Mortality decline by cause in urban and rural England and Wales, 1851-1910

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.