Why is mortality higher in Scotland

than in England and Wales?

An update of the 'Scottish Effect' work using 2011 Census data

Rosalia Munoz-ArroyoLauren Schofield

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Example of recently completed work

An update of the 'Scottish Effect' work

Overview

• Results of new national analyses for 2011 (update of previous paper 1981 – 2001)

• ‘Scottish effect’– By deprivation decile– By sex and age group– Specific causes

Excess mortality• Higher mortality observed in Scotland

(compared to elsewhere in the UK) over and above that explained by differences in socio-economic deprivation

• Also referred to as the ‘Scottish Effect’

Methods• Directly standardised mortality rates (by age,

sex and deprivation decile) for census years 1981 - 2011

• Carstairs deprivation (ward/pc sector)-four standardised census variables

• Male unemployment, lack of car ownership, low social class and overcrowding

• Deprivation scores used to categorise into deprivation deciles by population

Specific causes• Respiratory Disease• Cerebrovascular Disease• Ischaemic Heart Disease• Malignant Neoplasms• Lung Cancer• Intentional self-harm and events of undetermined

intentAdditional causes• External causes• Alcohol related deaths• Drug poisoning

Conclusions• Excess increasing over time• Affects all levels of deprivation, but highest among

comparisons of most deprived, increasing over time

• Seen for many different causes of death• Additional work – alternative measures of

deprivation, new smaller, more comparable geography

• David Walsh (GCPH) and Gerry McCartney (Health Scotland) large piece of work synthesise explanations of ‘Scottish Effect’