Report shows growing inequalities in mortality between rich and poor
Friday 16 February 2007
The Medical Research Council has found that figures showing falling mortality rates across Scotland are masking a more worrying trend: death rates in more deprived areas are falling more slowly than in affluent areas. The report’s authors, from the MRC’s Social and Public Health Sciences Unit in Glasgow, say this is leading to greater inequalities in different parts of the country.
The pattern of mortality uncovered by the report, funded by the Scottish Executive, reflects social changes over the past 20 years. Mortality rates for heart disease, lung cancer, stroke and chronic respiratory disease have all fallen considerably, thanks to advances in medical research and healthcare. They have delivered better prevention, diagnosis and treatment. But the declines in deaths from these causes have been more pronounced among those living in the more affluent areas.
The research combined death records from 1980 – 2002 with population data from the 1981, 1991 and 2001 Censuses. It provides one of the most accurate and robust pictures of changes in inequalities in mortality rates currently available.
The age standardized mortality rate in Scotland fell by 30% for men and 25% for women between 1981 and 2001, but male mortality rates in Clydeside, which contains around 30% of the Scottish population, were 17% higher than the Scottish average in 2001 compared with only 9% above the Scottish average in 1981.
There have been some exceptions to the general pattern of decreasing mortality rates. Mortality has actually increased among men between the ages of 15 and 44 and among women aged 15 to 29. These increases have largely been driven by deaths due to suicide, drug and alcohol use and assault, and have been most pronounced in the more deprived parts of the country.
Mortality rates due to suicides were up by 43%, and deaths from chronic liver disease trebled over 20 years. For men under 65, deaths from these two causes are now at around the same level as deaths due to colorectal cancer.
The report also highlighted an east-west divide, with the bleakest picture in Glasgow. Male mortality rates in the city in every social class were higher than those in Clydeside. Rates in Clydeside rule out the possibility that the region’s high mortality could be explained solely on the basis of the social structure of the population.
The lead author of the report, Professor Alastair Leyland, from the MRC’s Social and Public Health Sciences Unit in Glasgow explained:
“Although it’s true to say that overall mortality rates in Scotland have fallen, the steady decline we’ve seen in more affluent areas hasn’t been matched in more deprived areas, and so the relative difference between them has been increasing.”
Professor Leyland continued:
“The higher mortality rates in Glasgow at every level of social class may seem to support the theory of some type of ‘Glasgow effect’ adversely affecting health in the city. However, male mortality rates in the affluent parts of Glasgow are in line with those for the rest of Scotland and it is only in the more deprived areas that we see this excess.”
Inequalities in Mortality in Scotland is published by the MRC Social and Public Health Sciences Unit and can be ordered or downloaded online at www.inequalitiesinhealth.com
Notes for Editors
Terminology
Mortality rate is an expression of the number of deaths per 100,000 individuals per year in a given population. Thus, a mortality rate of 15 per 100,000 would equate to 150 deaths per year in a population of 1,000,000.
Age standardised mortality rates are used to make comparisons between populations or over time and take into account differences in population structure, such as the aging of the general population between 1981 and 2001 due to increased life expectancy.
The MRC Social and Public Health Sciences Unit was created in 1998 to promote human health via the study of social and environmental influences on health. (www.sphsu.mrc.ac.uk) The Unit's Measuring Health, Variations in Health and Determinants of Health programme, core funded by the Chief Scientist Office of the Scottish Executive, seeks to improve the methods used to measure population health and its determinants.
The Medical Research Council is dedicated to improving human health through the best scientific research. Its work, on behalf of the UK taxpayer, ranges from molecular level science to public health medicine and has led to pioneering discoveries in our understanding of the human body and the diseases which affect us all. www.mrc.ac.uk
The Chief Scientist Office, which co-funds the MRC Social and Public Health Sciences Unit, is part of the Scottish Executive Health Department. It supports research to improve health services and population health in Scotland. www.show.scot.nhs.uk/cso
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