P122 The steepest part of the gradient? Explaining life expectancy inequalities between the most and second most deprived quintiles in England

Le résumé fourni par la source

Background Spatial health inequalities are substantial and increasing in England, as in many other developed countries, with pronounced life expectancy gaps between the most and least deprived areas. While much research focuses on inequalities between the extreme ends of the deprivation continuum, a less recognised but critical pattern is that the largest gap within the social gradient occurs at its lower end - between the two most deprived quintiles. Understanding the drivers of this gap can contribute to generating more practical and policy-relevant insights for reducing health inequalities. Methods Using aggregate-level data from official national statistics for a period 2015-2022, we examined the contributors to the life expectancy gap between the 20% and 40% most deprived local authorities in England and compared these findings with the more conventional comparison between the most and least deprived areas. We applied Blinder-Oaxaca decomposition methods to decompose life expectancy gaps separately for men and women and to assess the relative contributions of material, behavioural, and psychosocial explanations of health inequalities. Results We have found that household income is the key contributing factor to life expectancy inequalities between the most deprived quintiles for both men and women, accounting for 29% [95% CI: 21.0-37.5%] and 35% [25.3-43.9%] of life expectancy gaps respectively. In addition, our results show that income constitutes a larger share of the inequality between the 20% and 40% most deprived areas than between the most and least deprived local authorities. Conclusion Overall, our findings underscore the importance of materialist explanations of health inequalities and demonstrate the potential policy value of examining inequalities across the social gradient, rather than focusing solely on its extremes.

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