ABSTRACT

This paper presents a new analysis of the contribution of particular causes of death to the decline of mortality in England and Wales between 1851 and 1910. We examine deaths in a set of 588 registration areas based on the registration districts but amalgamated where necessary so that the boundaries of the areas are consistent over time. The deaths are classified by cause, and the paper discusses changes in the classification of causes of death between 1851 and 1910 and attempts to use as congruent a set of classes as is possible. The results show that declines in deaths from waterborne diseases and scarlet fever had their greatest impact between the 1860s and the 1880s, pulmonary tuberculosis declined steadily throughout the period, and diseases of the lungs were important between the 1890s and 1901–1910. The paper then examines cause-specific death rates in urban and rural areas, using definitions of ‘urban’ based on both population density and settlement size. The results are largely insensitive to the definition of what constitutes an urban area. They reveal that mortality from typhus/typhoid and pulmonary tuberculosis declined in parallel in urban and rural areas. Mortality from scarlet fever converged to very low levels in all areas by 1901–1910. There were, however, differences between town and countryside in the pace and timing of the decline of mortality from diarrhoeal diseases. Where there were differences, it was often the smaller urban areas that stood apart: there was no gradation from rural areas through small towns to larger towns. The paper concludes with some remarks on the implications of our findings for the role of public investment in mortality decline.

摘要

本文提供了一种新的分析方法，用于分析1851至1910年间英格兰和威尔士特定死亡原因对死亡率下降的贡献。我们根据登记地区对588个登记地区中的死亡进行了研究，但在必要时将其合并，以便随着时间的流逝，区域的边界是一致的。死亡按原因分类，本文讨论了1851年至1910年之间死亡原因分类的变化，并尝试尽可能地使用一系列分类。结果表明，在1860年代至1880年代之间，水传播疾病和猩红热致死人数的下降具有最大的影响，在此期间，肺结核病稳步下降，在1890年代至1901-1910年间，肺部疾病十分重要。然后，本文使用基于人口密度和定居点规模的“城市”定义，研究了城乡特定原因的死亡率。结果对城市区域的定义不敏感。他们发现，在城乡地区，伤寒/伤寒和肺结核的死亡率同时下降。到1901年至1910年，猩红热导致的死亡率在所有地区均降至非常低的水平。但是，腹泻病死亡率下降的速度和时间在城乡之间存在差异。在存在差异的地方，通常是较小的城市地区分隔开来：没有从农村地区到小城镇到大城镇的等级划分。