An Official Statistics Publication for Scotland.
Scotland’s Chief Statistician today announced the publication of the latest Long-term Monitoring of Health Inequalities report.
The report includes a range of indicators selected in order to monitor health inequalities over time. These indicators include: healthy life expectancy, premature mortality, all-cause mortality, baby birthweight and a range of morbidity and mortality indicators relating to alcohol, cancer, coronary heart disease and drug use. The report investigates both absolute and relative inequalities.
The COVID-19 pandemic is likely to have had an impact on the most recent data for most indicators included in this report. Where there has been analysis undertaken to assess the impact of the pandemic that is relevant to a specific indicator the details have been included in the corresponding chapter.
With the exception of the healthy birthweight indicator, significant health inequalities persist for each indicator covered in the report.
Changes in the gap between the most and least deprived areas in Scotland
For a number of indicators, absolute inequalities (the gap between the most and least deprived areas) have narrowed over the longer term:
- Heart attack hospital admissions (aged under 75 years) – the gap in 2020 (63.2 per 100,000 population) is the lowest it has been since 2008 (58.4 per 100,000). The reduction in the gap between 2019 and 2020 has been driven by a 7% decrease in admissions in the most deprived areas and an increase of 13% in the least deprived areas.
- Coronary heart disease (CHD) deaths (aged 45-74 years) - the current gap is 47% lower than at the start of the time series (185.4 per 100,000 in 2020 compared to 347.3 per 100,000 in 1997). However, between 2019 and 2020 the CHD mortality rate increased in both the most and least deprived areas (by 14% and 40% respectively).
- Alcohol-related admissions (aged under 75 years) - the gap was widest at the start of the time series in 1996 (613.0 per 100,000) and reduced to its lowest level in 2020 (322.0 per 100,000). Between 2019 and 2020 the rate of admissions decreased in both the most and least deprived areas (by 14% and 10% respectively). It is possible that this reduction is a result of hospital admissions policies associated with the COVID-19 pandemic.
- Alcohol-specific deaths (aged 45-74 years) – the gap has reduced from a peak of 184.7 per 100,000 in 2002 to 71.8 per 100,000 in 2020, the lowest in the time series.
- Low birthweight - the absolute gap in 2020 was 3.4 percentage points, the lowest it has been since 2013 (3.2 percentage points).
The gap in healthy life expectancy for males has increased since the start of the time series, from 22.5 years in 2013-2015 to 23.7 years in 2018-2020.
The gap in premature mortality rates increased to its highest point since 2004 (680.4 per 100,000 in 2020 and 683.2 per 100,000 in 2004), although the gap remains lower than at the start of the time series (648.7 per 100,000 in 1997).
In 2020 the absolute gap in cancer deaths was the highest it’s been since 2015 at 353.7 per 100,000.
Whilst the gap for all-cause mortality (aged 15-44) reduced to its lowest level in 2013 (159.6 per 100,000), it has shown an overall increase since then and was 241.1 per 100,000 in 2020.
The gap for drug-related hospital admissions has increased overall since the start of the time series to reach a high of 696.1 per 100,000 in 2019/20 before falling slightly to 625.1 per 100,000 in 2020/21. This decrease may be due to hospital admission policies associated with the COVID-19 pandemic.
For the other indicators in the report, there has either been little change or long-term trends in the absolute gap are less clear:
- Healthy life expectancy for females
- Cancer incidence
The relative index of inequality (RII) indicates the extent to which health outcomes are worse in the most deprived areas compared to the average throughout Scotland. It is possible for absolute inequalities to improve, but relative inequalities to worsen.
There are three morbidity indicators for which the RII can reasonably be compared with one another: alcohol-related hospital admissions; heart attack hospital admissions; and cancer incidence.
Amongst these, relative inequalities in alcohol-related hospital admissions have remained highest over the longer term, though they have been decreasing. Relative inequalities in heart attack admissions have increased in recent years and cancer incidence inequalities have remained relatively stable.
Amongst the three comparable mortality indicators (CHD deaths, alcohol-specific deaths and cancer deaths), relative inequalities in both CHD and cancer deaths have increased over the long term whilst the RII in alcohol-specific deaths have shown more year to year fluctuation and are currently lower than at the start of the time series (2.02 vs 1.80). However, relative inequalities in alcohol-specific deaths remain higher than the other comparable mortality indicators.
Of the other indicators in the report, the two indicators relating to mortality (premature mortality for those aged under 75 and all-cause mortality for those aged 15-44) and healthy life expectancy for males and females have all shown increases in relative inequality over time.
A Ministerial Task Force on Health Inequalities led by the then Minister for Public Health was established in 2007 to identify and prioritise practical actions to reduce the most significant and widening health inequalities in Scotland. The Task Force recognised the need to monitor progress in tackling health inequalities in the longer term as well as managing short and medium term progress.
A technical advisory group was set up in early 2008 to advise the Task Force on long-term monitoring of health inequalities. The group recommended a range of indicators to be monitored over time, as reflected in this report.
The technical advisory group most recently convened in 2019 to review proposed changes to some existing indicators and discuss the inclusion of a new indicator to monitor drug-related hospital admissions. This indicator was presented in the report for the first time in 2020 and is now included annually.
Official statistics are produced in accordance with professional standards – more information on the standards of official statistics in Scotland can be accessed at: Producing official statistics - gov.scot (www.gov.scot)
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