University of Pennsylvania ScholarlyCommons Publicly Accessible Penn Dissertations 2016 Three Essays on the Behavioral, Socioeconomic, and Geographic Determinants of Mortality: Evidence From the United Kingdom and International Comparisons Laura Kelly University of Pennsylvania, [email protected] Follow this and additional works at: https://repository.upenn.edu/edissertations Part of the Demography, Population, and Ecology Commons, and the Epidemiology Commons Recommended Citation Kelly, Laura, "Three Essays on the Behavioral, Socioeconomic, and Geographic Determinants of Mortality: Evidence From the United Kingdom and International Comparisons" (2016). Publicly Accessible Penn Dissertations. 1806. https://repository.upenn.edu/edissertations/1806 This paper is posted at ScholarlyCommons. https://repository.upenn.edu/edissertations/1806 For more information, please contact [email protected]. Three Essays on the Behavioral, Socioeconomic, and Geographic Determinants of Mortality: Evidence From the United Kingdom and International Comparisons Abstract This dissertation contains three chapters covering the impact of behavioral, socioeconomic, and geographic determinants of health and mortality in high-income populations, with particular emphasis on the abnormally high mortality in Scotland, and the relative advantages of indirect and direct analyses in estimating national mortality. Chapter one identifies behavioral risk factors underlying mortality variation across small-areas in Great Britain, using the indirect estimation method of factor analysis on aggregate cause-of-death information from 1981-2009. Chapter two uses two indirect analytic methods to estimate the contribution of smoking to Scotland’s high mortality and low sex differences in life expectancy relative to other high-income populations from 1951-2009. Chapter three performs survival analysis on first and second generation migrants using a national longitudinal study in England and Wales from 1971-2013 to quantify mortality variation by migrant status and the relative impact of socioeconomic status. The findings highlight the importance of health behaviors on aggregate mortality inequality, support the methodological advantages of indirect estimation of behavioral-attributable mortality, and exposes the importance of subgroup variation within national mortality estimates. Degree Type Dissertation Degree Name Doctor of Philosophy (PhD) Graduate Group Demography First Advisor Michel Guillot Keywords Demography, Health behaviors, Mortality, Smoking, United Kingdom Subject Categories Demography, Population, and Ecology | Epidemiology | Medicine and Health Sciences This dissertation is available at ScholarlyCommons: https://repository.upenn.edu/edissertations/1806 THREE ESSAYS ON THE BEHAVIORAL, SOCIOECONOMIC, AND GEOGRAPHIC DETERMINANTS OF MORTALITY: EVIDENCE FROM THE UNITED KINGDOM AND INTERNATIONAL COMPARISONS Laura Amelia Kelly A DISSERTATION in Demography Presented to the Faculties of the University of Pennsylvania in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy 2016 Supervisor of Dissertation ___________________ Michel Guillot, Professor of Sociology Graduate Group Chairperson ___________________ Hans-Peter Kohler, Frederick J. Warren Professor of Demography Dissertation Committee Michel Guillot, Professor of Sociology Samuel H. Preston, Professor of Demography and Sociology Hans-Peter Kohler, Frederick J. Warren Professor of Demography THREE ESSAYS ON THE BEHAVIORAL, SOCIOECONOMIC, AND GEOGRAPHIC DETERMINANTS OF MORTALITY: EVIDENCE FROM THE UNITED KINGDOM AND INTERNATIONAL COMPARISONS COPYRIGHT 2016 Laura Amelia Kelly This work is licensed under the Creative Commons Attribution- NonCommercial-ShareAlike 3.0 License To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-sa/3.0/us/ ACKNOWLEDGMENTS I would like to here acknowledge several individuals who significantly contributed to the evolution of this dissertation and to my general personal and professional well-being over the past four years. First and foremost, I am grateful for the expert mentorship and guidance of my dissertation committee: Profs. Michel Guillot, Sam Preston, and Hans-Peter Kohler. Their insightful instruction helped shape this dissertation, and their exceptional example influenced my development as a demographer and colleague. I am further indebted to the entire faculty within the Graduate Group of Demography and thankful for the tireless support of the administrative staff: Tanya Yang, Dawn Ryan, Nykia Perez, and Sheri Luckey. My cohort – Tom, Megan, Edith, David, and Ezra – has alternately been my sounding board, my study buddies, and my support group. They continually inspire me with their demographic brilliance and personal merit, and I look forward to calling them friends and colleagues for many years to come. I gratefully acknowledge the National Institute of Child Health and Human Development and the University of Pennsylvania Graduate School of Arts and Sciences for their financial support towards my degree and work-related travel. I am extremely thankful for the administrative and technical assistance from the Office for National Statistics, in particular the Longitudinal Study team, and Dr. Paul Norman. I am grateful for my second home at Penn, the Graduate Student Center, and its wonderful staff. Finally, I would like to express my gratitude for my family and friends, though I hope they already know the depth of my love and appreciation. There is no greater inspiration for me than the personal integrity, vibrant curiosity, innate generosity, sparkling humor, whole- hearted compassion, and fundamental joie de vivre displayed by my family on a daily basis. I hope they, especially, enjoy this dissertation because it would not exist without them. iii ABSTRACT THREE ESSAYS ON THE BEHAVIORAL, SOCIOECONOMIC, AND GEOGRAPHIC DETERMINANTS OF MORTALITY: EVIDENCE FROM THE UNITED KINGDOM AND INTERNATIONAL COMPARISONS Laura Amelia Kelly Michel Guillot This dissertation contains three chapters covering the impact of behavioral, socioeconomic, and geographic determinants of health and mortality in high-income populations, with particular emphasis on the abnormally high mortality in Scotland, and the relative advantages of indirect and direct analyses in estimating national mortality. Chapter one identifies behavioral risk factors underlying mortality variation across small-areas in Great Britain, using the indirect estimation method of factor analysis on aggregate cause-of-death information from 1981-2009. Chapter two uses two indirect analytic methods to estimate the contribution of smoking to Scotland’s high mortality and low sex differences in life expectancy relative to other high-income populations from 1951-2009. Chapter three performs survival analysis on first and second generation migrants using a national longitudinal study in England and Wales from 1971-2013 to quantify mortality variation by migrant status and the relative impact of socioeconomic status. The findings highlight the importance of health behaviors on aggregate mortality inequality, support the methodological advantages of indirect estimation of behavioral-attributable mortality, and exposes the importance of subgroup variation within national mortality estimates. iv TABLE OF CONTENTS Acknowledgements……………………………………………………………………………….iii Abstract…………………………………………………………………………………………....iv List of Tables……………………………………………………………………………………..vii List of Figures……………………………………………………………………………………viii Chapter 1: Behavioral factors drive geographic mortality inequality in Great Britain …….……...1 Introduction……………………………………………………………………………………....1 Background……………………………………………………………………………………....1 Geographic variation in health in Britain………………………………………………………1 Health-related behaviors and mortality…………………………………………….…………..5 Methods for estimating behavior-attributable mortality……………………………………….6 Data……………………………………………………………………………………………....8 Methods………………………………………………………………………………………….9 Results………………………………………………………………………………………......12 Description of the study sample………………………………………………………………12 Male factor analysis…………………………………………………………………………...13 Female factor analysis………………………………………………………………………...18 Discussion………………………………………………………………………………………22 References………………………………………………………………………………………26 Chapter 2: The contribution of a history of heavy smoking to Scotland’s mortality disadvantage………………………………………………………………………………………44 Introduction……………………………………………………………………………………..44 Background……………………………………………………………………………………..44 Scotland’s life expectancy in international perspective……………………………………….44 Explanations of Scotland’s exceptionally high mortality……………………………………..46 Smoking in Scotland…………………………………………………………………………..48 Methods for calculating smoking-attributable mortality……………………………………...49 Data……………………………………………………………………………………………..51 Methods…………………………………………………………………………………………51 Attributable-risk calculation in the PGW method…………………………………………….51 Results…………………………………………………………………………………………..52 Smoking-attributable mortality above age 50, by sex and country, 1955-2009………………52 Effect on life expectancy……………………………………………………………………...53 Discussion………………………………………………………………………………………55 References………………………………………………………………………………………56 Chapter 3: Mortality among first and second generation migrants in England and Wales …….67 Introduction……………………………………………………………………………………..67 Background……………………………………………………………………………………..70 Migration and mortality……………………………………………………………………….70 Migrant health in the England