How do associations between healthy life expectancy and risk factors vary across small geographic areas in a UK integrated care system? Cross-sectional study.
Level 4 - case-series / case-control
Cross-sectional ecological study using area-level census and health data.
PubMed 42442804 · doi:10.1136/bmjopen-2025-108114
What was done
A cross-sectional population-based study was conducted across 128 Middle Layer Super Output Areas (MSOAs) and eight Lower Tier Local Authority Areas within the Norfolk and Waveney Integrated Care System in the UK. Healthy life expectancy (HLE) was estimated using self-reported general health status from the 2021 UK Census. The authors quantified associations between small-area HLE and 10 selected risk factors, including the Index of Multiple Deprivation, weekly net income, urban classification, dietary fruit and vegetable intake, physical inactivity, older adults living alone, falls admission rates, alcohol-related mortality, road casualties, and air pollution.
What was found
Overall HLE in 2021 was 66.5 years for men (range across areas: 52 to 73 years; 21-year gap) and 67.5 years for women (range across areas: 56 to 74 years; 18-year gap). Higher income showed the strongest association with HLE: every £100 increase in weekly net income was associated with 4.4 additional years (95% CI 3.5 to 5.2) of HLE at birth for males and 4.6 years (95% CI 3.8 to 5.4) for females, as well as 1.7 years (95% CI 1.3 to 2.2) and 2.0 years (95% CI 1.5 to 2.5) of HLE at age 65, respectively. Higher rates of older adults living alone correlated with lower HLE at birth for both sexes, while physical inactivity was associated with lower HLE at age 65 in males and at birth in females.
Why it matters
This study provides an accessible method using routinely collected census and public health data to identify small-area health inequalities. It allows local health and social care authorities to target resources and preventive interventions to the neighborhoods experiencing the greatest burdens of morbidity.
Limits
The study is cross-sectional and ecological, which prevents causal inferences and introduces the risk of ecological fallacy when applying area-level findings to individuals. Several important individual-level health determinants (such as smoking rates) could not be included due to lack of small-area data availability.
Cited by
- context As of recent ONS data, men and women in the UK can expect to spend approximately 60 years of their lives in good health.