Statistical Modelling 2 (2002), 63–88
A Life Table Approach To Small Area Health Need Profiling
Peter Congdon
Department of Geography,
Queen Mary, University of London,
Mile End Rd,
London E1 4NS
U.K.
e-mail: P.Congdon@qmul.ac.uk
Abstract:
Recent developments
in health outcome models for small areas have found benefits from pooling
information over areas to produce smoothed estimates of mortality and morbidity
rates. Such indices serve as proxies for the need for health care and are often
used in allocating health care resources. The present paper adopts a full life
table approach to such outcomes, which includes the joint modelling of
mortality and health variation between small areas. A further feature of the
approach here is random effects modelling of age specific death and wellness
rates, so pooling strength in estimating life table parameters for areas, such
as healthy and total life expectancies, which may be based on small event
counts. The basic model involves exchangeable random effects for age and area.
However, structured forms of variation considered include correlations between
mortality and health, spatial correlation in these outcomes, and
interrelatedness in age effects. A case study illustration uses deaths and long
term illness data to develop small area life tables for two London boroughs,
and includes a temporal perspective on deaths. It then considers the utility of
area life table measures in predicting health activity, providing a form of
validation in addition to formal statistical cross- validation.
Keywords:
Life Tables, Healthy Life Expectancy, Spatial Correlation, Long Term Illness,
Health Need, Health Resourcing
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