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Publication - Statistics publication

Long-term monitoring of health inequalities: December 2017

Published: 19 Dec 2017
Directorate:
Population Health Directorate
Part of:
Health and social care
ISBN:
9781788515313

Update of long-term indicators of health inequalities, such as healthy birth weight and alcohol-related hospital admissions.

58 page PDF

803.9 kB

58 page PDF

803.9 kB

Contents
Long-term monitoring of health inequalities: December 2017
Headline indicators of Health Inequalities

58 page PDF

803.9 kB

Headline indicators of Health Inequalities

Healthy Life Expectancy ( HLE)

In 2015-2016, male HLE at birth in the 10% most deprived areas in Scotland was 43.9 years, 26.0 years lower than in the least deprived areas (69.8 years).

Female HLE at birth was 49.9 years in the most deprived areas, 22.2 years lower than in the least deprived areas (72.0 years).

There have been no statistically significant changes to the gap in healthy life expectancy between the most and least deprived areas for men or women since 2009-2010.

Trends in HLE

Between 1999-2000 and 2007-2008, HLE increased by 3.0 years for males and by 2.3 years for females. In 2009, the format of the self-assessed health question, on which healthy life expectancy data is based, was changed to align with the European Union, leading to a major discontinuity in the series. The markedly lower estimates of HLE at birth from 2009 onwards are not comparable with estimates for earlier years.

In 2015-2016, HLE in Scotland was 59.6 years for males and 62.4 years for females. These values are not significantly different from the first estimates produced with the revised methodology in 2009-10 (59.9 and 62.1 for males and females respectively).

Inequalities in HLE, 2015-2016

HLE is significantly lower in the most deprived areas than in the least deprived areas.

In 2015-2016 males in the most deprived areas were, on average, expected to live 26 fewer years in good health than those in the least deprived areas (43.9 years vs 69.8 years). Females in the most deprived areas were, on average, expected to live 22 fewer years in good health than those in the least deprived areas (49.9 years vs 72.0 years).

Figure 1.1 Healthy Life Expectancy - Males - by Income-Employment Index, Scotland 2015-2016
Figure 1.1 Healthy Life Expectancy - Males - by Income-Employment Index Scotland 2015-2016

Figure 1.2 Healthy Life Expectancy - Females - by Income-Employment Index, Scotland 2015-2016
Figure 1.2 Healthy Life Expectancy - Females - by Income-Employment Index Scotland 2015-2016

Trends in relative inequalities

The relative index of inequalities ( RII) has shown little change in the period since 2009-2010, ranging from 0.36-0.41 for women and 0.38-0.45 for men over the period.

Although RII is lower in earlier years, the change in methodology used to calculate HLE means these figures are not comparable. Between 1999-2000 and 2007-2008, RII fluctuated in the range 0.29-0.33 for men and 0.25-0.28 for women and with no clear trend.

Figure 1.3 Relative Index of Inequality ( RII): Healthy Life Expectancy - Males, Scotland 1999-2000 to 2015-2016
Figure 1.3 Relative Index of Inequality (RII): Healthy Life Expectancy - Males Scotland 1999-2000 to 2015-2016

Figure 1.4 Relative Index of Inequality ( RII): Healthy Life Expectancy - Females, Scotland 1999-2000 to 2015-2016
Figure 1.4 Relative Index of Inequality (RII): Healthy Life Expectancy - Females Scotland 1999-2000 to 2015-2016

Trends in absolute inequalities

The absolute gap in male HLE has seen non-significant increases each year that the indicator has been updated since 2009-2010. The gap was 22.5 years in 2009-2010 and is 26.0 years for 2015-2016. The cumulative change from 2009-2010 is approaching statistical significance.

Among women, although there have been some fluctuations in HLE across the deprivation spectrum, recent changes have been similar in the most and least deprived areas.

Figure 1.5 Absolute Gap: Healthy Life Expectancy - Males, Scotland 1999-2000 to 2015-2016
Figure 1.5 Absolute Gap: Healthy Life Expectancy - Males Scotland 1999-2000 to 2015-2016

Figure 1.6 Absolute Gap: Healthy Life Expectancy - Females, Scotland 1999-2000 to 2015-2016
Figure 1.6 Absolute Gap: Healthy Life Expectancy - Females Scotland 1999-2000 to 2015-2016

Healthy Life Expectancy and Life Expectancy, 2009-2010 to 2015-2016

The difference between HLE and life expectancy ( LE) indicates the expected number of years spent in 'not good' health. In 2015-2016, men were expected to spend an average of 17.4 years in 'not good' health, compared to 18.6 years for women.

Men and women in the most deprived areas in Scotland spend more years in 'not good' health than those in the least deprived areas. In the most deprived areas, men spend on average 25.9 years in 'not good' health, compared to 12.9 years in the least deprived areas.

Females in the most deprived areas spend 26.1 years in 'not good' health, compared with 13.0 years in the least deprived areas.

Table 1.1: Trends in male healthy life expectancy and life expectancy, 2009-2010 onwards

Male HLE in years 95% LL 95% UL Male LE in years 95% LL 95% UL Estimated years spent in 'not good' health
2009-2010
Scotland 59.9 59.4 60.4 76.1 76.0 76.2 16.2
Most deprived decile 47.4 45.8 49.0 68.7 68.3 69.1 21.3
Least deprived decile 69.9 68.2 71.6 82.0 81.6 82.3 12.1
2011-2012
Scotland 59.8 59.3 60.4 76.6 76.4 76.7 16.7
Most deprived decile 46.4 44.7 48.2 69.2 68.8 69.6 22.7
Least deprived decile 70.2 68.5 71.9 82.1 81.8 82.4 11.9
2013-2014
Scotland 60.6 60.0 61.2 77.2 77.0 77.3 16.6
Most deprived decile 47.6 45.8 49.4 70.2 69.8 70.6 22.6
Least deprived decile 72.7 71.0 74.5 82.5 82.2 82.9 9.8
2015-2016
Scotland 59.6 59.0 60.2 77.0 76.9 77.1 17.4
Most deprived decile 43.9 41.9 45.8 69.8 69.4 70.2 25.9
Least deprived decile 69.8 67.9 71.8 82.7 82.4 83.0 12.9

Table 1.2: Trends in female healthy life expectancy and life expectancy, 2009-2010 onwards

Female HLE in years 95% LL 95% UL Female LE in years 95% LL 95% UL Estimated years spent in 'not good' health
2009-2010
Scotland 62.1 61.6 62.6 80.6 80.5 80.8 18.6
Most deprived decile 51.1 49.6 52.6 76.1 75.7 76.5 24.9
Least deprived decile 73.2 71.7 74.7 84.8 84.5 85.1 11.6
2011-2012
Scotland 62.3 61.8 62.9 80.9 80.8 81.0 18.5
Most deprived decile 50.2 48.6 51.8 76.4 76.0 76.7 26.1
Least deprived decile 72.8 71.2 74.5 84.8 84.5 85.2 12.0
2013-2014
Scotland 62.2 61.7 62.8 81.2 81.1 81.3 19.0
Most deprived decile 51.0 49.2 52.9 76.7 76.3 77.0 25.7
Least deprived decile 73.2 71.4 74.9 84.5 84.2 84.8 11.3
2015-2016
Scotland 62.4 61.9 63.0 81.1 81.0 81.2 18.6
Most deprived decile 49.9 48.0 51.8 76.0 75.6 76.3 26.1
Least deprived decile 72.0 70.2 73.9 85.0 84.7 85.3 13.0

Premature Mortality (under 75 years)

Despite increasing in each of the past three years, the gap in premature mortality rates between the most and least deprived areas has reduced overall from its widest point in 2002 and is lower than at the start of the time series in 1997.

Relative inequalities, however, have widened over the long term. In 1997, premature mortality rates were 2.7 times higher in the most deprived areas compared to the least deprived; in 2016, rates were 3.7 times higher in the most deprived areas.

Trends in premature mortality

More than 21,000 people in Scotland died before the age of 75 in 2016.

Over the long term there has been a reduction in the mortality rate among under-75s. The age-standardised mortality rate among under-75s in 2016 was 439.7 per 100,000 people, a reduction of 33 per cent since 1997 (651.9 per 100,000).

Inequalities in premature mortality, 2016

In 2016, the premature mortality rate in the 10% most deprived areas was 824.9 per 100,000, 3.7 times higher than the rate in the least deprived areas (220.4 per 100,000).

Figure 2.1 All cause mortality amongst those aged <75y by Income-Employment Index Scotland 2016 (European Age-Standardised Rates per 100,000)
Figure 2.1 All cause mortality amongst those aged <75y by Income-Employment Index Scotland 2016 (European Age-Standardised Rates per 100,000)

Trends in relative inequalities

Over the longer term, relative inequalities have increased. The RII for 2016 is 1.39, compared with 1.00 at the start of the time series in 1997.

Between 1997 and 2016, premature mortality rates declined by 42% in the least deprived areas, but by only 20% in the most deprived areas in Scotland.

In 1997, premature mortality rates were 2.7 times higher in the most deprived areas compared to the least deprived; in 2016, premature mortality rates were 3.7 times higher in the most deprived areas.

Figure 2.2 Relative Index of Inequality ( RII): All cause mortality <75y, Scotland 1997-2016
Figure 2.2 Relative Index of Inequality (RII): All cause mortality <75y Scotland 1997-2016

Trends in absolute inequalities

Absolute inequalities in premature mortality reached a peak in 2002. Between 2002 and 2013 there was a general downward trend. Most notably, the absolute gap between the most and least deprived areas reduced every year between 2007 and 2013.

Since 2013 the gap has increased, although it is currently still lower than at any point prior to 2010.

Figure 2.3 Absolute Gap: All cause mortality <75y, Scotland 1997-2016 (European Age-Standardised Rates per 100,000)
Figure 2.3 Absolute Gap: All cause mortality <75y, Scotland 1997-2016 (European Age-Standardised Rates per 100,000)

In 2002, the premature mortality rate in the most deprived areas was 1,033.2 per 100,000 and 319.8 per 100,000 in the least deprived areas, a gap of 713.4 per 100,000. In 2016, the gap had reduced to 604.5 per 100,000.

Table 2.1: Trends in premature mortality, 1997-2016

Year Number of deaths Target population size Rate per 100,000 ( EASR)
1997 26,081 4,740,269 651.9
1998 25,857 4,729,975 643.3
1999 25,491 4,721,298 632.5
2000 24,593 4,708,667 607.3
2001 24,168 4,703,661 593.1
2002 24,219 4,701,958 588.9
2003 23,789 4,702,431 573.4
2004 22,896 4,714,233 546.2
2005 22,441 4,735,320 530.3
2006 22,237 4,752,425 520.4
2007 22,359 4,783,452 516.8
2008 22,005 4,811,453 501.3
2009 21,229 4,835,007 477.0
2010 20,997 4,858,058 467.4
2011 20,685 4,888,316 456.1
2012 20,446 4,895,114 445.3
2013 20,344 4,903,074 437.5
2014 19,961 4,914,362 423.2
2015 20,988 4,935,283 440.5
2016 21,313 4,962,391 439.7

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