Trends in mortality from 1965 to 2008 across the English north-south divide: Comparative observational study

Objective: To compare all cause mortality between the north and south of England over four decades. Design: Population wide comparative observational study of mortality. Setting: Five northernmost and four southernmost English government office regions. Population: All residents in each year from 1965 to 2008. Main outcome measures: Death rate ratios of north over south England by age band and sex, and northern excess mortality (percentage of excess deaths in north compared with south, adjusted for age and sex and examined for annual trends, using Poisson regression). Results: During 1965 to 2008 the northern excess mortality remained substantial, at an average of 13.8% (95% confidence interval 13.7% to 13.9%). This geographical inequality was significantly larger for males than for females (14.9%, 14.7% to 15.0% v 12.7%, 12.6% to 12.9%, P