Discrepant legacies: premature mortality in two industrial towns.

Previous research has indicated that, while large parts of Middlesbrough and Sunderland appear to be equally severely deprived, premature mortality in the early 1980s was substantially worse in Middlesbrough. Postcoded mortality data from 1975 to 1986 were assembled, to ascertain whether this disparity reflected a temporary or consistent difference between these two towns. In addition, to enable detailed consideration of the differentials in premature mortality, data on cause of death for 23 cause-groups were assembled for the 6-year period 1978 to 1983. The results show that, throughout the 12-year period, death rates below the age of 65 years in Middlesbrough's poorer areas consistently exceeded death rates in comparable areas of Sunderland by a large margin. This disparity is demonstrated to affect both sexes and all age-groups below 65. Middlesbrough's excess mortality was evident for most causes of death (19 out of 22 causes among men, and 16 out of 23 causes among women), with cerebrovascular disease and genitourinary malignancy among women being the only major exceptions. Possible explanations for this wide difference are considered. The conclusions of research in Lancashire, suggesting that the antecedents of present differences may be found in infant health disparities from the 1920s and 1930s, do not seem to apply in this instance. The possibility that unmeasured differences in levels of poverty or the suddenness of its onset may be contributory influences remains problematic. Individual lifestyle is not considered a plausible explanation, but possible differences in the provision and use of health services between the two towns are thought worthy of closer investigation. It is also suggested that environmental differences, in terms of the built environment and atmospheric pollutants require closer scrutiny.