Community Health Profiles

35. ETHNICITY & OCCUPATION

TABLE 1 – INDICATOR DESCRIPTION

Information component	Pg 3 Health Inequalities: ethnicity
Subject category / domain(s)	Health inequalities
*Indicator name ( Indicator title in health profile)**	Ethnicity and occupation
PHO with lead responsibility	EMPHO
Date of PHO dataset creation	December 2006
Indicator definition	Percentage of people (aged 16-74) working in routine or manual occupations by ethnic group, 29^th April 2001.
Geography	England, GOR, Local Authority: Counties, County Districts, Metropolitan County Districts, Unitary Authorities, London Boroughs
Timeliness	Every 10 years, next census to be held in 2011
Rationale:What this indicator purports to measure	Percentage in low socio-economic groups as measured by those working in routine and manual occupations by ethnic group.
Rationale:Public Health Importance	Ethnic inequalities in health are well known¹, but are difficult to monitor and address due to limited data². National Statistics Socio-economic Classification has been shown to be related to health in that people in ‘routine and manual’ occupations have higher mortality rates than people in other groups^{3, 4}. Typical examples might be porters, cleaners, bar staff, waiters/waitresses, sales assistants, train drivers, people working in call centres, electricians and sewing machinists. People in these occupations are more likely to smoke.1 Aspinall P, Jacobson B. Ethnic disparities in health and health care: A focused review of the evidence and selected examples of good practice. London: LHO, 2004. 2 Aspinall P, Jacobson B, Polato GM. Missing record: The case for recording ethnicity at birth and death registration. London: LHO, 2003. 3 Fitzpatrick J. Examining Mortality Rates by NS-SEC using Death Registration Data and the 1991 Census. In Rose D, Pevalin DJ, eds. A Researcher’s Guide to the National Statistics Socio-economic Classification, pp 173-93. London: SAGE, 2003. 4 Office for National Statistics. Report: Infant and perinatal mortality by social and biological factors, 2003. Health Statistics Quarterly 2004; 66-70.
Rationale: Purpose behind the inclusion of the indicator	This indicator can help to indicate within a local area which ethnic groups are likely to experience poorer health than others and could be used to predict health care need and target resources.
Rationale:Policy relevance	There are two National Health Inequalities Public Service Agreement Targets which relate to those in ‘routine and manual’ occupations. 1. Starting with children under one year, by 2010 to reduce by at least 10 per cent the gap in mortality between routine and manual group and the population as a whole.2. Reduce smoking prevalence in manual group to 26% by 2010 (from 32% in 1998).
Interpretation: What a high / low level of indicator value means	A high percentage indicates an ethnic group with a high risk of poor health. The numbers provided allow local authorities to estimate the burden of this risk in their populations. Ethnics groups with a higher percentage than the England average, which is represented on the chart by a grey box, are at increased risk of poor health when compared to the England average. Ethnics groups with a lower percentage than the England average, which is represented on the chart by a grey box, are at decreased risk of poor health when compared to the England average.
Interpretation: Potential for error due to type of measurement method	The subjective, multi-faceted and changing nature of ethnic identification makes it a particularly difficult piece of information to collect. There is no consensus on what constitutes an ‘ethnic group’. Membership of any ethnic group is something that is subjectively meaningful to the person concerned and the terminology used to describe ethnic group has changed markedly over time. As a result, ethnic group, however defined or measured, will tend to change over time depending on social and political attitudes or developments. Basing ethnic identification upon an objective and rigid classification of ethnic groups is not therefore achievable in practice. In particular research has shown that people with mixed backgrounds may vary their answer to questions about ethnicity to suit their perception of the form they are completing.
Interpretation: Potential for error due to bias and confounding	In the 2001 census information was collected for usual residents. A usual resident was generally defined as someone who spent most of their time at a specific address. It included: people who usually lived at that address but were temporarily away (on holiday, visiting friends or relatives, or temporarily in a hospital or similar establishment); people who worked away from home for part of the time; students, if it was their term-time address; a baby born before 30 April 2001 even if it was still in hospital; and people present on Census Day, even if temporarily, who had no other usual address. However, it did not include anyone present on Census Day who had another usual address or anyone who had been living or intended to live in a special establishment, such as a residential home, nursing home or hospital, for six months or more. Arrangements were made to enumerate special groups such as the Armed Forces and people sleeping rough. However, there was under sampling in those sleeping rough.Although the proportion of the population counted on returned census forms was 94 per cent in 2001. Under-enumeration in the 2001 census did not occur uniformly across all areas. The patterns of census response were as expected, that is response rates were lowest for inner city areas where characteristics known to be related to census non-response are most prevalent such as multi-occupancy and higher proportions of non-English speaking population.
Confidence Intervals: Definition and purpose	A confidence interval is a range of values that is normally used to describe the uncertainty around a point estimate of a quantity, for example, a mortality rate. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. These occurrences result in random fluctuations in the indicator value between different areas and time periods. In the case of indicators based on a sample of the population, uncertainty also arises from random differences between the sample and the population itself.The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. Confidence intervals quantify the uncertainty in this estimate and, generally speaking, describe how much different the point estimate could have been if the underlying conditions stayed the same, but chance had led to a different set of data. The wider is the confidence interval the greater is the uncertainty in the estimate.Confidence intervals are given with a stated probability level. In Health Profiles 2007 this is 95%, and so we say that there is a 95% probability that the interval covers the true value. The use of 95% is arbitrary but is conventional practice in medicine and public health. The confidence intervals have also been used to make comparisons against the national value. For this purpose the national value has been treated as an exact reference value rather than as an estimate and, under these conditions, the interval can be used to test whether the value is statistically significantly different to the national. If the interval includes the national value, the difference is not statistically significant and the value is shown on the health summary chart with a white symbol. If the interval does not include the national value, the difference is statistically significant and the value is shown on the health summary chart with a red or amber symbol depending on whether it is worse or better than the national value respectively.

TABLE 2 – INDICATOR SPECIFICATION

Indicator definition: Variable	Persons aged 16-74 working in routine or manual occupations by ethnic group.
Indicator definition: Statistic	Percentage by ethnic group
Indicator definition: Gender	Persons
Indicator definition: age group	Aged 16-74
Indicator definition: period	Census, 29^th April 2001
Indicator definition: scale
Geography: geographies available for this indicator from other providers	England, GOR, Local Authority: Counties, County Districts, Metropolitan County Districts, Unitary Authorities, London Boroughs and 2003 standard table wards available from http://www.nomisweb.co.uk/
Dimensions of inequality: subgroup analyses of this dataset available from other providers	Available by gender. Source http://www.nomisweb.co.uk/
Data extraction: Source	Office for National Statistics – Census 2001, Nomis official labour market statistics
Data extraction: source URL	http://www.nomisweb.co.uk/
Data extraction: date	Data extracted from source as at: 30^th November 2006
Numerator: definition	Number of people aged 16-74 working in routine or manual occupations by ethnic group. Census, 29^th April 2001. Those in routine and manual occupations are defined as those in Class 3 using the NS-SEC classification consisting of three classes. For further information on NS-SEC Classification seehttp://www.statistics.gov.uk/methods_quality/ns_sec/default.asp.Data for 13 ethnic groups have been presented these come from the 16 ethnic groups on the census (White British, White Irish, White Other, White and Black Caribbean, White and Black African, White and Asian, Any Other Mixed, Indian, Pakistani, Bangladeshi, Any Other Asian, Black Caribbean, Black African, Any Other Black, Chinese, Any Other Ethnic Group) with all the mixed ethnic groups (White and Black Caribbean, White and Black African, White and Asian, Any Other Mixed) being combined and presented as one total.
Numerator: source	Office for National Statistics (ONS) Census 29^th April 2001.
Denominator: definition	Population 16-74 by ethnic group at census 29^th April 2001. Data for 13 ethnic groups have been presented these come from the 16 ethnic groups on the census (White British, White Irish, White Other, White and Black Caribbean, White and Black African, White and Asian, Any Other Mixed, Indian, Pakistani, Bangladeshi, Any Other Asian, Black Caribbean, Black African, Any Other Black, Chinese, Any Other Ethnic Group) with all the mixed ethnic groups (White and Black Caribbean, White and Black African, White and Asian, Any Other Mixed) being combined and presented as one total.
Denominator: source	Office for National Statistics (ONS) census 2001. Standard Table ST112: Sex and National Statistics Socio-economic Classification (NS-SEC) by ethnic group. Directly downloaded from Nomis http://www.nomisweb.co.uk/
Data quality: Accuracy and completeness	Census data should be regarded as reliable and complete. The level of response achieved in a population census is the key measure of its quality. The proportion of the population counted on returned census forms was 94 per cent in 2001. The patterns of census response were as expected, that is response rates were lowest for inner city areas where characteristics known to be related to census non-response are most prevalent such as multi-occupancy and higher proportions of non-English speaking population. Further details can be found in census 2001 Quality reporthttp://www.statistics.gov.uk/downloads/census2001/census_2001_quality_report.pdfThe One Number Census (ONC) had the goal of providing a methodology and processes to identify and adjust for the number of people and households not counted in the 2001 census. The extent of this under enumeration was identified using a large survey covering approximately 320,000 households, the Census Coverage Survey (CCS). Statistical sample techniques were then used to produce an adjusted database from which the final census results were produced. Further details can be found at http://www.statistics.gov.uk/census2001/proj_onc.asp

TABLE 3 – INDICATOR TECHNICAL METHODS

Numerator: extraction	Standard Table ST112 Sex and National Statistics Socio-economic Classification (NS-SEC) by ethnic group. Directly downloaded from Nomis:http://www.nomisweb.co.uk/
Numerator: aggregation /allocation	Not applicable
Numerator data caveats	Where the numerator is less than 5 no percentage is shown. One of the disclosure control methods used by ONS was small cell adjustment. This method adjusts small counts in tables to add uncertainty to tabular output in which individual information could be identified. The definition of a small count must remain confidential so that the protection provided by the adjustment is maintained. Totals and subtotals are calculated from adjusted data, thus ensuring consistency within tables.As a result of this method we considered percentages based on numerators less than 5 to be unreliable.
Denominator data caveats	Where the ethnic population is less than 30 the data has not been presented. One of the disclosure control methods used by ONS was small cell adjustment. This method adjusts small counts in tables to add uncertainty to tabular output in which individual information could be identified. The definition of a small count must remain confidential so that the protection provided by the adjustment is maintained. Totals and subtotals are calculated from adjusted data, thus ensuring consistency within tables.As a result of this method we considered percentages based on populations of less than 30 to be unreliable.
Methods used to calculate indicator value	The indicator is expressed as the percentage of people (aged 16-74) working in routine or manual occupations by ethnic groups. A percentage is defined as the number of observed events divided by the total population of interest multiplied by 100. A percentage, p, is given by: where:O is the number of observed events (i.e. number of people working in routine or manual occupations for each ethnic group);n is the size of the population of interest (i.e. the population in each ethnic group aged 16-74)
Small Populations: How Isles of Scilly and City of London populations have been dealt with	Data for the Isles of Scilly and City of London have not been presented. The Isles of Scilly are included in the Cornwall county and South East regional and national totals and the City of London figures have been included in the regional London and national totals.
Disclosure Control	Disclosure control methods have been applied to the data by ONS. Note that higher geographical levels are independently adjusted therefore, will not necessarily be the sum of the lower component geographical units. Further information is available athttp://www.statistics.gov.uk/methods_quality/ns_sec/default.asp.
Confidence Intervals calculation method	Confidence intervals have been calculated using the following method for a confidence interval of a proportion as described by Newcombe RG If r is the observed number of subjects with some feature in a sample of size n then the estimated proportion who have the feature is p = r/n. The proportion who do not have the feature is q = 1-p.First, calculate the three quantitiesA = 2r + z²; ; and C=2(n+z²),where z is z_1-_α_/2, from the standard Normal distribution. Then the confidence interval for the population proportion is given by **(A-B)/C to (A+B)/C*This method has the considerable advantage that it can be used for any data. When there are no observed events, r and hence p are both zero, and the recommended confidence interval simplifies to 0 to z²/(n+z²). When r = n* so that p = 1, the interval becomes n/(n+z²) to 1. Reference Newcombe, RG. Two-sided confidence intervals for the single proprotion: comparison of seven methods. Stat Med 1998;17:857-72.

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