Explaining the excess mortality in Scotland compared with England: pooling of 18 cohort studies
Open Access
- 12 September 2014
- journal article
- mortality and-life-expectancy
- Published by BMJ in Journal of Epidemiology and Community Health
- Vol. 69 (1), 20-27
- https://doi.org/10.1136/jech-2014-204185
Abstract
Background Mortality in Scotland is higher than in the rest of west and central Europe and is improving more slowly. Relative to England and Wales, the excess is only partially explained by area deprivation. We tested the extent to which sociodemographic, behavioural, anthropometric and biological factors explain the higher mortality in Scotland compared with England. Methods Pooled data from 18 nationally representative cohort studies comprising the Health Surveys for England (HSE) and the Scottish Health Survey (SHS). Cox regression analysis was used to quantify the excess mortality risk in Scotland relative to England with adjustment for baseline characteristics. Results A total of 193 873 participants with a mean of 9.6 years follow-up gave rise to 21 345 deaths. The age-adjusted and sex-adjusted all-cause mortality HR for Scottish respondents compared with English respondents was 1.40 (95% CI 1.34 to 1.47), which attenuated to 1.29 (95% CI 1.23 to 1.36) with the addition of the baseline socioeconomic and behavioural characteristics. Cause-specific mortality HRs attenuated only marginally to 1.43 (95% 1.28 to 1.60) for ischaemic heart disease, 1.37 (95% CI 1.15 to 1.63) for stroke, 1.41 (95% CI 1.30 to 1.53) for all cancers, 3.43 (95% CI 1.85 to 6.36) for illicit drug-related poisoning and 4.64 (95% CI 3.55 to 6.05) for alcohol-related mortality. The excess was greatest among young adults (16–44 years) and was observed across all occupational social classes with the greatest excess in the unskilled group. Conclusions Only a quarter of the excess mortality among Scottish respondents could be explained by the available baseline risk factors. Greater understanding is required on the lived experience of poverty, the role of social support, and the historical, environmental, cultural and political influences on health in Scotland.Keywords
This publication has 33 references indexed in Scilit:
- Why Do Males in Scotland Die Younger than Those in England? Evidence from Three Prospective Cohort StudiesPLOS ONE, 2012
- Why the Scots die younger: Synthesizing the evidencePublic Health, 2012
- Trends in national suicide rates for Scotland and for England & Wales, 1960–2008The British Journal of Psychiatry, 2012
- Rising premature mortality in the UK’s persistently deprived areas: Only a Scottish phenomenon?Social Science & Medicine (1982), 2011
- Has Scotland always been the ‘sick man’ of Europe? An observational study from 1855 to 2006European Journal of Public Health, 2011
- The social patterning of deaths due to assault in Scotland, 1980-2005: population-based studyJournal of Epidemiology and Community Health, 2010
- Cause-specific inequalities in mortality in Scotland: two decades of change. A population-based studyBMC Public Health, 2007
- Liver cirrhosis mortality rates in Britain from 1950 to 2002: an analysis of routine dataThe Lancet, 2006
- High rates of ischaemic heart disease in Scotland are not explained by conventional risk factorsJournal of Epidemiology and Community Health, 2005
- Why is mortality higher in Scotland than in England and Wales? Decreasing influence of socioeconomic deprivation between 1981 and 2001 supports the existence of a 'Scottish Effect'Journal of Public Health, 2005