     11.7          0.19         5.6      0.12       3.6       0.27        8.0
1999                   32.1      10.9       14.8      461           14.0     ..         7.5         ..           35.0     12.1          0.20         6.1      0.13       4.0       0.25        7.7
2000                   31.3      10.8       14.8      472           14.1     ..         7.2         ..           33.3     11.5          0.17         5.3      0.11       3.5       0.23        7.2
2001                   30.6      10.5       14.8      483             ..     ..         7.4P        ..           33.0     11.4          0.16         5.4      0.11       3.5       0.23        7.5
                                                                                                                     p        p             p           p          p        p          p          p
2002                     ..        ..         ..         ..           ..     ..          ..         ..           33.3     11.5          0.14         4.7      0.10       3.1       0.24        7.7

2001 March              7.7      10.8        3.7      477            1.4p    ..         1.9p        ..            9.1     12.6          0.05         6.5      0.03       3.6       0.06        8.0
     June               7.5      10.4        3.6      473            3.8p    ..         1.8p        ..            8.0     11.1          0.03         4.4      0.02       3.2       0.06        7.8
     Sept               7.7      10.6        3.7      481            5.7p    ..         1.8p        ..            7.6     10.4          0.04         5.3      0.03       3.2       0.05        6.7
     Dec                7.7      10.5        3.8      499            2.2p    ..         1.8p        ..            8.3     11.4          0.04         5.2      0.03       3.8       0.06        7.5
2002 March              7.3p     10.2p       3.6p     491p           ..      ..         1.8P        ..            9.0p    12.5p         0.03p        4.5p     0.02p      2.6p      0.05p       6.1p
     June               7.4p     10.2p       3.5p     481p           ..      ..         2.0P        ..            8.0p    11.0p         0.03p        4.4p     0.02p      2.9p      0.06p       8.0p
     Sept               7.9p     10.7p       4.0p     504p           ..      ..         1.9P        ..            7.9P    10.8P         0.04P        5.4P     0.03P      3.8P      0.07P       8.7P
                                                                                                                     p        p             p           p          p        p          p          p
     Dec                 ..        ..         ..         ..          ..      ..         1.7p        ..            8.5     11.6          0.04         4.6      0.03       3.3       0.06        8.0

Scotland
1976                   64.9      12.5        6.0       93           37.5    53.8        8.1     6.5              65.3     12.5          0.96        14.8      0.67      10.3       1.20       18.3
1981                   69.1      13.4        8.5      122           36.2    47.5        9.9     8.0              63.8     12.3          0.78        11.3      0.47       6.9       0.81       11.6
1986                   65.8      12.9       13.6      206           35.8    42.8       12.8    10.7              63.5     12.4          0.58         8.8      0.34       5.2       0.67       10.2
1991                   67.0      13.2       19.5      291           33.8    38.7       12.4    10.6              61.0     12.0          0.47         7.1      0.29       4.6       0.58        8.6
1996                   59.3      11.6       21.4      360           30.2    32.8       12.3    10.9              60.7     11.9          0.37         6.2      0.23       3.9       0.55        9.2

1998                   57.3      11.3       22.3      389           29.7    31.2       12.4    11.2              59.2     11.7          0.32         5.5      0.20       3.5       0.49        8.5
1999                   55.1      10.9       22.7      412           29.9    31.1       11.9    10.8              60.3     11.9          0.28         5.0      0.18       3.3       0.42        7.6
2000                   53.1      10.5       22.6      426           30.4    29.5       11.1    10.3              57.8     11.4          0.31         5.7      0.21       4.0       0.45        8.4
2001                   52.5      10.4       22.8      433           29.6    28.8P      10.6     9.8              57.4     11.3          0.29         5.5      0.20       3.8       0.45        8.5
                                                                                                                     p        p              p          p          p        p          p          p
2002                     ..        ..         ..         ..           ..      ..         ..      ..              58.1     11.5          0.27         5.2      0.16       3.1       0.39        7.5
                                                                                  p                       p
2001 March             13.5      10.8        6.0      445            3.4    13.6        2.6     9.9              15.8     12.5          0.09         6.4      0.06       4.5       0.13        9.6
     June              12.9      10.2        5.4      422            8.2    32.7p       2.7     9.9p             13.8     10.9          0.08         5.8      0.06       4.7       0.12        8.9
     Sept              13.2      10.3        5.6      427           11.9    46.5p       2.6     9.5p             13.3     10.4          0.07         4.9      0.04       3.3       0.10        7.3
                                                                                p                   p
     Dec               12.9      10.1        5.7      439            6.1    24.0        2.7    10.1              14.6     11.4          0.06         5.0      0.03       2.6       0.11        8.1
2002 March             12.4p      9.9p       5.5P     448p           3.5p   13.6p       2.4p    9.0p             15.3p    12.2p         0.05p        4.0p     0.03p      2.0p      0.09p       7.0p
     June              12.6p     10.0p       5.4P     430p           8.2p   32.6p       2.9P   10.6P             14.0P    11.1P         0.08P        6.5P     0.04P      3.3P      0.10P       8.0P
     Sept              13.2P     10.4P       5.7P     431P          11.9P   46.8P       2.6P    9.5P             13.6P    10.6P         0.07P        5.2P     0.05P      3.7P      0.10P       7.3P
                                                                                                                     p        p             p           p          p        p          p          p
     Dec                 ..        ..         ..         ..           ..      ..         ..      ..              15.2     11.9          0.07         5.1      0.04       3.4       0.10        7.8

Northern Ireland
1976                   26.4      17.3        1.3       50            9.9      ..        0.6          ..          17.0     11.2          0.48        18.3      0.35      13.3       0.59       22.3
1981                   27.2      17.0        1.9       69            9.6    45.4        1.4         4.2          16.3     10.6          0.36        13.2      0.23       8.3       0.42       15.3
1986                   28.0      17.8        3.6      127           10.2      ..        1.5          ..          16.1     10.3          0.36        13.2      0.23       8.3       0.42       15.3
1991                   26.0      16.2        5.3      203            9.2      ..        2.3          ..          15.1      9.4          0.19         7.4      0.12       4.6       0.22        8.4
1996                   24.4      14.7        6.3      260            8.3      ..        2.3          ..          15.2      9.2          0.14         5.8      0.09       3.7       0.23        9.4

1998                   23.7      14.1        6.7      284            7.8     ..         2.5         ..           15.0      8.9          0.13         5.6      0.09       3.9       0.20        8.1
1999                   23.0      13.7        7.0      303            7.6     ..         2.3         ..           15.7      9.3          0.15         6.4      0.11       4.8       0.23       10.0
2000                   21.5      12.8        6.8      318            7.6     ..         2.4         ..           14.9      8.9          0.11         5.1      0.82       3.8       0.15        7.3
2001                   22.0      13.0        7.1      325            7.3     ..         2.4         ..           14.5      8.6          0.13         6.1      0.98       4.5       0.19        8.5
                                                                                                                     p         p            p           p          p        p          p          p
2002                     ..        ..         ..         ..           ..     ..          ..         ..           14.6      8.6          0.10         4.7      0.73       3.4       0.19        8.8

2001 March              5.8      13.9        1.9      332            0.8     ..         0.6         ..            4.1      9.8          0.05         8.5      0.03       5.9       0.06        9.8
     June               5.3      12.7        1.7      312            2.0     ..         0.6         ..            3.6      8.5          0.03         5.4      0.02       3.9       0.04        7.4
     Sept               5.6      13.1        1.8      317            3.2     ..         0.5         ..            3.3      7.9          0.02         4.0      0.02       2.9       0.04        7.4
     Dec                5.3      12.4        1.8      341            1.3     ..         0.6         ..            3.5      8.2          0.03         6.5      0.03       5.1       0.05        9.1
2002 March              5.3p     12.8p       1.8p     336p           ..      ..         ..          ..            3.9p     9.3p         0.02p        4.5p     0.02p      3.6p      0.04p       7.9p
                            p         p          p        p
     June               5.3      12.7        1.8      331            ..      ..         ..          ..            3.5P     8.3P         0.03P        4.9P     0.02P      3.4P      0.05P       8.7P
     Sept               5.6p     13.0P       1.9P     334P           ..      ..         ..          ..            3.5P     8.3P         0.02P        4.1P     0.02P      2.9P      0.05P       8.6P
                                                                                                                     p         p            p           p          p        p          p          p
     Dec                 ..        ..         ..         ..          ..      ..         ..          ..            3.7      8.6          0.03         5.2      0.02       3.8       0.05       10.1
See notes opposite.                                                                                  6        Deaths under 4 weeks.
1    Per 1,000 population of all ages.                                                               7        Stillbirths and deaths under 1 week. In October 1992 the legal definition of a stillbirth
2    Per 1,000 live births.                                                                                   was changed, from baby born dead after 28 completed weeks of gestation or more, to
3    Persons marrying per 1,000 unmarried population 16 and over.                                             one born dead after 24 completed weeks of gestation or more.
4    Persons divorcing per 1,000 married population.                                                 8        Per 1,000 live births and stillbirths.
5    Deaths under 1 year.                                                                            p        Provisional.
                                                                                                     ..       Figures not available.




                                                                                                                                               45      National Statistics
        Health Statistics Quarterly 18                Summer 2003




 Table 2.2          Key demographic and health indicators

Constituent countries of the United Kingdom                                                                                             Numbers (thousands), rates, percentages, mean age

                                                                  Dependency ratio                      Live births                                     Expectation of
                                                                                                                                                         life (in years)
                                                                                                                                                             at birth6

                      Population    Live births    Deaths       Children1      Elderly2       TFR3        Outside     Mean age         Age-          Males         Females      Infant
                                                                                                        marriage as   of mother    standardised                                mortality
                                                                                                        percentage     at birth      mortality                                   rate5
                                                                                                          of total     (years)4        rate5
                                                                                                        live births

United Kingdom
1976                   56,216.1       675.5        680.8           42.1         29.5          1.74          9.0          26.4         10,486         69.6            75.2         14.5
1981                   56,357.5       730.7        658.0           37.1         29.7          1.82         12.5          26.8          9,506         70.8            76.8         11.2
1986                   56,683.8       754.8        660.7           33.5         29.7          1.78         21.4          27.0          8,914         71.9            77.7          9.5
1991                   57,438.9       792.3        646.2           33.2         30.0          1.82         29.8          27.7          8,168         73.2            78.7          7.4
1996                   58,043.0       733.2        636.0           33.9         30.0          1.73         35.5          28.6          7,591         74.2            79.4          6.1

1998                   58,305.3       716.9        629.2           33.7         30.1          1.72         37.6          28.9          7,364         74.7            79.7          5.7
1999                   58,481.1       700.0        632.1           33.6         30.0          1.69         38.8          28.9          7,328         75.0            79.9          5.8
                                                                                                                                                          p               p
2000                   58,643.2       679.0        608.4           33.3         30.0          1.65         39.5          29.1          6,985         75.3            80.1          5.6
2001                   58,836.7       669.1        602.3           32.8         29.9          1.63p        40.1p         29.2p         6,820           ..              ..          5.5
                                                        p                                                                                    p                                         p
2002                       ..            ..        608.0             ..           ..           ..            ..            ..          6,859           ..              ..          5.3

England
1976                   46,659.9       550.4        560.3           41.4         29.7          1.70          9.2          26.4         10,271           ..              ..         14.2
1981                   46,820.8       598.2        541.0           36.4         29.9          1.79         12.9          26.8          9,298         71.1            77.0         10.9
1986                   47,187.6       623.6        544.5           33.1         29.8          1.76         21.4          27.0          8,725         72.2            77.9          9.5
1991                   47,875.0       660.8        534.0           32.9         30.0          1.81         30.1          27.7          8,017         73.4            78.9          7.3
1996                   48,402.1       614.2        524.0           33.7         30.1          1.73         35.5          28.7          7,422         74.5            79.6          6.1

1998                   48,657.5       602.1        519.6           33.6         30.1          1.72         37.5          29.0          7,215         75.0            79.9          5.6
1999                   48,836.5       589.5        519.6           33.5         30.0          1.70         38.5          29.0          7,149         75.3p           80.1p         5.7
2000                   48,897.3       572.8        501.0           33.2         30.0          1.66         39.1          29.2          6,825         75.6            80.3          5.6
2001                   49,181.3       563.7        496.1           32.7         29.9          1.64         39.6          29.3          6,665           ..              ..          5.4
                                                        p                                                                                    p                                         p
2002                       ..            ..        500.8             ..           ..           ..            ..            ..          6,698           ..              ..          5.3

Wales
1976                   2,799.3         33.4         36.3           42.0         30.9          1.78          8.7          26.0         10,858           ..              ..         13.7
1981                   2,813.5         35.8         35.0           37.6         31.6          1.86         11.2          26.6          9,846         70.4            76.4         12.6
1986                   2,810.9         37.0         34.7           34.3         32.5          1.86         21.1          26.5          9,043         71.6            77.5          9.5
1991                   2,873.0         38.1         34.1           34.4         33.5          1.88         32.3          27.0          8,149         73.1            78.9          6.6
1996                   2,887.0         34.9         34.6           34.8         33.8          1.81         41.2          27.8          7,763         73.9            79.1          5.6

1998                   2,892.9         33.4         34.0           34.7         33.8          1.78         44.4          28.0          7,478         74.4            79.4          5.6
1999                   2,893.6         32.1         35.0           34.5         33.7          1.72         46.1          28.1          7,642         74.7            79.6          6.1
                                                                                                                                                          p               p
2000                   2,900.1         31.3         33.3           34.2         33.6          1.68         47.2          28.2          7,182         74.9            79.8          5.3
2001                   2,903.2         30.6         33.0           33.9         33.7          1.66         48.3          28.3          7,025           ..              ..          5.4
                                                         p                                                                                   p                                         p
2002                      ..             ..         33.3             ..           ..           ..            ..            ..          7,072           ..              ..          4.7

Scotland
1976                   5,233.4         64.9         65.3           44.7         28.4          1.80          9.3          26.0         11,675         68.2            74.4         14.8
1981                   5,180.2         69.1         63.8           38.2         28.4          1.84         12.2          26.3         10,849         69.1            75.3         11.3
1986                   5,111.8         65.8         63.5           33.6         28.1          1.67         20.6          26.6         10,120         70.2            76.2          8.8
1991                   5,083.3         67.0         61.0           32.4         28.9          1.69         29.1          27.4          9,216         71.4            77.1          7.1
1996                   5,092.2         59.3         60.7           32.3         29.2          1.56         36.0          28.5          8,791         72.2            77.9          6.2

1998                   5,077.1         57.3         59.2           31.9         29.6          1.55         39.0          28.8          8,432         72.6            78.2          5.5
1999                   5,072.0         55.1         60.3           31.7         29.7          1.51         41.2          28.9          8,493         72.8            78.4          5.0
2000                   5,062.9         53.1         57.8           31.4         29.8          1.48         42.6          29.0          8,082         73.1            78.6          5.7
2001                   5,064.2         52.5         57.4           30.8         30.0          1.49         43.3          29.2          7,930           ..              ..          5.5
                                                         p                                                                                   p                                         p
2002                      ..             ..         58.1             ..           ..           ..            ..            ..          8,008           ..              ..          5.2

Northern Ireland
1976                   1,523.5         26.4         17.0           56.1         25.3          2.70          5.0          27.4         11,746         67.5            73.8         18.3
1981                   1,543.0         27.2         16.3           50.6         25.3          2.59          7.0          27.5         10,567         69.2            75.5         13.2
1986                   1,573.5         28.0         16.1           46.1         25.5          2.44         12.8          27.5         10,071         70.9            77.1         10.2
1991                   1,607.3         26.0         15.1           44.1         26.1          2.16         20.3          28.0          8,303         72.6            78.4          7.4
1996                   1,661.8         24.4         15.2           41.8         25.5          1.96         26.0          28.8          7,742         73.8            79.2          5.8

1998                   1,677.8         23.7         15.0           40.7         25.4          1.90         28.5          29.0          7,460         74.3            79.5          5.6
1999                   1,679.0         23.0         15.7           40.2         25.5          1.86         30.3          29.0          7,699         74.5            79.6          6.4
2000                   1,682.9         21.5         14.9           39.5         25.4          1.75         31.8          29.2          7,279         74.8            79.8          5.1
2001                   1,689.3         22.0         14.5           38.6         25.5          1.80         32.5          29.4          6,976           ..              ..          6.1
                                                         p                                                                                   p                                         p
2002                      ..             ..         14.6             ..           ..           ..            ..            ..          7,034           ..              ..          4.7

Notes: Some of these indicators are also in other tables. They are brought together to make    3 TFR (total fertility rate) is the number of children that would be born to a woman if
       comparison easier.                                                                          current patterns of fertility persisted throughout her childbearing life. It is sometimes
       Figures for England and Wales represent the number of deaths registered in each year        called the TPFR (total period fertility rate).
       up to 1992, and the number of deaths occurring in each year from 1993.                  4 The mean ages shown in this table are not standardised for age and therefore take no
       From 1981 births to non-resident mothers in Northern Ireland are excluded from              account of the changing age structure of the population.
       the figures for Northern Ireland, and the United Kingdom.                               5 Per million population. The age-standardised mortality rate makes allowances for changes
1 Percentage of children under 16 to working population (males 16–64 and females 16–59).           in the age structure of the population. See Notes to tables.
2 Percentage of males 65 and over and females 60 and over to working population (males         5 Deaths under one year, per 1,000 live births.
  16–64 and females 16–59).                                                                    6. See ‘In brief’.
                                                                                               p Provisional.
                                                                                               . . Figures not available.




                       National Statistics           46
                                                                                                 Health Statistics Quarterly 18                  Summer 2003




 Table 3.1           Live births: age of mother

England and Wales                                                                                                                                  Numbers (thousands), rates, mean age and TFRs
                                          Age of mother at birth                                                         Age of mother at birth                                Mean1       TFR2
                                                                                                                                                                                 age
                                                                                                                                                                               (years)
Year and             All     Under      20–24      25–29       30–34      35–39      40 and       All       Under      20–24       25–29      30–34      35–39      40 and
quarter             ages      20                                                      over       ages        20                                                      over

                                           Total live births (numbers)                                                 Age-specific fertility rates3

1961              811.3       59.8      249.8       248.5      152.3       77.5       23.3       89.2       37.3       172.6       176.9       103.1     48.1        15.0       27.6       2.77

            1
1964(max)         876.0       76.7      276.1       270.7      153.5       75.4       23.6       92.9       42.5       181.6       187.3       107.7     49.8        13.7       27.2       2.93

1966              849.8       86.7      285.8       253.7      136.4       67.0       20.1       90.5       47.7       176.0       174.0        97.3     45.3        12.5       26.8       2.75

1971              783.2       82.6      285.7       247.2      109.6       45.2       12.7       83.5       50.6       152.9       153.2        77.1     32.8         8.7       26.2       2.37

1976              584.3       57.9      182.2       220.7       90.8       26.1        6.5       60.4       32.2       109.3       118.7        57.2     18.6         4.8       26.4       1.71

           1
1977(min)         569.3       54.5      174.5       207.9      100.8       25.5        6.0       58.1       29.4       103.7       117.5        58.6     18.2         4.4       26.5       1.66

1981              634.5       56.6      194.5       215.8      126.6       34.2        6.9       61.3       28.1       105.3       129.1        68.6     21.7         4.9       26.8       1.80

1986              661.0       57.4      192.1       229.0      129.5       45.5        7.6       60.6       30.1         92.7      123.8        78.0     24.6         4.8       27.0       1.77

1991              699.2       52.4      173.4       248.7      161.3       53.6        9.8       63.6       33.0         89.3      119.4        86.7     32.1         5.3       27.6       1.82

1992              689.7       47.9      163.3       244.8      166.8       56.7       10.2       63.6       31.7         86.2      117.5        87.3     33.4         5.8       27.9       1.80
1993              673.5       45.1      152.0       236.0      171.1       58.8       10.5       62.7       30.9         82.6      114.4        87.3     34.1         6.2       28.0       1.77
1994              664.7       42.0      140.2       229.1      179.6       63.1       10.7       62.0       28.9         79.1      112.4        89.3     35.8         6.4       28.4       1.75
1995              648.1       41.9      130.7       217.4      181.2       65.5       11.3       60.5       28.5         76.4      108.7        88.2     36.4         6.8       28.5       1.72
1996              649.5       44.7      125.7       211.1      186.4       69.5       12.1       60.6       29.7         77.0      106.9        89.7     37.5         7.2       28.6       1.74

1997              643.1       46.4      118.6       202.8      187.5       74.9       12.9       60.0       30.3         75.9      104.5        89.8     39.3         7.6       28.8       1.73
1998              635.9       48.3      113.5       193.1      188.5       78.9       13.6       59.3       31.2         74.9      101.6        90.7     40.4         7.9       28.9       1.72
1999              621.9       48.4      110.7       181.9      185.3       81.3       14.3       57.9       31.1         73.1       98.4        89.7     40.6         8.1       29.0       1.70
2000              604.4       45.8      107.7       170.7      180.1       85.0       15.1       56.0       29.5         70.2       94.5        88.1     41.4         8.4       29.1       1.66
2001              594.6       44.2      108.8       159.9      178.9       86.5       16.3       54.8       28.0         69.3       91.9        88.2     41.6         8.8       29.2       1.64

2000 March        148.7       11.4        26.4        42.5      44.1       20.6        3.6       55.4         30          69          95          87       40           8       29.1       1.64
     June         150.7       11.1        26.0        42.8      45.7       21.4        3.7       56.1         29          68          95          90       42           8       29.2       1.66
     Sept         155.0       11.8        27.8        43.6      46.2       21.7        3.9       57.1         30          72          96          90       42           9       29.1       1.69
     Dec          150.1       11.5        27.5        41.8      44.1       21.4        3.9       55.3         29          71          92          86       41           9       29.1       1.64

2001 March        145.5       11.0        26.5        39.8      43.3       21.0        4.0       54.5         28          69          91          86       41           9       29.2       1.62
     June         148.8       10.8        26.4        40.3      45.5       21.7        4.0       55.1         27          68          92          90       42           9       29.3       1.64
     Sept         153.0       11.4        28.1        41.0      46.4       22.0        4.1       56.6         29          72          94          92       42           9       29.2       1.68
     Dec          147.4       11.1        27.8        38.9      43.7       21.8        4.2       53.9         28          70          89          86       42           9       29.2       1.62

20024 Marchp      143.3       10.5        26.5       37.4       43.2       21.6        4.1       53.6         27          69          87          86       42           9       29.3       1.60
      Junep       147.2       10.4        26.7       37.9       45.5       22.4        4.3       54.5         27          68          87          90       43           9       29.4       1.62
      Septp       155.0       11.4        28.9       39.9       46.9       23.4        4.5       57.4         29          74          92          93       45          10       29.3       1.71

Note: The rates for women of all ages, under 20, and 40 and over are based upon the populations of women aged 15–44, 15–19, and 40–44 respectively.
1 The mean ages shown in this table are not standardised for age and therefore take no account of the changing age structure of the population.
2 TFR (total fertility rate) is the number of children that would be born to a woman if current patterns of fertility persisted throughout her childbearing life. It is sometimes called the TPFR
    (total period fertility rate). During the post Second World War period the TFR reached a maximum in 1964 and a minimum in 1977.
3 Births per 1,000 women in the age-group; all quarterly age-specific fertility rates are adjusted for days in the quarter. They are not adjusted for seasonality, and therefore have been revised
    from those previously published.
4 The rates and TFR for the quarters of 2002 are based on the mid-2001 population estimates.
p Provisional.




                                                                                                                                        47      National Statistics
           Health Statistics Quarterly 18               Summer 2003




Table 3.2             Live births outside marriage: age of mother and type of registration

England and Wales                                                                                                                                Numbers (thousands), mean age and percentages
                                       Age of mother at birth                                                           Age of mother at birth                                 Registration2

Year and             All     Under    20–24     25–29     30–34     35–39     40 and    Mean        All     Under       20–24     25–29      30–34    35–39    40 and           Joint          Sole
quarter             ages      20                                               over      age       ages      20                                                 over
                                                                                       (years)                                                                           Same Different
                                                                                                                                                                        address3 address3

                                Live births outside marriage (numbers)                                              Percentage of total live births                      As a percentage of all
                                                                                                                         in age-group                                   births outside marriage




                                                                                                                                                                        {
1971                65.7      21.6     22.0      11.5         6.2     3.2       1.1     23.7        8.4      26.1         7.7       4.7        5.7      7.0      9.0           45.5            54.5
1976                53.8      19.8     16.6       9.7         4.7     2.3       0.7     23.3        9.2      34.2         9.1       4.4        5.2      8.6     10.1           51.0            49.0
1981                81.0      26.4     28.8      14.3         7.9     1.3       0.9     23.4       12.8      46.7        14.8       6.6        6.2      3.9     12.5           58.2            41.8




                                                                                                                                                                        {
1986              141.3       39.6     54.1      27.7        13.1     5.7       1.1     23.8       21.4      69.0        28.2      12.1      10.1      12.6     14.7    46.6          19.6     33.8
1991              211.3       43.4     77.8      52.4        25.7     9.8       2.1     24.8       30.2      82.9        44.9      21.1      16.0      18.3     21.3    54.6          19.8     25.6

1992              215.2       40.1     77.1      55.9        28.9   10.9        2.3     25.2       31.2      83.7        47.2      22.8      17.3      19.3     22.9    55.4          20.7     23.9
1993              216.5       38.2     75.0      57.5        31.4   11.9        2.5     25.5       32.2      84.8        49.4      24.4      18.4      20.2     23.5    54.8          22.0     23.2
1994              215.5       35.9     71.0      58.5        34.0   13.4        2.7     25.8       32.4      85.5        50.6      25.5      18.9      21.2     25.2    57.5          19.8     22.7
1995              219.9       36.3     69.7      59.6        37.0   14.4        3.0     26.0       33.9      86.6        53.3      27.4      20.4      22.0     26.2    58.1          20.1     21.8
1996              232.7       39.3     71.1      62.3        40.5   16.2        3.2     26.1       35.8      88.0        56.5      29.5      21.7      23.4     26.7    58.1          19.9     21.9

1997              238.2       41.1     69.5      63.4        42.2   18.2        3.7     26.2       37.0      88.7        58.6      31.3      22.5      24.3     28.6    59.5          19.3     21.2
1998              240.6       43.0     67.8      62.4        43.9   19.6        3.9     26.3       37.8      89.1        59.7      32.3      23.3      24.8     29.0    60.9          18.3     20.8
1999              241.9       43.0     67.5      61.2        45.0   20.8        4.3     26.4       38.9      89.0        61.0      33.6      24.3      25.6     30.2    61.8          18.2     19.9
2000              238.6       41.1     67.5      59.1        43.9   22.3        4.7     26.5       39.5      89.7        62.6      34.6      24.4      26.2     31.0    62.7          18.2     19.2
2001p             238.1       39.5     68.1      56.8        45.2   23.3        5.1     26.7       40.0      89.5        62.6      35.5      25.3      26.9     31.6    63.2          18.4     18.4

1997 March          58.6      10.2     17.4      15.7        10.2     4.2       0.9     26.1       37.0      88.7        58.4      31.1      22.4      23.9     28.7    58.4          19.5     22.0
     June           58.9      10.1     17.1      15.5        10.6     4.7       0.9     26.3       36.1      89.1        58.0      30.1      22.0      24.3     28.4    59.6          19.4     21.0
     Sept           61.4      10.5     17.9      16.5        10.9     4.7       0.9     26.2       37.3      88.8        58.9      31.8      22.7      24.4     27.8    59.9          18.9     21.2
     Dec            59.3      10.4     17.2      15.7        10.4     4.6       0.9     26.2       37.8      88.3        59.2      32.2      23.0      24.8     29.3    60.0          19.2     20.7

1998 March          58.5      10.4     16.5      15.3        10.7     4.6       1.0     26.3       37.5      89.0        59.5      31.9      23.1      24.4     29.6    60.5          18.4     21.1
     June           58.4      10.3     16.2      15.4        10.8     4.7       0.9     26.3       36.8      89.6        59.1      31.8      22.5      24.0     28.3    61.0          18.2     20.8
     Sept           63.2      11.3     17.9      16.3        11.5     5.2       1.0     26.3       38.1      89.2        60.0      32.3      23.6      25.2     28.5    60.9          18.4     20.7
     Dec            60.5      11.0     17.2      15.4        10.9     5.0       1.0     26.3       38.9      88.5        60.4      33.3      24.0      25.7     29.7    61.2          18.4     20.4

1999 March          59.0      10.8     16.4      15.0        10.9     5.0       1.0     26.3       38.8      89.7        60.5      33.4      24.1      25.4     29.5    61.4          18.2     20.4
     June           59.8      10.5     16.5      15.3        11.2     5.2       1.1     26.5       38.0      89.2        60.6      33.0      23.4      25.3     31.3    61.6          18.2     20.1
     Sept           62.9      11.1     17.7      16.0        11.7     5.4       1.1     26.4       39.3      88.7        61.7      34.1      24.7      25.6     29.3    62.2          18.1     19.6
     Dec            60.2      10.6     17.0      14.9        11.1     5.3       1.1     26.4       39.5      88.4        61.2      34.0      24.8      26.2     30.8    62.0          18.4     19.5

2000 March          59.0      10.2     16.5      14.8        10.9     5.4       1.2     26.5       39.7      89.7        62.6      34.8      24.7      26.1     31.7    62.5          18.1     19.5
     June           57.9      10.0     16.1      14.4        10.9     5.5       1.1     26.6       38.5      89.7        61.9      33.5      23.8      25.7     30.6    62.9          17.8     19.2
     Sept           61.7      10.6     17.6      15.3        11.3     5.7       1.2     26.5       39.8      89.7        63.3      35.0      24.5      26.5     30.4    62.7          18.1     19.2
     Dec            60.1      10.3     17.3      14.7        10.9     5.7       1.2     26.5       40.0      89.5        62.8      35.2      24.7      26.6     31.4    62.6          18.6     18.8

2001 March          58.0       9.9     16.7      13.9        10.8     5.7       1.1     26.5       39.8      90.4        63.0      34.9      24.8      26.9     28.0    62.5          18.7     18.8
     June           58.1       9.6     16.3      14.1        11.2     5.7       1.3     26.7       39.1      89.0        61.5      34.9      24.5      26.4     32.2    63.3          18.6     18.6
     Sept           61.8      10.2     17.6      14.7        12.0     6.0       1.3     26.7       40.4      89.5        62.6      35.9      25.8      27.2     32.2    63.5          18.4     18.2
     Dec            60.2       9.9     17.5      14.1        11.3     5.9       1.4     26.7       40.9      89.2        63.1      36.4      25.9      27.2     33.9    63.4          18.6     18.0

2002 Marchp         58.0       9.4     16.7      13.6        10.9     6.0       1.3     26.8       40.5      89.4        63.0      36.4      25.4      27.7     31.5    63.2          18.5     18.3
     Junep          58.1       9.6     16.3      14.1        11.2     5.7       1.3     26.8       39.6      89.4        62.2      35.6      25.0      27.2     31.7    64.2          18.2     17.7
     Septp          63.4      10.2     18.4      14.6        12.3     6.5       1.5     26.8       40.9      89.3        63.8      36.6      26.1      27.9     32.7    63.9          18.5     17.5

1   The mean ages shown in this table are not standardised for age and therefore take no account of the changing age structure of the population.
2   Births outside marriage can be registered by both the mother and father (joint) or by the mother alone (sole).
3   Usual address(es) of parents.
p   Provisional.




                           National Statistics          48
                                                                                                  Health Statistics Quarterly 18               Summer 2003




 Table 4.1           Conceptions: age of women at conception

England and Wales (residents)                                                                                             Numbers (thousands) and rates; and percentage terminated by abortion

                                                                                               Age of woman at conception

Year and quarter           All ages          Under 16            Under 18           Under 20              20–24              25–29             30–34             35–39          40 and over

                     (a) numbers (thousands)
1991                       853.7           7.5                      40.1              101.6               233.3              281.5             167.5              57.6             12.1
1993                         819.0                7.3               35.8                87.2              203.6              271.7             181.0              63.0             12.6
1994                         801.6                7.8               36.1                85.4              190.4              261.8             185.0              66.2             12.9
1995                         790.3                8.1               37.9                86.6              181.1              250.3             190.3              68.7             13.2
1996                         816.9                8.9               43.5                94.9              179.8              252.6             200.0              75.5             14.1
1997                         800.4                8.3               43.4                96.0              167.3              242.6             200.9              78.9             14.7
1998                         797.0                8.5               44.1              101.6               163.3              232.4             201.4              82.9             15.4
1999                         774.0                7.9               42.0               98.8               157.6              218.5             197.1              86.0             16.0
2000p                        767.0                8.1               41.3               97.7               159.0              209.3             195.3              88.7             17.0
2001                         763.3                7.9               41.0               95.9               161.6              199.2             196.6              92.2             17.8
1999 March                   191.5                1.9               10.4                24.9                39.6               54.3              48.4             20.6               3.8
     June                    190.4                2.0               10.5                24.4                39.1               53.8              47.9             21.2               4.1
     Sept                    194.0                2.0               10.4                24.1                38.4               54.7              50.7             22.1               4.1
     Dec                     198.0                2.1               10.8                25.4                40.5               55.6              50.2             22.2               4.1
2000 March                   193.1                2.0               10.5                25.1                40.4               53.2              48.3             21.9               4.2
     June                    188.7                2.1               10.4                24.3                39.3               51.5              47.5             21.8               4.3
     Sept                    190.0                2.1               10.0                23.5                38.4               52.0              49.7             22.2               4.2
     Dec                     195.2                2.0               10.4                24.7                40.9               52.7              49.8             22.7               4.3
2001 Marchp                  189.2                1.9               10.2                24.3                40.4               50.0              47.8             22.3               4.4
     Junep                   187.4                2.1               10.2                24.0                39.8               48.8              47.7             22.8               4.4
     Septp                   189.3                1.9               10.0                23.1                39.2               49.5              49.9             23.2               4.4
     DecP                    197.4                2.0               10.6                24.5                42.2               51.0              51.2             23.9               4.7
2002 Marchp                  191.7                1.9               10.2                23.9                41.1               48.6              48.9             23.6               4.6
                   (b) rates (conceptions per thousand women in age group)
1991                          77.7            8.9         44.6             64.1                           120.2              135.1               90.1             34.4               6.6
1993                            76.2              8.1               42.3                59.7              110.6              131.7               92.4             36.6               7.4
1994                            74.8              8.3               41.8                58.7              107.4              128.4               92.0             37.6               7.6
1995                            73.8              8.6               42.0                58.8              105.9              125.1               92.7             38.1               8.0
1996                            76.2              9.6               46.4                63.1              110.1              127.9               96.2             40.7               8.4
1997                            74.7              9.0               46.3                62.8              107.1              125.0               96.2             41.4               8.7
1998                            74.3              9.0               47.6                65.8              107.7              122.2               96.9             42.4               8.9
1999                            72.0              8.3               45.8                63.4              104.0              118.2               95.5             42.9               9.1
2000                            71.0              8.3               44.1                62.8              103.5              115.9               95.6             43.2               9.4
2001P                           70.4              8.0               42.5                60.9              102.9              114.5               96.9             44.4               9.6
1999 March                      72.3              8.0               45.8                65.0              106.0              117.9               94,8             42.0               8.8
     June                       71.1              8.5               45.6                62.9              103.5              116.4               93.0             42.5               9.3
     Sept                       71.6              8.1               44.7                61.5              100.3              117.8               97.5             43.5               9.1
     Dec                        73.0              8.5               46.2                64.7              105.7              120.3               96.8             43.6               9.2
2000 March                      72.1              8.5               45.6                65.0              106.3              117.3               94.7             43.4               9.4
     June                       70.3              8.5               44.8                62.8              103.2              114.3               93.4             43.0               9.6
     Sept                       70,0              8.3               42.2                60.1               99.1              115.1               96.8             42.9               9.3
     Dec                        71.8              8.0               43.7                62.9              105.1              117.7               97.2             43.9               9.5
2001 Marchp                     70.9              7.8               43.3                63.0              105.3              114.9              95.3              43.8              9.7
     Junep                      69.4              8.4               42.7                61.1              101.8              111.9              94.3              44.1              9.5
     Septp                      69.3              7.7               41.1                58.1               99.0              112.9              97.7              44.3              9.4
     DecP                       72.2              8.0               43.5                61.8              106.5              116.3             100.1              45.6             10.0
2002 Marchp                     71.7              7.6               42.9                61.6              106.1              113.4               97.7             46.0             10.1
                   (c) percentage terminated by abortion
1991                         19.4          51.1                     39.9                34.5                22.2               13.4              13.7             22.0             41.6
1993                            19.2             49.9               39.2                34.3                22.8               13.9              13.5             21.5             40.2
1994                            19.5             50.3               39.8                34.7                23.4               14.3              13.6             21.1             40.9
1995                            19.7             47.6               38.7                34.6                24.2               14.8              13.6             20.7             38.0
1996                            20.8             49.2               40.0                36.2                25.7               15.6              14.1             21.2             37.6
1997                            21.3             49.7               40.6                36.8                26.7               16.4              14.2             21.0             38.0
1998                            22.3             52.4               42.0                37.8                27.8               17.1              14.9             21.5             37.9
1999                            22.6             52.6               43.0                38.6                28.5               17.5              14.7             21.2             37.0
2000                            22.7             54.0               44.2                39.3                29.2               17.7              14.5             20.5             35.4
2001P                           23.2             55.7               45.7                40.3                29.7               18.3              14.6             20.4             34.6
1999 March                      22.3             51.4               42.0                38.0                27.9               17.2              14.7             21.6             36.2
     June                       23.0             52.9               43.5                38.6                28.6               18.0              15.5             21.5             37.8
     Sept                       22.1             52.7               43.1                38.7                28.5               17.2              14.1             20.6             37.3
     Dec                        22.8             53.5               43.6                39.1                29.2               17.7              14.7             21.2             36.6
2000 March                      22.9             53.8               44.3                39.6                29.6               17.7              14.5             20.4             35.3
     June                       23.2             55.1               44.4                39.2                29.7               18.1              15.1             20.9             35.1
     Sept                       22.0             53.2               43.8                38.7                28.2               17.4              14.0             19.8             35.4
     Dec                        22.8             54.0               44.1                39.8                29.2               17.5              14.4             20.8             35.9
2001 Marchp                     23.4             54.3               44.9                40.1                29.8               18.5              14.8             20.7             34.9
     Junep                      23.8             58.8               47.0                41.1                30.3               18.6              15.3             21.0             36.0
     Septp                      22.5             55.0               45.7                40.1                29.2               18.1              13.8             20.0             33.5
     DecP                       22.9             54.7               45.1                40.0                29.5               18.0              14.3             20.2             34.0
2002 March1                     22.5             53.6               44.3                39.7                29.1               17.8              13.9             19.5             34.8
Notes:    Conceptions are estimates derived from birth registrations and abortion notifications.
          Rates for women of all ages, under 16, under 18, under 20 and 40 and over are based on the population of women aged 15–44, 13–15, 15–17, 15–19 and 40–44 respectively.
For a quarterly analysis of conceptions under 18 for local authority areas see the National Statistics website, www.statistics.gov.uk.
1 Provisional estimates based on incomplete abortion data.
p Provisional.


                                                                                                                                         49    National Statistics
           Health Statistics Quarterly 18               Summer 2003




    Table 4.2          Abortions: residents and non-residents; age and gestation (residents only)                                                                        England and Wales

England and Wales                                                                                                          Numbers (thousands) and rates; and percentages for gestation weeks

                                                                                                                          All women (residents)
                                       All ages                                                   Age group                                            Gestation weeks (percentages)

Year and quarter            All1       Residents1      Non-1       Under      16–19       20–24      25–29       30–34      35–44       45 and      Under       9–12       13–19      20 and
          women                        residents        16                                                                   over         9                                 over

                         Numbers (thousands)                                                                                                        Percentages
1971                     126.8        94.6              32.2        2.3        18.2        24.5        17.3        14.2      15.9         0.5        16.6     57.9           21.8        1.0
1976                     129.7       101.9              27.8        3.4        24.0        23.6        19.3        14.6      14.7         0.5        24.8     55.8           15.0        1.1
1981                     162.5       128.6              33.9        3.5        31.4        34.3        21.9        18.7      17.6         0.6        31.0     53.4           13.5        1.3
1986                     172.3       147.6              24.7        3.9        33.8        45.3        28.7        18.0      17.5         0.4        33.4     53.8           11.5        1.4
1991                     179.5       167.4              12.1        3.2        31.1        52.7        38.6        23.4      17.9         0.4        35.2     52.9           10.6        1.2
1992                       172.1         160.5          11.6        3.0        27.6        49.1        38.4        23.9      18.1         0.5       36.8         51.8        10.3        1.2
1993                       168.7         157.8          10.9        3.1        25.8        46.8        38.1        24.7      18.8         0.5       39.2         49.7         9.9        1.2
1994                       166.9         156.5          10.3        3.2        25.2        44.9        38.1        25.5      19.2         0.4       40.5         48.4         9.9        1.2
1995                       163.6         154.3           9.3        3.3        24.9        43.4        37.3        25.8      19.2         0.5       41.9         47.3         9.6        1.2
1996                       177.5         167.9           9.6        3.6        28.8        46.4        39.3        28.2      21.1         0.4       40.0         48.7        10.1        1.3
1997                       179.7         170.1           9.6        3.4        29.9        45.0        40.2        28.9      22.3         0.5       41.2         47.9         9.6        1.2
1998                       187.4         177.9           9.5        3.8        33.2        45.8        40.4        30.4      23.8         0.5       41.4         47.6         9.7        1.3
1999                       183.2         173.7           9.5        3.6        32.8        45.0        38.5        29.1      24.1         0.5       42.5         46.5         9.5        1.4
2000p                      185.4         175.5           9.8        3.7        33.2        47.1        37.9        28.7      24.4         0.5       43.3         45.0        10.3        1.5
2001                       186.32        176.42          9.9        3.7        33.4        48.3        36.5        28.8      25.2         0.5       42.8         45.0        10.6        1.6
1997 March                  46.2          43.6           2.5        0.9         7.7        11.8        10.3         7.3       5.5         0.1       37.4         50.2        11.1        1.3
     June                   45.2          42.8           2.4        0.8         7.4        11.4        10.2         7.2       5.6         0.1       41.3         48.0         9.4        1.2
     Sept                   45.1          42.7           2.4        0.9         7.5        11.1        10.0         7.3       5.8         0.1       42.0         47.2         9.6        1.2
     Dec                    43.3          41.0           2.3        0.8         7.4        10.7         9.6         7.0       5.4         0.1       44.5         46.0         8.3        1.2
1998 March                  48.4          45.9           2.5        1.0         8.7        12.0        10.5         7.7       5.8         0.1       37.5         50.4        10.8        1.3
     June                   46.4          44.0           2.4        0.9         8.1        11.4        10.1         7.6       5.8         0.1       40.8         48.3         9.5        1.4
     Sept                   46.9          44.5           2.4        1.0         8.3        11.3        10.0         7.6       6.2         0.1       42.5         46.7         9.5        1.2
     Dec                    45.7          43.5           2.2        0.9         8.1        11.0         9.8         7.5       5.9         0.1       44.9         45.0         8.9        1.2
1999 March                  47.5          45.2           2.4        0.9         8.7        11.8        10.0         7.5       6.1         0.1       40.1         48.2        10.3        1.5
     June                   45.3          42.9           2.4        0.9         8.0        11.1         9.6         7.2       5.9         0.1       42.3         46.9         9.3        1.4
     Sept                   45.8          43.4           2.4        0.9         8.2        11.2         9.5         7.3       6.1         0.1       43.1         46.1         9.3        1.4
     Dec                    44.6          42.3           2.4        0.9         7.9        10.9         9.4         7.0       6.0         0.1       44.7         44.7         9.2        1.4
2000 March                  49.5          46.9           2.6        1.0         9.1        12.5        10.2         7.5       6.4         0.1       38.9         47.9        11.6        1.6
     June                   45.8          43.4           2.5        0.9         8.2        11.8         9.2         7.1       6.0         0.1       42.2         46.0        10.3        1.4
     Sept                   46.1          43.6           2.5        1.0         8.1        11.5         9.5         7.3       6.1         0.1       44.5         44.0        10.1        1.4
     Dec                    43.9          41.7           2.2        0.9         7.8        11.2         8.9         6.8       5.9         0.1       47.8         41.7         9.0        1.4
2001 MarchP                 47.8          45.3           2.5        0.9         8.7        12.4         9.4         7.3       6.4         0.1       40.5         46.3        11.6        1.5
     JuneP                  46.6          44.1           2.5        0.9         8.3        12.1         9.1         7.2       6.3         0.1       42.0         45.8        10.6        1.6
     SeptP                  46.2          43.8           2.4        1.0         8.2        11.8         9.1         7.3       6.3         0.1       43.1         44.7        10.6        1.5
     DecP                   45.6          43.3           2.4        0.9         8.2        11.9         8.9         7.0       6.2         0.1       45.7         43.1         9.7        1.6
2002 MarchP                 47.0          44.5           2.5        0.9         8.4        12.4         9.1         7.2       6.4         0.1       38.9         47.4        12.0        1.6
     June5 P                45.5          43.0           2.4        0.8         7.8        11.9         8.9         7.0       6.4         0.1       42.2         45.3        10.9        1.6
     SeptP                  45.3          42.9           2.5        0.9         8.0        11.6         8.7         7.1       6.4         0.2       42.8         45.0        10.7        1.5
Rates (per thousand women residents)
                     ASR3        Crude rate2
                 (women 15–44) (women 15–44)
1971                   9.9         10.1                   :         2.3        13.9        13.1        10.7        10.0       5.6         0.3
1976                  10.2         10.5                   :         2.9        16.9        14.2        10.4         9.2       5.3         0.3
1981                  11.9         12.4                   :         3.0        19.4        18.6        13.1        10.1       5.9         0.4
1986                  13.0         13.5                   :         3.7        22.0        21.9        15.5        10.8       5.1         0.3
1991                  15.0         15.2                   :         3.8        24.0        27.1        18.5        12.6       5.1         0.3
1992                        14.6           14.8           :         3.5        22.3        25.9        18.5        12.5       5.2         0.3
1993                        14.5           14.7           :         3.4        21.9        25.4        18.5        12.6       5.5         0.3
1994                        14.6           14.6           :         3.5        21.9        25.3        18.7        12.7       5.6         0.2
1995                        14.5           14.4           :         3.5        21.5        25.4        18.6        12.5       5.5         0.3
1996                        16.0           15.7           :         3.9        24.3        28.4        19.9        13.6       6.0         0.2
1997                        16.3           15.9           :         3.7        24.4        28.8        20.7        13.8       6.2         0.3
1998                        17.2           16.6           :         4.0        26.8        30.2        21.2        14.6       6.5         0.3
1999                        16.8           16.2           :         3.8        26.3        29.7        20.8        14.1       6.4         0.3
2000                        17.0           16.3           :         3.8        26.9        30.7        21.0        14.1       6.3         0.3
2001p                       17.1           16.3           :         3.7        26.8        30.7        21.0        14.2       6.4         0.3
1997 March                  16.7           16.3           :         3.8        25.4        29.6        21.2        14.1       6.2         0.2
     June                   16.4           16.0           :         3.7        24.1        29.1        20.9        13.9       6.2         0.3
     Sept                   16.3           15.9           :         3.8        24.4        28.4        20.7        14.1       6.4         0.3
     Dec                    15.8           15.3           :         3.6        24.1        27.7        20.0        13.4       5.9         0.3
1998 March                  17.7           17.1           :         4.2        28.2        31.4        21.8        14.8       6.4         0.3
     June                   17.0           16.4           :         3.8        26.2        29.9        21.2        14.5       6.3         0.3
     Sept                   17.2           16.6           :         4.1        26.7        29.9        21.2        14.7       6.7         0.3
     Dec                    16.8           16.2           :         3.9        26.1        29.1        20.8        14.5       6.4         0.3
1999 March                  17.5           16.8           :         3.9        28.0        31.2        21.3        14.6       6.5         0.3
     June                   16.6           16.0           :         3.6        25.8        29.3        20.7        14.0       6.3         0.3
     Sept                   16.8           16.2           :         3.7        26.4        29.5        20.7        14.2       6.5         0.3
     Dec                    16.3           15.7           :         3.8        25.4        28.6        20.5        13.7       6.3         0.3
2000 March                  18.2           17.4           :         4.2        29.4        32.9        22.4        14.7       6.7         0.3
     June                   16.8           16.1           :         3.6        26.4        30.7        20.4        13.9       6.3         0.3
     Sept                   16.9           16.1           :         4.0        26.4        30.0        21.1        14.2       6.3         0.3
     Dec                    16.2           15.4           :         3.6        25.3        29.0        20.0        13.4       6.0         0.2
2001 MarchP                 17.6           16.7           :         3.6        28.0        31.9        21.2        14.4       6.6         0.3
     JuneP                  17.1           16.3           :         3.7        26.7        30.9        20.9        14.2       6.4         0.3
     Sept4, P               16.9           16.1           :         3.9        26.1        30.1        20.9        14.4       6.4         0.3
     Dec4, P                16.8           16.0           :         3.6        26.4        30.3        20.5        13.8       6.3         0.2
2002 March4, P              17.3           16.4           :         3.6        27.0        31.7        20.9        14.1       6.6         0.2
     June4,5 P              16.7           15.9           :         3.4        24.9        30.4        20.5        13.7       6.6         0.3
     Sept4, P               16.6           15.8           :         3.7        25.5        29.6        20.0        14.1       6.5         0.4
1     Includes cases with not stated age and/or gestation week.
2     Includes incomplete forms that have been returned to practitoners.
3     Rates for all women residents age-standardised to the European population for ages 15–44.
4     The denominators used to calculate the quarterly rates are 2001 mid-year population estimates. Rates for Under 16 and 45 and over are based on female populations aged 13–15 and
      45–49 respectively.
5     Provisional estimates based on 2 months forms; the reporting form has been revised and a new data processing system is in use; data quality implications arising from these changes are
      being investigated and will be reported in due course.
p     Provisional
                         National Statistics           50
                                                                                                  Health Statistics Quarterly 18                  Summer 2003




 Table 5.1           Expectation of life at birth and selected age

Constituent countries of the United Kingdom                                                                                                                                                 Years
                                                          Males                                                                                        Females

Year                    At                             At age                                        Year                 At                                 At age
                       birth                                                                                             birth
                                  5        20        30           50    60        70     80                                          5          20      30        50       60        70      80

United Kingdom
1981                   70.8      66.9     52.3      42.7      24.1     16.3      10.1    5.8         1981                76.8       72.7        57.9   48.2       29.2    20.8      13.3     7.5
1986                   71.9      67.8     53.2      43.6      24.9     16.8      10.5    6.0         1986                77.7       73.4        58.6   48.8       29.8    21.2      13.8     7.8
1991                   73.2      68.9     54.2      44.7      26.0     17.7      11.1    6.4         1991                78.7       74.3        59.5   49.7       30.6    21.9      14.3     8.2

1994                   73.8      69.4     54.7      45.2      26.5     18.1      11.3    6.4         1994                79.1       74.6        59.8   50.0       30.9    22.1      14.4     8.3
1995                   74.1      69.7     55.0      45.4      26.7     18.4      11.5    6.5         1995                79.3       74.8        60.0   50.2       31.1    22.3      14.5     8.4
1996                   74.2      69.8     55.1      45.6      26.9     18.5      11.6    6.6         1996                79.4       74.9        60.1   50.3       31.2    22.3      14.5     8.3
1997                   74.5      70.1     55.4      45.9      27.2     18.7      11.7    6.7         1997                79.6       75.1        60.2   50.4       31.3    22.5      14.6     8.4
1998                   74.7      70.3     55.6      46.1      27.4     18.9      11.9    6.7         1998                79.7       75.2        60.3   50.5       31.4    22.6      14.7     8.4
1999                   75.0      70.6     55.8      46.3      27.6     19.2      12.0    6.8         1999                79.9       75.4        60.5   50.7       31.6    22.8      14.8     8.5
2000p                  75.3      70.9     56.1      46.6      27.9     19.5      12.2    7.0         2000                80.1       75.6        60.8   50.9       31.8    23.0      15.0     8.6

England and Wales
1981              71.0           67.1     52.5      42.9      24.3     16.4      10.1    5.8         1981                77.0       72.9        58.1   48.3       29.4    20.9      13.4     7.5
1986              72.1           68.0     53.4      43.8      25.0     16.9      10.5    6.1         1986                77.9       73.6        58.8   49.0       30.0    21.4      13.9     7.9
1991              73.4           69.1     54.4      44.8      26.1     17.8      11.2    6.4         1991                78.9       74.5        59.7   49.9       30.8    22.0      14.4     8.3

1994                   74.0      69.6     54.9      45.4      26.6     18.2      11.4    6.5         1994                79.3       74.8        60.0   50.2       31.1    22.2      14.5     8.3
1995                   74.3      69.9     55.2      45.6      26.9     18.5      11.5    6.6         1995                79.5       75.0        60.2   50.3       31.2    22.4      14.6     8.4
1996                   74.5      70.1     55.3      45.8      27.1     18.6      11.6    6.6         1996                79.6       75.1        60.2   50.4       31.3    22.5      14.6     8.4
1997                   74.7      70.3     55.6      46.1      27.3     18.9      11.8    6.7         1997                79.7       75.2        60.4   50.6       31.5    22.6      14.7     8.4
1998                   75.0      70.5     55.8      46.3      27.6     19.1      11.9    6.8         1998                79.9       75.3        60.5   50.7       31.6    22.7      14.8     8.4
1999                   75.2      70.8     56.1      46.5      27.8     19.3      12.1    6.9         1999                80.1       75.6        60.7   50.9       31.8    22.9      14.9     8.5
     p
2000                   75.6      71.1     56.4      46.8      28.1     19.6      12.3    7.0         2000                80.3       75.8        60.9   51.1       32.0    23.1      15.1     8.6

England
1981                   71.1      67.1     52.5      42.9      24.3     16.4      10.1    5.8         1981                77.0       72.9        58.2   48.4       29.4    20.9      13.4     7.5
1986                   72.2      68.1     53.4      43.8      25.1     17.0      10.6    6.1         1986                77.9       73.6        58.8   49.0       30.0    21.4      13.9     7.9
1991                   73.4      69.1     54.4      44.9      26.2     17.8      11.2    6.4         1991                78.9       74.5        59.7   49.9       30.8    22.0      14.4     8.3

1994                   74.1      69.7     55.0      45.4      26.7     18.3      11.4    6.5         1994                79.3       74.8        60.0   50.2       31.1    22.2      14.5     8.3
1995                   74.3      69.9     55.2      45.7      26.9     18.5      11.6    6.6         1995                79.5       75.0        60.2   50.4       31.3    22.4      14.6     8.4
1996                   74.5      70.1     55.4      45.8      27.1     18.7      11.7    6.6         1996                79.6       75.1        60.3   50.4       31.3    22.5      14.6     8.4
1997                   74.8      70.4     55.6      46.1      27.4     18.9      11.8    6.7         1997                79.8       75.3        60.4   50.6       31.5    22.6      14.7     8.4
1998                   75.0      70.6     55.8      46.3      27.6     19.1      12.0    6.8         1998                79.9       75.4        60.5   50.7       31.6    22.7      14.8     8.5
1999                   75.3      70.8     56.1      46.6      27.8     19.3      12.1    6.9         1999                80.1       75.6        60.7   50.9       31.8    22.9      14.9     8.5
     p
2000                   75.6      71.2     56.4      46.9      28.2     19.6      12.4    7.0         2000                80.3       75.8        61.0   51.2       32.0    23.1      15.1     8.6

Wales
1981                   70.4      66.5     51.9      42.2      23.6     15.8       9.7    5.6         1981                76.4       72.3        57.5   47.7       28.9    20.5      13.1     7.4
1986                   71.6      67.5     52.8      43.2      24.6     16.6      10.3    6.0         1986                77.5       73.3        58.5   48.7       29.7    21.1      13.7     7.8
1991                   73.1      68.8     54.1      44.6      25.8     17.6      11.0    6.4         1991                78.8       74.3        59.5   49.7       30.6    21.8      14.3     8.3

1994                   73.4      69.0     54.3      44.8      26.1     17.8      11.1    6.4         1994                78.9       74.4        59.5   49.7       30.7    21.9      14.3     8.2
1995                   73.7      69.2     54.6      45.1      26.4     18.1      11.3    6.5         1995                79.1       74.6        59.7   49.9       30.8    22.0      14.4     8.3
1996                   73.9      69.4     54.7      45.3      26.6     18.2      11.3    6.4         1996                79.1       74.6        59.7   49.9       30.9    22.1      14.4     8.3
1997                   74.2      69.8     55.1      45.6      26.9     18.5      11.6    6.6         1997                79.3       74.8        59.9   50.1       31.0    22.2      14.5     8.4
1998                   74.4      69.9     55.2      45.8      27.1     18.6      11.6    6.6         1998                79.4       74.9        60.0   50.2       31.1    22.3      14.5     8.3
1999                   74.7      70.2     55.5      46.0      27.4     18.9      11.9    6.8         1999                79.6       75.0        60.2   50.4       31.3    22.5      14.6     8.4
     p
2000                   74.9      70.5     55.7      46.3      27.6     19.1      12.0    6.8         2000                79.8       75.2        60.4   50.6       31.5    22.6      14.7     8.4

Scotland
1981                   69.1      65.2     50.6      41.1      22.9     15.4       9.6    5.5         1981                75.3       71.2        56.4   46.7       27.9    19.7      12.7     7.2
1986                   70.2      66.0     51.4      41.9      23.5     15.8       9.9    5.7         1986                76.2       71.9        57.1   47.3       28.4    20.1      13.0     7.5
1991                   71.4      67.1     52.5      43.0      24.6     16.6      10.4    6.1         1991                77.1       72.7        57.9   48.1       29.2    20.7      13.5     7.9

1994                   71.9      67.5     52.8      43.4      25.0     17.0      10.6    6.2         1994                77.4       73.0        58.2   48.4       29.4    20.9      13.5     7.9
1995                   72.1      67.7     53.0      43.6      25.2     17.2      10.8    6.3         1995                77.7       73.2        58.4   48.6       29.7    21.1      13.8     8.0
1996                   72.2      67.8     53.1      43.7      25.3     17.3      10.9    6.3         1996                77.9       73.3        58.5   48.8       29.8    21.2      13.8     8.0
1997                   72.4      68.0     53.3      43.9      25.6     17.5      11.0    6.4         1997                78.0       73.5        58.7   48.9       30.0    21.4      13.9     8.0
1998                   72.6      68.2     53.5      44.2      25.8     17.8      11.1    6.5         1998                78.2       73.6        58.8   49.0       30.1    21.4      13.9     8.0
1999                   72.8      68.4     53.7      44.4      26.0     18.0      11.3    6.6         1999                78.4       73.8        59.0   49.2       30.3    21.6      14.0     8.1
     p
2000                   73.1      68.6     53.9      44.6      26.3     18.2      11.5    6.6         2000                78.6       74.0        59.2   49.4       30.5    21.8      14.1     8.1

Northern Ireland
1981                   69.2      65.4     50.9      41.5      23.2     15.6       9.7    5.8         1981                75.5       71.6        56.8   47.1       28.3    20.0      12.8     7.3
1986                   70.9      66.8     52.2      42.7      24.2     16.4      10.4    6.2         1986                77.1       72.9        58.1   48.3       29.3    20.8      13.4     7.8
1991                   72.6      68.2     53.6      44.1      25.5     17.3      11.0    6.4         1991                78.4       74.0        59.2   49.4       30.3    21.6      14.2     8.3

1994                   73.1      68.8     54.2      44.7      26.0     17.8      11.2    6.6         1994                78.7       74.2        59.4   49.6       30.6    21.9      14.3     8.4
1995                   73.5      69.1     54.5      45.0      26.3     18.0      11.3    6.6         1995                78.9       74.5        59.6   49.8       30.8    22.0      14.4     8.4
1996                   73.8      69.4     54.7      45.3      26.6     18.2      11.4    6.6         1996                79.2       74.7        59.9   50.0       30.9    22.1      14.4     8.4
1997                   74.2      69.7     55.0      45.5      26.8     18.4      11.5    6.6         1997                79.5       75.0        60.2   50.3       31.2    22.4      14.5     8.4
1998                   74.3      69.8     55.2      45.7      27.0     18.6      11.6    6.6         1998                79.5       75.0        60.2   50.4       31.2    22.4      14.5     8.2
1999                   74.5      70.0     55.4      45.9      27.2     18.8      11.7    6.6         1999                79.6       75.1        60.2   50.4       31.3    22.5      14.6     8.2
2000                   74.8      70.4     55.7      46.2      27.6     19.1      11.9    6.6         2000                79.8       75.2        60.4   50.6       31.5    22.6      14.6     8.2
Note: Figures from 1981 are calculated from the population estimates revised in the light of the 2001 Census; see ‘In brief’. All figures are based on a three-year period; see Notes to tables for
      further information.
      P provisional



                                                                                                                                           51     National Statistics
         Health Statistics Quarterly 18              Summer 2003




 Table 6.1          Deaths: age and sex

England and Wales                                                                                                                                      Numbers (thousands) and rates
                                                                                                     Age group

Year and quarter     All ages    Under 11     1–4         5–9       10–14       15–19      20–24       25–34       35–44      45–54       55–64      65–74     75–84    85 and over

Numbers (thousands)

Males
1976                  300.1       4.88        0.88        0.68       0.64        1.66       1.66        3.24        5.93       20.4        52.0      98.7       80.3       29.0
1981                  289.0       4.12        0.65        0.45       0.57        1.73       1.58        3.18        5.54       16.9        46.9      92.2       86.8       28.5
1986                  287.9       3.72        0.57        0.33       0.38        1.43       1.75        3.10        5.77       14.4        43.6      84.4       96.2       32.2
1991                  277.6       2.97        0.55        0.34       0.35        1.21       1.76        3.69        6.16       13.3        34.9      77.2       95.8       39.3
1996                  268.7       2.27        0.44        0.24       0.29        0.93       1.41        4.06        5.84       13.6        30.1      71.0       90.7       47.8

1998                  264.7       2.07        0.41        0.24       0.29        0.88       1.29        4.01        5.90       13.6        29.1      66.1       90.5       50.4
1999                  264.3       2.08        0.41        0.22       0.28        0.90       1.27        3.85        5.93       13.6        28.7      64.3       90.4       52.3
2000                  255.5       1.89        0.34        0.22       0.28        0.87       1.22        3.76        6.05       13.4        27.9      60.6       87.1       51.9
2001                  252.4       1.81        0.32        0.19       0.28        0.88       1.27        3.63        6.07       13.3        27.5      57.5       87.0       52.7
2002P                 254.4       1.83        0.33        0.20       0.29        0.91       1.31        3.67        6.26       13.0        27.8      56.6       88.5       53.7

Females
1976                  298.5       3.46        0.59        0.45       0.42        0.62       0.67        1.94        4.04       12.8        29.6      67.1      104.7       72.1
1981                  288.9       2.90        0.53        0.30       0.37        0.65       0.64        1.82        3.74       10.5        27.2      62.8      103.6       73.9
1986                  293.3       2.59        0.49        0.25       0.27        0.56       0.67        1.65        3.83        8.8        25.8      58.4      106.5       83.6
1991                  292.5       2.19        0.44        0.25       0.22        0.46       0.64        1.73        3.70        8.4        21.3      54.2      103.3       95.7
1996                  291.5       1.69        0.32        0.18       0.20        0.43       0.51        1.85        3.66        8.9        18.2      50.2       96.7      108.7

1998                  290.3       1.56        0.31        0.18       0.19        0.41       0.48        1.72        3.68        9.1        17.9      46.9       94.7      113.2
1999                  291.8       1.55        0.30        0.17       0.22        0.39       0.47        1.67        3.79        9.0        18.0      45.1       93.9      117.2
2000                  280.1       1.49        0.25        0.16       0.18        0.38       0.47        1.69        3.87        9.1        17.6      42.2       89.3      113.4
2001                  277.9       1.43        0.27        0.19       0.18        0.38       0.47        1.59        3.77        8.9        17.6      40.5       88.8      113.9
2002P                 281.0       1.34        0.24        0.16       0.20        0.39       0.47        1.60        3.77        8.7        17.8      39.6       90.2      116.4

Rates (deaths per 1,000 population in each age group)

Males
1976                   12.5       16.2        0.65        0.34       0.31        0.88       0.96        0.92        2.09       6.97        19.6      50.3      116.4      243.2
1981                   12.0       12.6        0.53        0.27       0.29        0.82       0.83        0.89        1.83       6.11        17.7      45.6      105.2      226.5
1986                   11.8       11.0        0.44        0.21       0.23        0.72       0.83        0.88        1.68       5.27        16.6      42.8      101.2      215.4
1991                   11.2        8.3        0.40        0.21       0.23        0.72       0.89        0.94        1.76       4.56        13.9      38.1       93.1      205.6
1996                   10.8        6.8        0.32        0.14       0.18        0.60       0.87        1.02        1.67       4.06        11.9      34.5       85.0      199.0

1998                   10.6         6.4       0.31        0.14       0.17        0.55       0.87        1.04        1.63       4.00        11.3      32.4       81.1      193.9
1999                   10.5         6.5       0.31        0.12       0.16        0.56       0.85        1.02        1.60       4.00        10.9      31.6       80.0      194.7
2000                   10.1         6.1       0.26        0.13       0.16        0.54       0.81        1.01        1.60       3.93        10.4      29.8       76.0      187.7
2001                   10.0         5.9       0.25        0.11       0.16        0.53       0.81        1.00        1.58       3.90        10.0      28.1       74.2      186.6
20022P                 10.0         6.0       0.26        0.12       0.16        0.55       0.84        1.01        1.63       3.82        10.2      27.6       75.4      190.0

2001 March             10.9         6.5       0.26        0.11       0.16        0.53       0.85        1.02        1.62       4.10        10.8      30.6       81.8      211.1
     June               9.7         5.5       0.27        0.11       0.18        0.50       0.81        1.02        1.53       3.89         9.8      27.3       72.8      178.9
     Sept               9.2         5.8       0.22        0.14       0.13        0.54       0.83        1.00        1.60       3.73         9.6      26.3       67.6      166.0
     Dec               10.0         6.0       0.24        0.08       0.17        0.57       0.77        0.97        1.56       3.89        10.1      28.1       74.7      190.9

20022 MarchP           10.9         6.5       0.30        0.13       0.17        0.52       0.84        1.01        1.61       3.92        10.4      29.9       82.3      217.9
      Junep             9.8         6.0       0.24        0.10       0.16        0.62       0.84        0.97        1.60       3.76        10.0      27.2       73.0      182.7
      SeptP             9.3         5.6       0.25        0.12       0.14        0.50       0.78        0.98        1.61       3.76         9.8      25.7       69.1      166.6
     DecP              10.2         5.9       0.23        0.11       0.18        0.58       0.90        1.09        1.69       3.85        10.4      27.8       77.4      193.5

Females
1976                   11.8       12.2        0.46        0.24       0.21        0.35       0.40        0.56        1.46       4.30        10.1      26.0       74.6      196.6
1981                   11.3        9.4        0.46        0.19       0.19        0.32       0.35        0.52        1.26       3.80         9.5      24.1       66.2      178.2
1986                   11.4        8.0        0.40        0.17       0.17        0.29       0.33        0.47        1.12       3.24         9.2      23.4       62.5      169.4
1991                   11.2        6.4        0.33        0.16       0.15        0.29       0.33        0.44        1.05       2.87         8.2      21.8       58.7      161.6
1996                   11.1        5.3        0.25        0.10       0.13        0.29       0.31        0.46        1.04       2.63         7.1      20.6       55.8      159.1

1998                   11.0         5.0       0.24        0.11       0.12        0.26       0.32        0.43        1.00       2.64            6.8   19.8       53.9      159.3
1999                   11.0         5.1       0.24        0.10       0.13        0.25       0.31        0.43        1.01       2.62            6.7   19.3       53.4      162.8
2000                   10.5         5.1       0.20        0.10       0.11        0.25       0.30        0.44        1.01       2.63            6.4   18.1       50.9      155.4
2001                   10.4         4.9       0.22        0.12       0.11        0.24       0.30        0.42        0.96       2.57            6.3   17.4       50.2      155.3
20022P                 10.5         4.6       0.20        0.10       0.12        0.25       0.30        0.42        0.96       2.51            6.3   17.1       51.0      158.8

2001 March             11.7         5.1       0.30        0.14       0.10        0.28       0.27        0.48        1.01       2.67            6.6   19.2       56.2      179.6
     June              10.0         4.6       0.22        0.11       0.10        0.25       0.32        0.40        0.93       2.58            6.3   17.0       48.8      147.3
     Sept               9.4         4.9       0.15        0.11       0.08        0.22       0.25        0.41        0.97       2.47            5.9   15.9       45.5      137.3
     Dec               10.5         5.2       0.22        0.11       0.14        0.22       0.35        0.41        0.93       2.58            6.3   17.7       50.7      157.2

20022 Marchp           11.7         4.8       0.17        0.11       0.13        0.27       0.27        0.40        0.99       2.55            6.5   18.3       56.2      183.3
      Junep            10.1         4.6       0.20        0.07       0.15        0.23       0.35        0.42        0.96       2.47            6.2   16.9       48.9      148.4
      SeptP             9.6         4.0       0.19        0.09       0.12        0.23       0.26        0.47        0.92       2.44            6.2   16.2       46.8      140.7
      DecP             10.7         5.1       0.23        0.12       0.09        0.26       0.30        0.40        0.96       2.57            6.5   16.9       52.4      163.1

Note: Figures represent the numbers of deaths registered in each year up to 1992 and the numbers of deaths occurring in each year from 1993.
1 Rates per 1,000 live births.
2 The data for 2002 are based on the mid-2001 population estimates.
p Provisional registrations.




                      National Statistics            52
                                                                                                Health Statistics Quarterly 18               Summer 2003




 Table 6.2           Deaths: subnational

Government Office Regions of England1                                                                                                                                                      Rates
Year and                 North East           North          Yorkshire and      East Midlands          West                East             London              South              South
quarter                                       West            the Humber                              Midlands                                                   East              West

Total deaths (deaths per 1,000 population of all ages)
1995                        11.9               11.8               11.3               10.8              11.0                10.5                9.8               10.9               12.0
1996                        11.8               11.7               11.2               10.7              10.7                10.3                9.5               10.7               11.7
1997                        11.6               11.6               11.1               10.5              10.6                10.2                9.2               10.6               11.7
1998                        12.0               11.7               11.2               10.8              10.6                10.2                8.9               10.4               11.4
1999                        11.7               11.5               10.9               10.7              10.8                10.3                8.9               10.5               11.6
2000                        10.9               10.7               10.3               10.0              10.4                 9.9                8.4                9.8               11.3
2001                        11.2               11.1               10.4               10.2              10.2                 9.9                8.1                9.9               11.0
20022P                      11.3               11.1               10.6               10.3              10.3                10.1                8.0               10.0               11.2
2001 March                  12.5               12.4               11.6               11.4              11.5                10.9                9.1               10.8               12.0
     June                   10.6               10.8               10.1                9.9               9.9                 9.6                7.8                9.7               10.7
     Sept                   10.3               10.0                9.4                9.3               9.3                 9.1                7.4                9.2               10.1
     Dec                    11.3               11.2               10.6               10.2              10.3                10.0                8.1               10.0               11.2
20022 Marchp                12.4               12.3               11.5               11.3              11.2                11.1                8.7               11.1               12.2
      Junep                 11.1               10.8               10.2                9.9               9.9                 9.7                7.7                9.6               10.9
      SeptP                 10.3               10.0                9.8                9.4               9.6                 9.2                7.5                9.2               10.4
      DecP                  11.6               11.3               10.9               10.7              10.6                10.2                8.2               10.2               11.3
Infant mortality (deaths under 1 year per 1,000 live births)
1995                         6.7                6.5                6.9                5.7               7.1                 5.2                6.4                5.2                5.3
1996                         6.2                6.3                6.5                6.3               6.8                 5.3                6.3                5.3                5.5
1997                         5.8                6.7                6.5                5.7               7.0                 4.8                5.8                5.0                5.8
1998                         5.0                6.3                6.9                5.6               6.5                 5.0                6.0                4.4                4.8
1999                         5.6                6.5                6.3                6.0               6.9                 4.6                6.0                4.8                4.7
2000                         6.5                6.2                7.3                5.4               6.8                 4.4                5.4                4.4                4.7
2001                         5.4                5.8                5.5                4.9               6.4                 4.5                6.1                4.2                5.4
2002P                        5.0                5.4                6.2                5.6               6.5                 4.4                5.6                4.5                4.4
2001 March                   6.1                6.4                6.4                4.7               6.7                 4.0                6.4                4.7                6.4
     June                    5.1                5.7                5.4                5.6               6.8                 4.5                4.9                3.8                4.3
     Sept                    5.5                5.4                4.1                5.3               5.5                 4.6                6.8                4.6                4.8
     Dec                     4.7                5.9                6.2                4.2               6.7                 5.0                6.5                3.8                6.1
2002 Marchp                  4.3                7.1                6.6                6.6               6.3                 4.2                5.7                4.9                4.8
     Junep                   5.7                5.6                5.6                5.4               6.1                 5.2                5.6                4.6                4.2
     SeptP                   4.6                4.2                5.8                4.9               6.3                 4.2                5.2                3.9                3.7
     DecP                    5.3                5.0                6.9                5.5               7.4                 4.2                6.0                4.5                5.0
Neonatal mortality (deaths under 4 weeks per 1,000 live births)
1995                         4.7                4.2                4.8                3.8               5.3                 3.4                4.3                3.6                3.7
1996                         4.1                4.0                4.2                4.2               4.9                 3.5                4.4                3.5                3.8
1997                         3.7                4.3                4.4                3.7               5.0                 3.3                3.7                3.4                3.9
1998                         3.1                4.1                4.5                3.7               4.8                 3.4                4.1                2.9                3.3
1999                         4.1                4.4                4.1                4.3               4.8                 3.0                4.1                3.2                3.2
2000                         4.4                4.3                5.0                4.1               5.0                 3.0                3.7                3.1                3.0
2001                         3.5                3.8                3.2                3.4               4.4                 2.9                4.1                2.9                3.7
2002P                        3.3                3.6                4.1                4.0               4.8                 2.9                3.6                3.0                3.2
2001 March                   3.1                3.6                4.2                2.7               4.8                 2.6                4.3                3.2                4.3
     June                    4.1                3.5                3.0                3.9               4.5                 2.9                3.3                2.8                3.1
     Sept                    3.7                3.7                2.2                3.9               4.0                 3.0                4.7                3.6                3.2
     Dec                     3.3                4.3                3.4                3.0               4.4                 3.2                4.1                2.1                4.2
2002 Marchp                  2.5                4.4                4.2                4.8               4.9                 3.1                3.6                3.3                3.4
     Junep                   4.6                3.9                3.4                4.2               4.6                 3.4                3.7                3.0                3.0
     SeptP                   2.6                2.6                3.9                3.7               4.6                 2.6                3.6                2.6                2.8
     DecP                    3.6                3.6                4.7                3.3               5.2                 2.5                3.6                3.1                3.7
Perinatal mortality (stillbirths and deaths under 1 week per 1,000 total births)3
1995                        10.5                8.1                9.2                8.5              10.1                 7.7                9.7                7.7                7.4
1996                         9.2                8.6                8.3                8.7              10.2                 7.5                9.6                7.8                7.5
1997                         8.0                8.9                8.3                7.7               9.6                 7.3                9.0                7.3                8.7
1998                         8.2                8.7                9.2                8.0               9.3                 7.4                9.0                6.8                7.3
1999                         8.2                8.7                8.3                7.8               9.9                 7.0                9.0                6.9                7.8
2000                         8.5                8.6                9.6                7.8               9.6                 7.1                9.0                6.6                6.6
2001                         7.8                8.7                7.5                7.9               9.1                 7.1                8.9                6.9                7.2
2002P                        7.7                8.4                9.1                8.4              10.1                 7.5                9.2                6.8                6.9
2001 March                   7.6                7.7                9.7                6.8               9.8                 7.1                9.4                6.7                7.8
     June                    7.9                8.8                7.3                8.7               8.6                 7.2                8.9                6.2                7.1
     Sept                    8.0                8.7                5.8                7.7               8.7                 7.2                8.4                7.6                5.4
     Dec                     7.6                9.4                7.5                8.3               9.1                 6.8                8.9                6.9                8.7
2002 Marchp                  6.3                8.7               10.3                9.2              11.4                 7.2                9.0                7.7                6.8
     Junep                   7.0                8.6                9.5                8.7               9.9                 7.4                9.9                6.9                6.9
     SeptP                   7.8                8.1                7.8                7.7               9.3                 7.5                8.8                6.3                6.8
     DecP                    9.7                8.3                8.8                8.1              10.0                 7.9                9.2                6.5                6.9

Note: Figures represent the numbers of deaths occurring in each year with the exception of provisional data which relate to registrations.
1. The regions presented in this table have changed from the Regional Offices of the Department of Health to the Government Office Regions. See ‘In brief’ Health Statistics Quarterly no.15
   for details.
2. Crude death rates for 2002 are based on the mid-2001 population estimates.
3. In October 1992 the legal definition of a stillbirth was changed, from a baby born dead after 28 completed weeks of gestation or more, to one born dead after 24 completed weeks of
   gestation or more.
p Provisional registrations.




                                                                                                                                      53     National Statistics
           Health Statistics Quarterly 18                     Summer 2003



                                                                              This table is spread over 2 pages. Altogether there is 1 spread (2pages).
 Table 6.3             Deaths: selected causes (International Classification) 1,4 and sex

England and Wales                                                                      Number(thousands) and rate for all deaths and age-standardised rates2 per million population for selected causes

                                                                                                                                 Malignant neoplasms

Year and                   All deaths              All causes Oesophagus           Stomach        Colon        Rectosigmoid Trachea,          Melanoma         Other          Breast         Cervix         Ovary
quarter                                               (age -                                                      junction, bronchus           of skin       malignant                        uteri
                                                  standardised                                                  rectum, and and lung                         neoplasms
                                                       per                                                          anus                                       of skin
                     Number           Crude          million
                    (thousands)      rate per     population2)
                                     100,000
                                    population

                                                    A00–R99           (C15)         (C16)          (C18)       (C19–C21)       (C33–C34)         (C43)         (C44)           (C50)         (C53)          (C56)
                                                    V01–Y89


Males
     1971             288.4             1,207        13,466             76           317             187            144           1,066            10             12                4             :                  :
     1981             289.0             1,196        12,189             90           251             181            135           1,028            17              9                3             :                  :
     1991             277.6             1,125        10,291            118           186             194            117             844            23             10                3             :                  :

       1993           279.6             1,129        10,105            123           163             189            106             769            26              8                3             :                  :
       1994           267.6             1,079         9,582            129           163             183            102             745            24              9                3             :                  :
       1995           274.4             1,104         9,667            126           149             182            100             715            26              9                3             :                  :
       1996           268.7             1,078         9,362            126           146             175             99             684            25              8                2             :                  :
       1997           264.9             1,060         9,118            126           137             176             93             651            25              7                2             :                  :

       1998           264.7             1,057         8,994            129           132             169             95             644            26              8                3             :                  :
       1999           264.3             1,051         8,878            127           127             161             90             612            27              7                2             :                  :
       2000           255.5             1,013         8,455            128           118             158             89             593            28              7                2             :                  :
       2001           252.4               995         8,209            129           111             156             89             571            26              7                3             :                  :
       2002P          254.4             1,003         8,260            133           111             153             92             570            27              8                3             :                  :

2001 March              68.1            1,090         8,973            132           111             163             88             577            24              8                3             :                  :
     June               61.4              971         8,003            130           111             152             86             563            28              7                3             :                  :
     Sept               58.8              920         7,615            124           114             158             87             567            26              6                2             :                  :
     Dec                64.0            1,002         8,258            130           109             150             93             577            27              7                3             :                  :

20023 Marchp            68.1            1,089         8,945            125           114             151             90             571            28              7                3             :                  :
      Junep             61.8              977         8,050            129           111             149             91             577            28              9                2             :                  :
      SeptP             59.2              925         7,639            131           111             152             93             560            26              9                3             :                  :
      DecP              65.4            1,023         8,420            147           109             161             95             571            28              8                3             :                  :

Females
    1971              278.9             1,104         8,189             40           149             176             79             183            14              6             379            83             126
    1981              288.9             1,134         7,425             42           111             157             74             252            16              5             405            69             121
    1991              292.5             1,122         6,471             50            75             147             62             300            18              4             403            54             118

       1993           299.2             1,143         6,430             52             66            138             53             295            22              3             378            47             115
       1994           285.6             1,088         6,120             51             67            137             52             297            22              4             371            42             114
       1995           295.2             1,122         6,211             52             62            131             49             295            20              4             361            42             116
       1996           291.5             1,105         6,075             52             55            126             49             293            20              3             344            41             121
       1997           290.4             1,099         6,007             51             57            122             48             285            20              3             337            37             115

       1998           290.3             1,096         5,952             49             54            117             47             292            21              3             328            35             116
       1999           291.8             1,098         5,936             52             51            116             46             289            20              3             319            33             111
       2000           280.1             1,051         5,664             51             48            107             45             285            21              3             312            33             109
       2001           277.9             1,040         5,553             48             46            103             45             283            20              3             308            31             112
       2002P          281.0             1,051         5,572             51             45            104             44             287            19              3             306            29             114

2001 March              77.0            1,168         6,154             47             53            103             45             287            20              3             305            30             116
     June               66.9            1,003         5,389             49             47            107             43             281            20              3             308            30             113
     Sept               63.3              940         5,069             49             43            102             46             274            19              3             308            31             109
     Dec                70.8            1,051         5,610             49             42            100             45             291            20              3             311            31             111

20023 Marchp            76.8            1,165         6,067             53             45            100             44             289            19              3             304            30             111
      Junep             67.0            1,006         5,383             52             44            106             43             281            19              3             308            28             115
      SeptP             64.9              962         5,177             50             46            106             48             284            20              3             294            29             119
      DecP              72.3            1,073         5,671             51             44            104             43             293            18              4             318            29             110

1. The Ninth Revision of the International Classification of Diseases, 1975, came into operation in England and Wales on 1 January 1979. The Tenth Revision of the International Classification of Diseases, 1992,
   came into operation in England and Wales on 1 January 2001. The cause descriptions and codes relate to ICD-10.
2. Directly age-standardised to the European Standard Population. See Notes to Tables.
3. Rates for the quarters of 2002 are based on the mid-2001 population estimates.
4. For changes to this table see ‘In Brief’, Heath Statistics Quarterly number 14.
p Provisional registrations.

Notes: Between 1 January 1984 and 31 December 1992, ONS applied its own interpretation of the International Classification of Diseases Section Rule 3 in the coding of deaths where terminal events and other
       ‘modes of dying’ such as cardiac arrest, cardiac failure, certain thrombembolic disorders, and unspecified pneumonia and bronchopneumonia, were stated by the certifier to be the underlying cause of death
       and other major pathology appeared on the certificate. In these cases ONS Rule 3 allowed the terminal event to be considered a direct sequel to the major pathology and that primary condition was
       selected as the underlying cause of death. Prior to 1984 and between 1 January 1993 and 31 December 2000, such certificates were coded to the terminal event. National Statistics also introduced
       automated coding of cause of death in 1993, which may also affect comparisons of deaths by cause from 1993. Further details can be found in the annual volumes Mortality statistics: Cause 1984, Series
       DH2 no. 11, and Mortality statistics: Cause 1993 (revised) and 1994, Series DH2 no. 21.
       From 1 January 2001, under ICD-10, Rule 3 has again been changed – for details see the article in Health Statistics Quarterly no. 13. This has resulted in a fall in the death rates from respiratory diseases,
       notably pneumonia, and consequently slight rises in the rates for other causes eg. strokes. For details of the major changes between ICD-9 and ICD-10, see the articles in Health Statistics Quarterly 08, 13
       and 14.




                          National Statistics               54
                                                                                       Health Statistics Quarterly 18               Summer 2003




 Table 6.3             Deaths: selected causes (International Classification) 1,4 and sex
 continued
England and Wales                                                                                                 Age-standardised rates2 per million population for selected causes

        Malignant neoplasms

  Prostate    Bladder Leukaemia     Diabetes   Ischaemic   Cerebro    Pneumonia    Bronchitis,   Asthma       Gastric    Diseases          Land        Intentional      Year and
                                    mellitus      heart    vascular                emphysema                    and     of the liver     transport    self harm and     quarter
                                                 disease   diseases                 and other                duodenal                    accidents      events of
                                                                                     chronic                   ulcer                                  undetermined
                                                                                    obstructiv                                                             intent
                                                                                   pulmonary                                                           with inquest
                                                                                     disease                                                              Verdict
                                                                                                                                                          ’Open‘


   (C61)       (C67)     (C91–C95) (E10–E14)   (120–125) (160–169)     (J12–J18)    (J40–J44)    (J45–J46)   (K25–K27) (K70–K76)        (V01–V89)       (X60–X84,
                                                                                                                                                         Y10–Y34)


                                                                                                                                                                          Males
    198         124           74       82       3,801      1,541          920         944           21          107            41           209              124           1971
    214         121           74       82       3,664      1,141        1,053         683           28           90            58           119              151           1981
    304         121           77      131       2,994        945          395         609           31           73            76           125              160           1991

    298         114           71      101       2,845        801         770          571           25           67          77              97              152           1993
    297         110           69       98       2,610        762         690          498           23           67          84              93              152           1994
    298         112           72      101       2,551        762         766          528           20           64          92              90              150           1995
    290         105           66       97       2,427        752         738          484           19           64          97              95              142           1996
    279         101           67       95       2,278        723         754          479           20           61         104              95              145           1997

    277          99           67       94       2,217        707         721          464           18           60         115              87              153           1998
    273          93           68       94       2,098        674         771          475           18           64         119              87              151           1999
    260          92           67       88       1,962        623         736          417           17           59         119              87              141           2000
    274          93           70       94       1,876        692         389          404           16           56         140              87              135           2001
    277          92           69       93       1,822        704         396          405           16           57         147              94              136           2002

    288          92           71      101       2,081        776         489          519           17           70         141              82              133      2001 March
    270          92           62       95       1,863        659         376          391           15           50         128              86              140            June
    259          91           75       89       1,687        631         290          313           15           51         136              95              139            Sept
    280          97           72       92       1,876        703         403          394           18           51         153              85              129            Dec

    280          90           72       98       2,012        790         510          520           18           59         156              94              129 20023 Marchp
    271          87           67       91       1,790        680         365          385           15           57         133              99              137        Junep
    278          96           67       84       1,654        616         307          331           15           55         147              83              139        SeptP
    280          94           71       98       1,835        731         404          386           17           56         152             101              140        DecP

                                                                                                                                                                       Females
    :            32           47       89       1,668      1,352         624          193           25           44            31            82               84          1971
    :            35           47       66       1,601      1,012         740          155           30           57            43            41               81          1981
    :            34           44       96       1,421        823         333          213           30           46            49            46               51          1991

    :            34           43       74       1,348        725         585          224           27           46            49            35               48           1993
    :            35           42       69       1,238        690         513          204           24           44            50            34               44           1994
    :            33           41       73       1,195        690         569          229           24           42            55            30               46           1995
    :            32           41       67       1,141        680         549          222           21           44            57            30               44           1996
    :            31           43       66       1,075        651         574          227           23           42            61            29               45           1997

    :            32           41       65       1,056        646         547          227          22            41            64            28               43            1998
    :            30           45       65         988        630         592          241          22            40            67            28               45            1999
    :            31           39       63         909        577         547          217          20            41            68            25               44            2000
    :            29           41       62         880        621         307          220          19            39            77            24               40            2001
    :            30           44       65         850        621         319          226          20            37            79            26               43           2002P

    :            28           41       67         992        696         415          286          24            44            81            24               42      2001 March
    :            31           42       61         868        588         273          206          19            38            74            23               43            June
    :            28           43       57         780        568         223          163          16            35            78            24               40            Sept
    :            29           40       64         880        633         321          227          19            40            77            23               38            Dec

    :            30           45       69         931        681         443          310          22            44            81            26               38 20023 Marchp
    :            31           41       69         838        598         283          196          20            35            75            25               45        Junep
    :            29           44       61         783        560         233          171          18            33            77            27               44        SeptP
    :            30           43       62         848        646         319          229          19            37            85            24               44        DecP
See notes opposite.




                                                                                                                          55        National Statistics
     Health Statistics Quar terly 18       Summer 2003




Notes to tables
Time series                                        are registrations. Figures for both Scotland        Sources
For most tables, years start at 1971 and then      and Northern Ireland relate to the number of        Figures for Scotland and Northern Ireland
continue at five-year intervals until 1991.        deaths registered in each year.                     have been provided by the General Register
Individual years are shown thereafter. If a year                                                       Office for Scotland and the Northern Ireland
                                                   Since Health Statistics Quarterly 15, Table 6.2
is not present the data are not available.                                                             Statistics and Research Agency respectively,
                                                   presents deaths for Government Offices for the
                                                                                                       except for the projections in Table 1.2 which
United Kingdom                                     Regions rather than Health Regional Office
                                                                                                       are provided by the Government Actuary.
The United Kingdom comprises England,              areas in England. More details can be found in
Wales, Scotland and Northern Ireland. The          Health Statistics Quarterly 15, page 2.             Rounding
Channel Islands and the Isle of Man are not                                                            All figures are rounded independently;
                                                   Age-standardised mortality
part of the United Kingdom.                                                                            constituent parts may not add to totals.
                                                   Directly age-standardised rates make
                                                                                                       Generally numbers and rates per 1,000
Population                                         allowances for changes in the age structure of
                                                                                                       population are rounded to one decimal place
The estimated and projected populations of an      the population. The age-standardised rate for
                                                                                                       (eg 123.4); where appropriate, for small
area include all those usually resident in the     a particular condition is that which would
                                                                                                       figures (below 10.0), two decimal places are
area, whatever their nationality. Members of       have occurred if the observed age-specific
                                                                                                       given (eg 7.62). Figures which are
                                                   rates for the condition had applied in a given
HM forces stationed outside the United                                                                 provisional or estimated are given in less
                                                   standard population. Tables 2.2 and 6.3 use
Kingdom are excluded. Students are taken to                                                            detail (eg 123 or 7.6 respectively) if their
                                                   the European Standard Population. This is a
be resident at their term-time addresses.                                                              reliability does not justify giving the
                                                   hypothetical population standard which is the
                                                                                                       standard amount of detail. Where, figures
The population estimates for mid-2001 are          same for both males and females allowing
                                                                                                       need to be treated with particular caution, an
final figures based on the 2001 Census of          standardised rates to be compared for each
                                                                                                       explanation is given as a footnote.
Population. For details of rebased estimates       sex, and between males and females.
following the results of the 2001 Census, see                                                          Latest figures
                                                   Abortions
Health Statistics Quarterly 17, page 3.                                                                Figures for the latest quarters and years may
                                                   Figures relate to numbers occurring in a
                                                                                                       be provisional and will be updated in future
The table giving population estimates for          period.
                                                                                                       issues when later information becomes
Health Regional Office areas in England            Improvements to National Statistics on              available. Where figures are not yet
(Table 1.3 in Health Statistics Quarterly 14       abortions performed in England and Wales were       available, cells are left blank.
and earlier editions) has been dropped and         published in Health Statistics Quarterly 11. The
subsequent tables renumbered. The                                                                      Shaded background
                                                   revised figures are presented in Table 4.2. These
Government Offices for the Regions (see                                                                Where available, the final revised population
                                                   changes include an improvement in the
Table 1.4 in Health Statistics Quarterly 14 and                                                        estimates based on the 2001 Census of
                                                   calculation of quarterly abortion rates. The mid-
earlier editions, now Table 1.3) now represent                                                         Population have been incorporated into this
                                                   quarter population estimates, used to calculate
Health as well as Administrative Regions.                                                              edition of Population Trends. Where they are
                                                   these rates, were produced by linear
More details can be found in Health Statistics                                                         not yet available, the original estimates
                                                   interpolation as follows:
Quarterly 15, page 2.                                                                                  continue to be included or used as
                                                                                                       denominators. The shaded background
Live births                                        March quarter         7.5/12*(P2-P1)+P1
                                                                                                       indicates figures that are subject to revision
                                                   June quarter          10.5/12*(P2-P1)+P1
For England and Wales, figures relate to                                                               when the relevant rebased estimates are
                                                   September quarter     1.5/12*(P3-P2)+P2
numbers occurring in a period; for Scotland                                                            available.
                                                   December quarter      4.5/12*(P3-P2)+P2
and Northern Ireland, figures relate to those
                                                                                                       As all the sub-national projections will be
registered in a period. See also Note on page
                                                   Where P1 = mid-year population estimate of          rebased in due course, all projected figures in
63 of Population Trends 67.
                                                              previous year;                           Table 1.3 are shaded. These shaded figures
Perinatal mortality                                      P2 = mid-year population estimate of          are based on the original mid-1996 population
In October 1992 the legal definition of a                     year being calculated;                   estimates and are therefore not comparable
stillbirth was changed, from a baby born dead            P3 = population projection for next           with the rebased estimates shown in the same
after 28 completed weeks of gestation or more,                year.                                    table.
to one born dead after 24 completed weeks of                                                           For further details of the rebased estimates
gestation or more.                                 For example
                                                                                                       following the results of the 2001 Census, see
                                                   March quarter 2000 = 7.5/12*(pop2000-
Expectation of life                                                                                    ‘in brief’ on page 3.
                                                   pop1999)+pop1999;
The life tables on which these expectations are
based use current death rates to describe          September quarter 2000 = 1.5/12*(pop2001-
mortality levels for each year. Each               pop2000)+pop2000.
individual year shown is based on a three-
year period, so that for instance 1986             Marriages and divorces
represents 1985–87. More details can be            Marriages are tabulated according to date of
                                                   solemnisation. Divorces are tabulated
found in Population Trends 60, page 23.
                                                   according to date of decree absolute, and the
Deaths                                             term ‘divorces’ includes decrees of nullity.
Figures for England and Wales relate to the        The fact that a marriage or divorce has taken
number of deaths registered in each year up        place in England, Wales, Scotland or
to 1992, and the number occurring in each          Northern Ireland does not necessarily mean
year from 1993, though provisional figures         that either of the parties is resident there.


                   National Statistics     56
                                                                                                 Health Statistics Quarterly 18           S ummer 2003




Report:
Death registrations in
England and Wales, 2002:
causes
This report gives numbers of deaths registered in England and Wales in                            Table 1 shows death rates by age and sex, for the years 2000 to 2002,
2002 by age and sex, and for selected underlying causes of death. It                              together with percentage changes.
also compares death rates by sex and age with those for deaths that
occurred in 2000 and 2001. Cause of death in 2002 has been coded                                  q   In 2002 the provisional crude death rates (based on mid-2001
according to the Tenth Revision of the International Classification of                                population estimates) were 10.0 per thousand population for males,
Diseases (ICD-10).                                                                                    and 10.5 per thousand for females.

Deaths by sex and age of deceased                                                                 q   The largest absolute changes in age-specific death rates occurred in
                                                                                                      the same age group for both sexes; the rate for boys aged 5–9 rose
q     A total of 535,356 deaths were registered in 2002, compared with
                                                                                                      by 7.0 per cent between 2001 and 2002, while that for girls aged 5
      532,498 registered in 2001, an increase of 0.5 per cent.
                                                                                                      to 9 fell by 14.9 per cent. However, these are based on small
                                                                                                      numbers of deaths.
q     The number of male deaths increased by 0.3 per cent and female
      deaths by 0.7 per cent between 2001 and 2002.

    Table 1           Death rates per 1,000 population, by sex and age: 2000–2002*


England and Wales
Age group                                       2000*                          2001*                          2002†             Percentage change 2000–01   Percentage change 2001–02

                                        Males           Females       Males            Females        Males           Females     Males         Females        Males        Females
All ages                                10.1              10.5         10.0              10.4         10.0             10.5        -1.7          -1.0           0.8          1.1

Under 1**                                 6.1              5.1           5.9              4.9           6.0              4.6       -2.6          -2.4           1.3          -6.6
1–4                                       0.3              0.2           0.2              0.2           0.3              0.2       -3.4          11.7           3.5         -11.1
5–9                                       0.1              0.1           0.1              0.1           0.1              0.1      -13.1          22.7           7.0         -14.9
10–14                                     0.2              0.1           0.2              0.1           0.2              0.1       -2.1          -1.4           1.8          14.6

15–19                                     0.5              0.2           0.5              0.2           0.6              0.2       -1.1          -2.8            3.4          3.4
20–24                                     0.8              0.3           0.8              0.3           0.8              0.3        0.3          -2.0            3.5          0.0
25–29                                     1.0              0.4           0.9              0.3           0.9              0.3       -8.0          -3.7            4.4         -3.5
30–34                                     1.1              0.5           1.1              0.5           1.1              0.5        4.2          -4.0           -1.5          2.7

35–39                                     1.4              0.8           1.3              0.7           1.4              0.7       -2.4          -3.4            2.2         -1.5
40–44                                     1.9              1.3           1.9              1.2           1.9              1.2       -0.8          -5.6            3.8          1.0
45–49                                     3.1              2.0           3.0              2.0           3.1              2.0       -0.5          -2.0            2.7          4.3
50–54                                     4.7              3.2           4.7              3.1           4.5              2.9       -0.7          -1.9           -4.7         -6.5

55–59                                     7.8              5.0           7.7              4.8           8.0              5.1       -1.9          -2.7            4.1          4.7
60–64                                    13.3              8.0          12.8              7.9          12.7              7.8       -3.6          -0.7           -0.8         -1.4
65–69                                    22.4             13.4          21.1             12.7          20.9             12.5       -5.6          -4.9           -1.0         -1.5
70–74                                    38.4             23.1          36.2             22.4          35.5             21.9       -5.7          -3.1           -1.9         -2.3

75–79                                    63.2             39.9          61.4             38.9          60.2             38.3       -2.9          -2.3           -2.0         -1.7
80–84                                    99.1             67.2          95.4             65.6         100.8             68.4       -3.8          -2.4            5.7          4.3

85 and over                             187.7            155.4         186.6            155.3         190.0           158.8        -0.6          -0.1           1.8           2.3
*     2000 and 2001 rates are based on death occurrences; 2002 rates on death registrations.
†     Provisional rates based on mid-2001 population estimates and 2001 live births.
**    Deaths per 1,000 live births.
                                                                                                                                  57      National Statistics
           Health Statistics Quarterly 18     Summer 2003




q    For both males and females there were sizeable percentage rises in       of the International Classification of Diseases (ICD-10).1,2,3 This was
     the age-specific rates in the age groups 55–59 and 80–84 and             introduced on the recommendation of the World Health Organisation
     sizeable percentage falls in the 50–54 age group.                        (WHO) and replaced the Ninth Revision (ICD-9)4,5, which had been in
                                                                              use since 1979. ICD-10 represents the largest change in the ICD in over
q    The infant mortality rate in 2002 fell to 5.3 deaths per thousand live   50 years. The major changes have been described in detail in Health
     births from 5.5 in 2001. This continues the long-term decline.           Statistics Quarterly 086 and 13.7 In order to help quantify the changes,
                                                                              ONS has carried out a bridge coding study. All deaths registered in
Figures 1 and 2 show the relative change between 1992 and 2002 in             1999 were independently coded to both ICD-9 and ICD-10 and the
age-specific death rates for males and females respectively. The long-        causes in each revision compared using internationally agreed groups of
term decline in death rates continued for most sex/age groups. The            equivalent codes. The results can be found in the Report ‘Results of the
relative fall between 1992 and 2002 was most pronounced at ages               ICD bridge coding study, England and Wales, 1999’ in Health Statistics
1–14 for both sexes. There was comparatively little decline for females       Quarterly 14.8
in mortality rates at ages 15–44 and a slight rise at ages 85 and over
during the ten-year period. This is reversed for males with a small           Cause of death is assigned by an automated coding system with the
decline at ages 85 and over and a small rise at ages 15–44. Male death        exception of deaths due to external causes (ICD-10 codes V01–Y89).
rates declined more than female rates in all the age groups shown             These are coded clerically using information from coroners’ certificates
except at ages 15–44. However, absolute mortality rates remain higher         (including inquest verdicts) to produce consistent figures on suicides,
in males for every age group.                                                 homicides and other deaths not from natural causes.

Deaths by underlying cause                                                    Occurrences and registrations
Table 2 gives deaths by sex and age for selected underlying causes of         The year in which a death is registered may not correspond to the year
death.                                                                        of occurrence of that death. Up to 1992 ONS (formerly OPCS)
                                                                              publications gave numbers of deaths registered in the data year.
In 2002 the main causes of death were cancer (neoplasms), accounting          However, since 1993 most of our published figures represent the
for 26 per cent of all deaths; ischaemic heart disease (IHD), 19 per cent;    number of deaths which occurred in the data year. This change has little
respiratory diseases, 13 per cent; and cerebrovascular diseases (stroke       effect on annual totals but makes it easier to analyse seasonal variations
and related conditions), 11 per cent.                                         in mortality. We, therefore, take two annual extracts:9

Within these overall percentages, there are some differences between          q     The first annual extract from our deaths database, produced in April
the figures of males and females. Higher proportions of men than                    following the data year, comprises registrations in that year.
women died of cancer (29 and 24 per cent respectively) and IHD (22                  Outputs produced using this extract include this Report and an area-
and 16 per cent respectively), while more women than men died of                    based Report in Population Trends, as well as the annual VS tables
cerebrovascular diseases (13 and 9 per cent). However, the proportions              and the Compendium of Clinical and Health Indicators.
dying of respiratory diseases were similar (13 per cent of males and 14
per cent of females).                                                         q     The second extract is produced in the September following the year
                                                                                    to which it relates and comprises occurrences in the data year. This
                                                                                    extract forms the basis for the annual mortality reference volumes
EXPLANATORY NOTES                                                                   in the DH series.
Coding of underlying cause of death
Since Januay 2001 cause of death has been coded to the Tenth Revision

    Figure 1        Male age-specific death rates 1992–2002, as a                  Figure 2           Female age-specific death rates 1992–2002, as
                    percentage of rates in 1992                                                       a percentage of rates in 1992

    England and Wales                                                             England and Wales
    110                                                                           110


                                                                                                                                      85 and over
                                                             15–44
    100                                                                           100
                                                         85 and over
                                                                                                                                        15–44

     90                                                                           90                                                         75–84

                                                               75–84                                                                         65–74

     80                                                        65–74              80                                                 45–64

                                                               45–64
                                                                                                                                        1–14
     70                                                       1–14                70




     60                                                                           60
          1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002                        1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
                                   Year                                                                          Year


                        National Statistics   58
                                                                                            Health Statistics Quarterly 18          S ummer 2003




Table 2               Deaths by age, sex and underlying cause, 2002 registrations


England and Wales                                                                                                                                                     Numbers

                                                                                                                   Age group

ICD10 code     Causes of death *                               All      Under 1       1–4   5–14   15–24   25–34     35–44        45–54     55–64    65–74   75–84    85 and
                                                              ages                                                                                                     over

A00-R99,       All causes, all ages                  M     254,390       1,831        329   484    2,222   3,665     6,255        13,011   27,807   56,584   88,493 53,709
V01-Y89                                              F     280,966       1,337        240   364      858   1,597     3,767         8,689   17,807   39,645   90,213 116,449

               All causes, ages under                M        1,227      1,227          -     -        -       -         -             -        -        -        -        -
               28 days                               F          910        910          -     -        -       -         -             -        -        -        -        -

A00-R99,       All causes, ages 28 days              M     253,163         604        329   484    2,222   3,665     6,255        13,011   27,807   56,584   88,493 53,709
V01-Y89        and over                              F     280,056         427        240   364      858   1,597     3,767         8,689   17,807   39,645   90,213 116,449

A00-B99        Certain infectious and                M         2,075        34         37    14      28       67       141           173      192      342     635       412
               parasitic diseases                    F         2,260        28         13    12      31       44        64            74      165      294     703       832

A00-A09        Intestinal infectious                 M          299           -         -     -        -       -         1             3        7       39     130       119
               diseases                              F          545           -         1     -        -       -         1             4       14       35     184       306

A15-A16        Respiratory tuberculosis              M          197           -         -     -       1       4          8            27       27      40       68        22
                                                     F          118           -         -     1       2       3          5             6       11      23       47        20

A17-A19        Other tuberculosis                    M            40          -         -     -       2       3          1             5        4        9      12         4
                                                     F            32          -         -     -       2       1          1             1        1       11      10         5

A39            Meningococcal infection               M            61        10         17     6      12       6          2             -        3        -       2         3
                                                     F            59         7          7     1       8       3          6             3        7        6       9         2

A40-A41        Septicaemia                           M           862        13         11     4       3       5         16            36       68      157     333       216
                                                     F         1,071        12          2     3       5      11         16            32       83      146     356       405

B15-B19        Viral hepatitis                       M          115           -         -     -       -        6        16            40       24       15       9         5
                                                     F           58           -         -     -       1        -         6             9       16       15      10         1

B20-B24        Human immunodeficiency virus          M          155           2         -     1       2      20         68            38       16        7       1         -
               [HIV] disease                         F           42           -         -     -       2      15         14             7        3        1       -         -

B90            Sequelae of tuberculosis              M            31          -         -     -        -       -         -             1        1        4      20         5
                                                     F            29          -         -     -        -       -         -             -        2       10      13         4

C00-D48        Neoplasms                             M       72,858           6        49   130     191     359      1,124         4,023   11,256   21,129   24,817    9,774
                                                     F       67,595           8        41    87     132     444      1,589         4,502    9,362   15,834   22,070   13,526

C00-C97        Malignant neoplasms                   M       71,224           3        46   123     185     338      1,081         3,960   11,124   20,776   24,166    9,422
                                                     F       65,827           5        36    80     122     435      1,565         4,450    9,263   15,565   21,408   12,898

C00-C14        Malignant neoplasms of lip,           M         1,101          -         -     -        2       9        34           168      314      271     221        82
               oral cavity and pharynx               F           602          -         -     -        1       8        25            48      114      126     166       114

C15            Malignant neoplasm of                 M         4,008          -         -     -        2     10         71           319      807    1,196    1,231      372
               oesophagus                            F         2,324          -         -     -        -      4         19            85      254      517      883      562

C16            Malignant neoplasm of stomach         M         3,484          -         -     -        2       6        43           149      466    1,058    1,295      465
                                                     F         2,104          -         -     -        -       6        25            76      168      434      810      585

C18            Malignant neoplasm of colon           M         4,746          -         -     -        3     11         64           220      728    1,392    1,666      662
                                                     F         4,759          -         -     -        -     12         50           185      441    1,075    1,766    1,230

C19-C21        Malignant neoplasm of rectosigmoid M            2,803          -         -     -        -       9        35           181      511      810     895       362
               junction, rectum and anus          F            1,981          -         -     -        1       7        31            90      234      390     705       523

C22            Malignant neoplasm of liver and       M         1,246          -         2     1        2      15        26           107      207      390     385       111
               intrahepatic bile ducts               F           930          -         -     1        6       5        14            36      113      234     330       191

C23-C24        Malignant neoplasm of gallbladder     M          171           -         -     -        -       -         -             4       27       51      54        35
               and biliary tract                     F          370           -         1     -        -       -         5            18       50       90     127        79

C25            Malignant neoplasm of pancreas        M         2,971          -         -     -        -       3        49           216      542      924      935      302
                                                     F         3,182          -         -     -        -       3        39           154      423      766    1,141      656

C32            Malignant neoplasm of larynx          M          592           -         -     -        -       1         5            54      143      176     163        50
                                                     F          149           -         -     -        -       -         1             7       22       46      48        25

C33-C34        Malignant neoplasm of trachea,        M       17,494           -         -     -       -       7        132           893    3,107    5,841    5,944    1,570
               bronchus and lung                     F       11,394           -         -     -       2      14        111           668    1,756    3,381    4,137    1,325

* The figures for individual cause categories exclude deaths at ages under 28 days.




                                                                                                                             59     National Statistics
          Health Statistics Quarterly 18                 Summer 2003




 Table 2              Deaths by age, sex and underlying cause, 2002 registrations
 continued
                                                                                                                                                               Numbers
England and Wales
                                                                                                                   Age group

ICD10 code      Causes of death *                               All       Under 1     1–4   5–14   15–24   25–34     35–44     45–54   55–64   65–74   75–84   85 and
                                                               ages                                                                                             over

C43             Malignant melanoma of skin           M           786           -       1      1      11      28        62        115    148     190      172       58
                                                     F           690           -       -      -       5      33        37         92    104     141      173      105

C44             Other malignant neoplasms of skin M              257           -        -     -       1       -         3          5     22      40      101       85
                                                  F              188           -        -     -       1       -         -          3     13      18       51      102

C45             Mesothelioma                         M         1,381           -        -     -       -       -         1         70    324     534      383       69
                                                     F           238           -        -     -       -       1         2         16     58      69       75       17

C46             Kaposi’s sarcoma                     M                2        -        -     -       -       -          -         2       -       -       -        -
                                                     F                1        -        -     -       -       -          -         -       -       -       -        1

C50             Malignant neoplasm of breast         M            82           -        -     -       -       -         -          3      15      23      25       16
                                                     F        11,491           -        -     -       1     113       590      1,375   2,033   2,270   2,875    2,234

C53             Malignant neoplasm of cervix         F         1,003           -        -     -       5      37       110        163    169     158      249      112
                uteri

C54-C55         Malignant neoplasm of other and      F         1,362           -        -     -       -       5        12         71    196     348      465      265
                unspecified parts of uterus

C56             Malignant neoplasm of ovary          F         4,105           -        -     1       3      23        84        379    855    1,221   1,102      437

C61             Malignant neoplasm of prostate       M         9,004           -        -     -       1       -         7         85    570    2,052   3,897    2,392

C62             Malignant neoplasm of testis         M            61           -        -     -       5      14        12         14      6       4       6         -

C64             Malignant neoplasm of kidney,        M         1,737           -       1      -       2       6        33        163    383     522      470      157
                except renal pelvis                  F         1,034           -       1      2       -       4        14         70    150     277      323      193

C67             Malignant neoplasm of bladder        M         2,920           -        -     -       -       2        11         68    288     744    1,153      654
                                                     F         1,502           -        -     -       -       2        10         29     99     293      579      490

C71             Malignant neoplasm of brain          M         1,676          1       13     34      23      57       127        265    391     468      258       39
                                                     F         1,236          -       10     23      21      42        99        149    287     320      223       62

C81             Hodgkin’s disease                    M           146           -        -     1       7       7        13         16     20      42      33         7
                                                     F           106           -        -     -       7      18        16          5     12      23      17         8

C82-C85         Non-Hodgkin’s lymphoma               M         2,251           -       1      3      23      36        95        158    426     663      624      222
                                                     F         1,963           -       2      2       6      15        48        114    262     487      672      355

C90             Multiple myeloma and malignant       M         1,207           -        -     -       -       -        13         64    165     380      419      166
                plasma cell neoplasms                F         1,113           -        -     -       -       2        10         43    129     299      388      242

C91-C95         Leukaemia                            M         2,097          -       11     52      33      44        62        114    261     560      678      282
                                                     F         1,809          3       10     26      36      30        38         96    196     381      570      423

C97             Malignant neoplasms of independent M             545           -        -     -       3       3         5         24     59     121      225      105
                (primary) multiple sites           F             397           -        -     -       -       2         5         27     66      86      117       94

D00-D48         In situ and benign neoplasms, and M            1,634          3        3      7       6      21        43         63    132     353      651      352
                neoplasms of uncertain or unknown F            1,768          3        5      7      10       9        24         52     99     269      662      628
                behaviour

D50-D89         Diseases of the blood and            M           449          9        4      7      12      18        20         30     54      85      112       98
                blood-forming organs and certain     F           631          3        4      5       5      16        28         21     39      79      172      259
                disorders involving the immune
                mechanism

D50-D64         Anaemias                             M           190          -        2      3       8       6         5          6     16      31      47        66
                                                     F           364          1        1      3       3       8         7          2     12      27      99       201

E00-E90         Endocrine, nutritional and           M         3,572         11       22     24      46      68        95        186    386     855    1,190      689
                metabolic diseases                   F         4,317         19       16     23      45      60        82        131    252     686    1,388    1,615

E10-E14         Diabetes mellitus                    M         2,905           -       -      2       9      30        59        129    293     730    1,052      601
                                                     F         3,282           -       1      -      12      24        51         73    184     562    1,147    1,228

F00-F99         Mental and behavioural disorders     M         4,769           -       -      7     170     366       218        155    151     343    1,532    1,827
                                                     F         9,676           -       1      5      41      63        54         60     65     341    2,616    6,430

* The figures for individual cause categories exclude deaths at ages under 28 days.




                        National Statistics              60
                                                                                            Health Statistics Quarterly 18       S ummer 2003




 Table 2              Deaths by age, sex and underlying cause, 2002 registrations
 continued
                                                                                                                                                                  Numbers
England and Wales
                                                                                                                   Age group

ICD10 code     Causes of death *                               All       Under 1      1–4   5–14   15–24   25–34     35–44     45–54   55–64    65–74    75–84    85 and
                                                              ages                                                                                                 over

F01,F03         Vascular and unspecified dementia    M         3,618           -        -     -       -        -         -         5      55      301     1,476    1,781
                                                     F         9,163           -        -     -       -        -         -         6      29      311     2,530    6,287

F10-F19         Mental and behavioural disorders M             1,045           -        -     6     167     359        218       149      90       31       14        11
                due to psychoactive substance use F              253           -        -     4      34      56         51        48      32       19        9         -

G00-G99         Diseases of the nervous system       M         6,800         52        37    64     127     155        258       389     552     1,199    2,490    1,477
                                                     F         7,990         37        23    41      72      85        165       326     453     1,063    2,686    3,039

G00-G03         Meningitis                           M            89         10         2     2       5       4          9         9      21        8       13         6
                (excluding meningococcal)            F            82          8         5     -       5       2          4         6       8       15       21         8

G12.2           Motor neuron disease                 M           794           -        -     -       -       6         24        75     148      282      201        58
                                                     F           675           -        -     -       1       1          6        42     110      247      205        63

G20             Parkinson’s disease                  M         2,278           -        -     -       -        -         -         3      38      355     1,193      689
                                                     F         1,792           -        -     -       -        -         1         2      17      185       849      738

G30             Alzheimer’s disease                  M         1,494           -        -     -       -        -         -         5      42      204       689      554
                                                     F         3,298           -        -     -       -        -         3         6      38      264     1,128    1,859

G35             Multiple sclerosis                   M           321           -        -     -       1       6         27        72      86       76       45         8
                                                     F           602           -        -     -       -      14         39       142     143      137      107        20

H00-H59         Diseases of the eye and adnexa       M             2           -        -     -       -        -         -         1        -        -       -         1
                                                     F            12           -        -     -       -        -         -         -        -        -       3         9

H60-H95         Diseases of the ear and              M            19          2         -     -       -       3          3         1       -        4        3         3
                mastoid process                      F             9          -         -     -       -       1          1         1       1        1        2         2

I00-I99         Diseases of the circulatory system M         100,147         22        17    22      92     347      1,412     4,324   10,124   22,767   38,197   22,823
                                                   F         109,801         17        11    21      74     157        565     1,602    4,041   13,215   38,974   51,124

I05-I09         Chronic rheumatic heart diseases     M           311           -        -     -       -       3          5        18      40      100      110        35
                                                     F           872           -        -     -       -       2          6        17      63      189      367       228

I10-I15         Hypertensive diseases                M         1,462           -        -     -       1        5        32        97     164      328      551       284
                                                     F         1,950           -        -     -       1        -        16        42     100      268      692       831

I20-I25         Ischaemic heart diseases             M        56,951          1         -     1       1     113        827     2,949    6,969   14,368   21,088   10,634
                                                     F        46,231          -         -     1       8      30        158       624    2,030    6,836   17,517   19,027

I21-I22         Acute myocardial infarction          M        25,501          1         -     -       -      62        381     1,353    3,280    6,701    9,543    4,180
                                                     F        20,096          -         -     1       6      18         83       306      978    3,399    8,128    7,177

I26-I51         Other heart diseases                 M         9,894         17        13    12      58     117        219       406     767     1,644    3,485    3,156
                                                     F        15,409         12         9    12      34      49        106       216     450     1,375    4,655    8,491

I60-I69         Cerebrovascular diseases             M        22,590          4         4     8      19      60        230       598    1,387    4,065    9,261    6,954
                                                     F        36,578          4         2     6      16      50        213       538      982    3,305   12,416   19,046

I60-I62         Intracranial haemorrhage             M         3,330          -         1     6      13      54        182       361     529      825       965      394
                                                     F         4,341          1         1     6      15      40        165       412     537      816     1,406      942

I63             Cerebral infarction                  M         2,600          1         1     2       4       2         22        83     191      499     1,067      728
                                                     F         3,485          -         -     -       -       7         25        39      87      316     1,276    1,735

I64             Stroke, not specified as             M        12,267           -        -     -       1       3         20       127     571     2,176    5,364    4,005
                haemorrhage or infarction            F        21,406           -        -     -       1       2         17        75     306     1,762    7,448   11,795

I70             Atherosclerosis                      M           368           -        -     -       -        -         3         1      12       51      126       175
                                                     F           688           -        -     -       -        -         -         2       3       32      186       465

I71             Aortic aneurysm and dissection       M         5,497           -        -     1       4      14         34        90     430     1,526    2,428      970
                                                     F         3,404           -        -     -       3       8          9        32     120       557    1,531    1,144

J00-J99         Diseases of the respiratory system M          31,908         39        21    31      65      89        223       628    1,939    5,724   12,844   10,305
                                                   F          38,240         26        19    29      39      81        155       443    1,462    4,528   12,077   19,381

J10-J11         Influenza                            M            16          -         1     -       1       1          2         -       1        3        5         2
                                                     F            23          2         1     1       -       -          -         -       -        3        6        10

* The figures for individual cause categories exclude deaths at ages under 28 days.




                                                                                                                         61     National Statistics
           Health Statistics Quarterly 18                Summer 2003




 Table 2             Deaths by age, sex and underlying cause, 2002 registrations
 continued

England and Wales                                                                                                                                              Numbers

                                                                                                                   Age group

ICD10 code     Causes of death *                               All      Under 1       1–4   5–14   15–24   25–34     35–44     45–54   55–64   65–74   75–84   85 and
                                                              ages                                                                                              over

J12-J18        Pneumonia                             M        12,488        20          4     7      15      41        126       260    505    1,400   4,420    5,690
                                                     F        20,281        15         10     7      11      30         57       147    331    1,123   5,153   13,397

J40-J44        Bronchitis, emphysema and other       M        13,254          -         1     1       2       2         16       170    941    3,191   6,072    2,858
               chronic obstructive pulmonary         F        10,993          -         -     1       1       2         13       140    752    2,532   4,821    2,731
               diseases

J45-J46        Asthma                                M          460           -         1    14      27      26         30        53     64      82      109       54
                                                     F          816           -         -    11      15      24         34        53    100     137      214      228

K00-K93        Diseases of the digestive system      M        11,037        18          7     9      29     167        723     1,399   1,670   2,214   3,098    1,703
                                                     F        13,127         9         10    16      22     100        399       782   1,049   1,891   4,182    4,667

K25-K27        Gastric and duodenal ulcer            M         1,781          -         -     1       3       9         29        95    195     400      677      372
                                                     F         1,980          -         -     -       4       6         18        42    106     264      736      804

K40-K46        Hernia                                M          297           2         -     -       -       2         4          8     20      53      109       99
                                                     F          447           -         1     -       1       -         3          2     13      58      164      205

K57            Diverticular disease of intestine     M           498          -         -     -       -       1         1         14     44     114      202      122
                                                     F         1,360          -         -     -       -       -         1         12     49     189      533      576

K70-K76        Diseases of the liver                 M         3,932          2         4     -       7     120        580     1,068    980     699      379       93
                                                     F         2,435          -         2     4       1      58        319       577    520     462      363      129

L00-L99        Diseases of the skin and              M           458          -         1     -       1       1          8        17     40      94      155      141
               subcutaneous tissue                   F         1,024          -         -     -       -       2          6        14     39     117      337      509

M00-M99        Diseases of the musculoskeletal       M         1,271          2         -     2       3       6         18        46    111     239      442      402
               system and connective tissue          F         3,349          -         -     2       6      26         34        48    133     424    1,042    1,634

M05-M06,       Rheumatoid arthritis and              M          208           -         -     -       -       -         1          7     25      66       83       26
M08            juvenile arthritis                    F          754           -         -     -       1       1         2         13     42     177      314      204

M80-M81        Osteoporosis                          M           323          -         -     -       -        -        -          1      2      20      111      189
                                                     F         1,270          -         -     -       -        -        1          -      6      55      332      876

N00-N99        Diseases of the genitourinary         M         3,642          2         1     1       6      21         37        78    170     544    1,408    1,374
               system                                F         4,815          3         -     1       6      21         39        74    160     476    1,528    2,507

N00-N15        Glomerular and renal                  M          365           -         1     -       2       7         7         16     22      76      143       91
               tubulo-interstitial diseases          F          424           2         -     -       1       5         9         16     20      74      150      147

N17-N19        Renal failure                         M         1,530          1         -     -       1       6         17        43     79     256      570      557
                                                     F         1,522          -         -     1       2       5         13        24     68     164      493      752

N40            Hyperplasia of prostate               M          171           -         -     -       -        -         -         1      5      20       65       80

O00-O99        Pregnancy, childbirth and             F            37          -         -     -       6      24         6          1       -       -       -        -
               the puerperium

P00-P96        Certain conditions originating        M          134        129          5     -       -        -         -         -       -       -       -        -
               in the perinatal period               F           73         69          2     -       2        -         -         -       -       -       -        -

Q00-Q99        Congenital malformations,             M          657        115         49    34      41      55         58        70     94      58       58       25
               deformations and chromosomal          F          596         99         46    32      33      33         39        60     87      67       60       40
               abnormalities

Q20-Q28        Congenital malformations of           M          301         62         19    19      21      33         25        33     29      26       31        3
               the circulatory system                F          258         36         22    11      18      21         15        27     25      37       33       13

R00-R99        Symptoms, signs and abnormal          M         2,926       131         17     3      39      77        114       127    113     108      394    1,803
               clinical and laboratory findings,     F        10,180        85         12     5       7      29         35        51     52      91    1,044    8,769
               not elsewhere classified

R54            Senility without mention              M         2,093          -         -     -       -        -         -         -       -     11      324    1,758
               of psychosis                          F         9,593          -         -     -       -        -         -         -       -     33      942    8,618

R95            Sudden infant death syndrome          M            99        96          3     -       -        -         -         -       -       -       -        -
                                                     F            57        56          1     -       -        -         -         -       -       -       -        -

* The figures for individual cause categories exclude deaths at ages under 28 days.




                        National Statistics              62
                                                                                                Health Statistics Quarterly 18        S ummer 2003




 Table 2                Deaths by age, sex and underlying cause, 2002 registrations
 continued

England and Wales                                                                                                                                                    Numbers

                                                                                                                       Age group

ICD10 code       Causes of death *                              All      Under 1          1–4   5–14   15–24   25–34     35–44       45–54   55–64   65–74   75–84    85 and
                                                               ages                                                                                                    over

R99             Other ill-defined and unspecified    M           607         35           12      2      29      63       100         120     101      82      49        14
                causes of mortality                  F           298         29            9      1       5      24        30          45      43      40      48        24

V01-Y89         External causes of morbidity         M        10,439         32           62    136    1,372   1,866     1,803       1,364    955     879    1,118       852
                and mortality                        F         6,324         24           42     85      337     411       506         499    447     538    1,329     2,106

V01-X59         Accidents                            M         6,087         16           50    121     881     901       793         640     478     554      886       767
                                                     F         4,627         16           32     62     184     159       210         244     245     369    1,125     1,981

V01-V99,        Transport accidents **               M         2,485          -           21     73     663     544       384         272     171     150     139        68
Y85                                                  F           790          3           10     40     143      80        80          79      75      76     141        63

V01-V89         Land transport accidents involving   M         2,412          -           20     71     661     529       370         253     162     141     138        67
                pedestrians, pedalcyclists, motor    F           772          3           10     40     143      77        79          75      72      72     138        63
                cyclists and occupants of motor
                vehicles

W00-W19         Falls                                M         1,290          1            3      3      31      46        86         143     141     214     366       256
                                                     F         1,221          1            2      2       2      13        30          52      78     137     396       508

W65-W74         Accidental drowning and              M           137          3            5      9      22      17        29          21      14      12       3         2
                submersion                           F            54          2            5      7       -       3         7           3       8       6       9         4

X00-X09         Exposure to smoke,                   M           186          2           11     16      11      16        14          25      23      23      33        12
                fire and flames                      F           166          -            9      5       7      10        15          18      13      25      37        27

X40-X49         Accidental poisoning by and          M           663           -           -      -     105     230       188          81      29      18       7         5
                exposure to noxious substances       F           281           -           1      2      26      45        61          62      36      19      12        17

X41             Accidental poisoning by and         M             55           -            -     -      11      18        12          10       3       1       -         -
                exposure to antiepileptic,          F             56           -            -     -       5      11         9          14       9       5       1         2
                sedative-hypnotic, antiparkinsonism
                and psychotropic drugs,
                not elsewhere classified

X42             Accidental poisoning by and          M           307           -            -     -      54     131        94          24       4       -       -         -
                exposure to narcotics and            F            64           -            -     1       8      19        20          10       4       -       1         1
                psychodysleptics [hallucinogens],
                not elsewhere classified

X44             Accidental poisoning by and       M              152           -           -      -      29      54        36          16       7       6       1         3
                exposure to other and unspecified F               70           -           1      -       4       8        18          11      11       3       5         9
                drugs, medicaments and
                biological substances

X59             Accidental exposure to unspecified M             853           -            -     1      12      13        22          25      48      84     269        379
                factor                             F           1,856           -            -     -       -       4         5          17      20      85     449      1,276

X60-X84         Intentional self-harm                M         2,551           -            -     4     245     576       627         469     296     177     111        46
                                                     F           768           -            -     3      62     135       135         138     114      71      71        39

X85-Y09         Assault                              M           265          5            4      3      54      68        56          30      23      16       4         2
                                                     F           120          2            5      6      26      19        25           6      11       4      12         4

Y10-Y34         Event of undetermined intent         M         1,294         11            8      7     186     304       304         208     115      83      49        19
                                                     F           598          5            5     13      62      94       130          94      61      52      47        35

X60-X84,        Intentional self-harm; and event     M         3,545          4            2      5     373     799       864         639     398     250     149        62
Y10-Y34,        of undetermined intent, excluding    F         1,228          2            2      8     103     211       239         213     165     114     104        67
excl.           other specified events with
Y33.9           undetermined intent

X85-Y09,        Assault; and other specified         M           565         12           10      9     112     149       123          68      36      26      15         5
Y33.9           events of undetermined intent        F           258          5            8     14      47      37        51          25      21      13      26        11

*     The figures for individual cause categories exclude deaths at ages under 28 days.
**    Including sequelae of transport accidents.




                                                                                                                                63    National Statistics
        Health Statistics Quarterly 18    Summer 2003




Population Estimates
The population figures used to calculate death rates for 2002 are the
2001 mid-year estimates of the resident population of England and
Wales, based on the 2001 Census of Population.

ONS mid-year population estimates are based on updates from the most
recent Census, allowing for births, deaths, net migration and ageing of
population. Whenever results become available from a Census, a new
base is created for the population estimates. This has just happened and
the historic series for 1982 to 2000 has been revised to be consistent
with the results of the 2001 Census.10


REFERENCES
1. World Health Organisation (1992) International Statistical
    Classification and Related Health Problems, Tenth Revision.
    Volume 1, World Health Organisation: Geneva.
2. World Health Organisation (1992) International Statistical
    Classification and Related Health Problems, Tenth Revision.
    Volume 2: Instruction Manual, World Health Organisation: Geneva.
3. World Health Organisation (1992) International Statistical
    Classification and Related Health Problems, Tenth Revision.
    Volume 3: Alphabetical Index, World Health Organisation: Geneva.
4. World Health Organisation (1992) International Statistical
    Classification and Related Health Problems, Ninth Revision.
    Volume 1, World Health Organisation: Geneva.
5. World Health Organisation (1992) International Statistical
    Classification and Related Health Problems, Ninth Revision.
    Volume 2: Alphabetical Index, World Health Organisation: Geneva.
6. Rooney C and Smith S (2000) Implementation of ICD-10 for
    mortality in England and Wales from January 2001. Health
    Statistics Quarterly 13, 31–41.
7. Rooney C, Griffiths C and Cook L (2002) The implementation of
    ICD-10 for cause of death coding – some preliminary results from
    the bridge coding study. Health Statistics Quarterly 14, 75–83.
8. Office for National Statistics (2002) Results of the ICD-10 bridge
    coding study, England and Wales, 1999. Health Statistics Quarterly
    14, 75–83.
9. ONS (2001) Mortality Statistics: cause 2000, series DH2 no 27,
    section 2.2.
10. Methods used to revise the 1982-2000 annual mid-year population
    estimates for England and Wales. http://www.statistics.gov.uk/
    downloads/theme_population/Meth_PopES_82_2000.pdf




                   National Statistics    64
Other population and health articles, publications and data


Population Trends 112                                                                  Health Statistics Quarterly 19
Publication 26 June 2003                                                               Publication 21 August 2003



     Planned       q         Population review of 2001: England and                        Planned       q         How deaths among Harold Shipman’s
     articles:               Wales                                                         articles                patients have affected mortality statistics by
                   q         Family building intentions: trends, outcomes                                          cause in England and Wales
                             and explanations in England and Wales                                       q         Trends in the mortality of young adults aged
                   q         Care for parents and care for children                                                15–44 in England and Wales, 1961–2001
                   q         Mothers with living children and children                                   q         Trends in mortality from injury and
                             with living mothers: the role of fertility and                                        poisoning in England and Wales: the effects
                             mortality in the period 1911–2050                                                     of changing to ICD-10

     Reports:      q         Live births in England and Wales 2002: local
                             and health authority areas                                    Reports:      q         Sudden infant deaths, 2002
                   q         Death registrations in England and Wales                                    q         Death registrations in England and Wales,
                             2002: area of residence                                                               2002: local and health authority areas
                                                                                                         q         Infant and perinatal mortality, 2002: health
                                                                                                                   areas, England and Wales

                                                                                           Annual        q         Mortality statistics: injury and poisoning,
                                                                                           Update:                 England and Wales, 2001




Forthcoming Annual Reference Volumes                                                   Vital Statistics data – annual data for each Health
                                                                                       and Local Authority in England and Wales
Title                                                            Planned publication
Mortality Statistics, injury and poisoning, England and Wales,                         VS1 Births and mortality summary data
2001, DH4 no.26                                                          June 2003     Population, births and deaths, fertility and mortality rates, comparisons with
                                                                                       the region, and with England and Wales.
Marriage, divorce and adoption statistics, England and Wales,
2001, FM2 no.29                                                          July 2003     VS2 Births data
                                                                                       Births by age of mother, number of previous children, place of confinement
* Available through the National Statistics website only www.statistics.gov.uk         and birthweight.

                                                                                       VS3 Mortality data by cause
                                                                                       Deaths by cause, sex and age.

                                                                                       VS3sc Mortality data by cause
                                                                                       Deaths by cause, sex and age.

                                                                                       VS4 Births and mortality by ward
                                                                                       Live births, stillbirths and deaths (by age).

                                                                                       VS4D Mortality by selected causes by ward
                                                                                       Deaths for wards in local authorities by 14 selected causes.

                                                                                       VS5 Infant and perinatal mortality data
                                                                                       Live births, stillbirths and infant deaths. Numbers and rates.
                                                                                       Live births and stillbirths by birthweight.
                                                                                       Stillbirths by gestation period.

                                                                                       How to order:

                                                                                       Most Vital Statistics data are available on paper and CD-ROM for each year
                                                                                       1993–2001. Prices range from £15. To order contact:

                                                                                       Vital Statistics Outputs Branch
                                                                                       Room 1300
                                                                                       Office for National Statistics
                                                                                       Segensworth Road
                                                                                       Titchfield
                                                                                       Hampshire PO15 5RR
                                                                                       Tel: 01329 813758

				
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