Health inequalities: Scottish comparisons and trends

The Scottish Government’s Long-Term Monitoring of Health Inequalities report presents trends in socio-economic inequalities for a number of different health outcomes. These include healthy life expectancy, mental wellbeing, all-cause premature mortality and cause-specific mortality and hospitalisation. Two brief examples are included here in relation to all-cause mortality under 75 years.

The first presents a relative measure of inequality. Inequalities can be expressed in both absolute (e.g. the difference in mortality rates between groups) and relative (e.g. how many times higher the mortality rate is across groups) terms. A more sophisticated relative measure is the Relative Index of Inequality (RII)). This is shown in Chart 1: it is used here as a summary statistic to measure of how steep the gradient of mortality is across the whole deprivation spectrum (from the most through to the least deprived areas in Scotland, using the Scottish Index of Multiple Deprivation (SIMD)) relative to the mean level of mortality of the whole Scottish population. Using this measure, Chart 1 shows that, in a relative sense, inequalities in premature mortality in Scotland have widened considerably over the past 25 years.

It should be noted that prior to the changes of the last decade (discussed further below, and elsewhere on the website) mortality rates had fallen across all sections of Scottish society. And in an absolute sense the gap in premature mortality between those living in the least and most deprived areas of the country had also decreased (Chart 2). However, the relative gap (presented in Chart 1) increased over the whole period because the mortality rates of the least deprived decreased much more than those of the most deprived.

Note, however, that despite these longer-term declines in the absolute gap, Chart 2 also suggests a widening of the gap in the most recent years.  Scottish Government data confirm this. Chart 3 compares the Relative Index of Inequality (RII) (shown above in Chart 1) with a more sophisticated measure of absolute inequality called the Slope Index of Inequality (SII): this shows a widening of both relative and absolute inequality in premature mortality in the last few years. It has been shown that the most recent increases in rates in the most deprived areas - and the resulting further widening of inequality - are linked to UK Government 'austerity' measures, as discussed here.

Note that the additional increases in mortality rates in 2020 are related to the COVID-19 pandemic.

The scale of inequalities in premature mortality in Scotland is shown in Chart 4: in 2020 mortality rates of those living in the 10% most disadvantaged neighbourhoods in Scotland were more than four times greater than those living in the 10% least disadvantaged neighbourhoods (defined by domains of the SIMD). Other data presented in the Scottish Government’s Long-Term Monitoring of Health Inequalities report show that, for example, rates of mortality for causes such as alcohol related conditions and coronary heart disease are more than five times higher among the most disadvantaged groups compared to the least disadvantaged.

Finally in this section Chart 5 shows how the scale of these relative inequalities varies for different causes of death and by age group. Taken from work by the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, this shows that inequalities are greatest (the height of the y axis) among those of younger working ages, and that the contribution of particular causes varies by age: for example, among those aged 60+ years, inequalities are greatest in terms of deaths from cancer, heart disease and stroke, whereas for younger ages inequalities in mortality tend to be greater for drugs and suicide. Note these data are for the period 2012-16 and for males only.