Is economic adversity always a killer? Disadvantaged areas with relatively low mortality rates.

objectivesTo identify areas of Britain whose residents have relatively low age specific mortality, despite experiencing long-term economic adversity.

methodsLongitudinal, ecological study of all residents of Britain from 1971 to 2001.

results54 of Britain's 641 parliamentary constituencies were identified as having been persistently economically disadvantaged in the period 1971-2001. Within this group, there was marked variation in age group specific mortality and in the age ranges with relatively high or low mortality. A systematic scoring process identified 18 constituencies as providing strong and consistent evidence of low mortality across a range of age groups, relative to the 54 constituencies as a whole. These 18 were labelled "resilient". Among age groups >24 years, mortality rates in the resilient areas were significantly lower than in the other economically disadvantaged areas. For example, at ages 45-59 years, the average all cause mortality rate in the resilient constituencies was 607 per 100 000 population (95% CI 574 to 641) and 728 (670 to 787) in the non-resilient constituencies (p = 0.013).

conclusionsAreas with similar adverse economic histories do not all have similarly high mortality rates. It is unlikely that a single factor explains these results. Selective migration cannot be discounted as an explanation, but particular sociocultural features of areas (including the political, economic, ethnic and religious characteristics of their population) may also be protective.