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Excess winter mortality from heart disease is lower in colder countries
in Western Europe, where homes are well-heated and insulated and people
know to wrap up warm when they go out, and slightly lower in Scotland
than in the other UK countries. There's also a puzzling lack of a social
gradient ...
Peter
-----Original Message-----
From: The Health Equity Network (HEN)
[mailto:[log in to unmask]] On Behalf Of Dr Douglas
McCulloch
Sent: 18 July 2005 10:41
To: [log in to unmask]
Subject: Re: The Scottish Effect: Why is mortality higher in Scotland
than in England and Wales?
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Isn't it colder in Scotland? So I've heard.....
Douglas.
----- Original Message -----
From: "Mcdaid,D" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, July 14, 2005 3:42 PM
Subject: The Scottish Effect: Why is mortality higher in Scotland than
in
England and Wales?
FYI From the Journal of Public Health
Best wishes
David McDaid
LSE Health and Social Care
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'
P. Hanlon, R. S. Lawder, D. Buchanan, A. Redpath, D. Walsh, R. Wood, M.
Bain, D. H. Brewster, J. Chalmers, David Walsh,
Journal of Public Health 2005 27(2):199-204; doi:10.1093/pubmed/fdi002
Objectives To determine the degree to which changing patterns of
deprivation
in Scotland and the rest of Great Britain between 1981 and 2001 explain
Scotland's higher mortality rates over that period.
Design Cross-sectional analyses using population and mortality data from
around the 1981, 1991 and 2001 censuses.
Setting Great Britain (GB).
Participants Populations of Great Britain enumerated in the 1981, 1991
and
2001 censuses.
Main outcome measures Carstairs deprivation scores derived for wards
(England and Wales) and postcode sectors (Scotland). Mortality rates
adjusted for age, sex and deprivation decile.
Results Between 1981 and 2001 Scotland became less deprived relative to
the
rest of Great Britain. Age and sex standardized all-cause mortality
rates
decreased by approximately 25% across Great Britain, including Scotland
but
mortality rates were on average 12% higher in Scotland in 1981 rising to
15%
higher in 2001. While over 60% of the excess mortality in 1981 could be
explained by differences in deprivation profile, less than half the
excess
could be explained in 1991 and 2001. After adjusting for age, sex and
deprivation, excess mortality in Scotland rose from 4.7% (95% CI: 3.9%
to
5.4%) in 1981 to 7.9% (95% CI: 7.2% to 8.7%) in 1991 and 8.2% (95% CI:
7.4%
to 9.0%) in 2001. All deprivation deciles showed excess indicating that
populations in Scotland living in areas of comparable deprivation to
populations in the rest of Great Britain always had higher mortality
rates.
By 2001 the largest excesses were found in the most deprived areas in
Scotland with a 17% higher mortality rate in the most deprived decile
compared to similarly deprived areas in England and Wales. Excess
mortality
in Scotland has increased most among males aged <65 years.
Conclusions Scotland's relative mortality disadvantage compared to the
rest
of Great Britain, after allowing for deprivation, is worsening. By 1991
measures of deprivation no longer explained most of the excess mortality
in
Scotland and the unexplained excess has persisted during the 1990s. More
research is required to understand what is causing this 'Scottish
effect'.
Keywords: deprivation, inequalities in health, mortality
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