Why Do Males in Scotland Die Younger than Those in England? Evidence from Three Prospective Cohort Studies
Open Access
- 11 July 2012
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 7 (7), e38860
- https://doi.org/10.1371/journal.pone.0038860
Abstract
To examine explanations for the higher rates of male mortality in two Scottish cohorts compared with a cohort in south-east England for which similar data were collected. We compared three cohort studies which recruited participants in the late 1960s and early 1970s. A total of 13,884 men aged 45–64 years at recruitment in the Whitehall occupational cohort (south-east England), 3,956 men in the Collaborative occupational cohort and 6,813 men in the Renfrew & Paisley population-based study (both central Scotland) were included in analyses of all-cause and cause-specific mortality. All-cause mortality was 25% (age-adjusted hazard ratio 1.25, 95% confidence interval (CI)1.21 to 1.30) and 41% (hazard ratio 1.41 (95% CI 1.36 to 1.45) higher in the Collaborative and Renfrew & Paisley cohorts respectively compared to the Whitehall cohort. The higher mortality rates were substantially attenuated by social class (to 8% and 17% higher respectively), and were effectively eliminated upon the further addition of the other baseline risk factors, such as smoking habit, lung function and pre-existing self-reported morbidity. Despite this, coronary heart disease mortality remained 11% and 16% higher, stroke mortality 45% and 37% higher, mortality from accidents and suicide 51% and 70% higher, and alcohol-related mortality 46% and 73% higher in the Collaborative and Renfrew & Paisley cohorts respectively compared with the Whitehall cohort in the fully adjusted model. The higher all-cause, respiratory, and lung cancer male mortality in the Scottish cohorts was almost entirely explained by social class differences and higher prevalence of known risk factors, but reasons for the excess mortality from stroke, alcohol-related causes, accidents and suicide remained unknown.Keywords
This publication has 23 references indexed in Scilit:
- Has Scotland always been the ‘sick man’ of Europe? An observational study from 1855 to 2006European Journal of Public Health, 2011
- Relationship between distance to social gathering facilities and risk of trachoma for households in rural Tanzanian communitiesSocial Science & Medicine, 2011
- Occupational exposures contribute to educational inequalities in lung cancer incidence among men: Evidence from the EPIC prospective cohort studyInternational Journal of Cancer, 2009
- The aftershock of deindustrialization--trends in mortality in Scotland and other parts of post-industrial EuropeEuropean Journal of Public Health, 2009
- Cause-specific inequalities in mortality in Scotland: two decades of change. A population-based studyBMC Public Health, 2007
- The Midspan studiesInternational Journal of Epidemiology, 2005
- The widening health gap: What are the solutions?Critical Public Health, 1999
- Individual social class, area-based deprivation, cardiovascular disease risk factors, and mortality: the Renfrew and Paisley StudyJournal of Epidemiology and Community Health, 1998
- Education and occupational social class: which is the more important indicator of mortality risk?Journal of Epidemiology and Community Health, 1998
- Deprivation: explaining differences in mortality between Scotland and England and Wales.BMJ, 1989