Long-term monitoring of health inequalities: January 2021 report

Summary

Introduction

This report presents a range of indicators selected in order to monitor health inequalities over time.

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

In a number of indicators, absolute inequalities (the gap between the most and least deprived areas) have narrowed over the longer term:

• Healthy life expectancy for females – the gap has decreased since the start of the time series, from 23.8 years in 2013-2015 to 22.1 years in 2017-2019, and is currently at its lowest point.
• Mental wellbeing - the gap has decreased since its peak 2012/2013 (21 percentage points) and is currently the same as at the start of the time series in 2008/2009 (15 percentage points)
• Coronary heart disease deaths - the gap has reduced from a high of 390.1 per 100,000 in 1998. The current gap is less than half what it was in 1998 (172.9 per 100,000 in 2019).
• Alcohol-related admissions - the gap in 2019 (377.6 per 100,000) was lower than at the of the time series in 1996 (613.0 per 100,000).
• Alcohol-specific deaths – the gap has reduced to 85.8 per 100,00 in 2019, from its peak of 184.7 per 100,000 in 2002.

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 26.0 in 2017-2019, and is currently at its highest point.

The gap in premature mortality rates increased to its highest point since 2007 in 2019 (619.4 per 100,000 in 2019 and 656.2 per 100,000 in 2007), although the gap remains lower than at the start of the time series (648.7 per 100,000 in 1997).

Whilst the gap for all-cause mortality (aged 15-44) reduced to its lowest level in 2013 (159.6 per 100,000), it has increased in each of the last six years and is currently at its highest point in the time series (257.9 per 100,000 in 2019).

The gap for low birthweight has reduced from its widest point in 2004 (5.7 percentage points). However, the gap has increased in most years since 2013, from 3.2 percentage points to 4.8 percentage points in 2019.

The gap for poor self-assessed health has increased from 13 percentage points at the start of the time series in 2008/2009, to 18 percentage points in 2018/2019.

The gap for limiting long-term conditions has reduced since its peak in 2014/2015 (29 percentage points), however it is currently higher than at the start of the time series (23 percentage points in 2018/2019 compared to 21 percentage points in 2008/2009).

The gap for drug-related hospital admissions has increased in each of the last six years to its highest point in 2018/19 (608.8 per 100,000) and has almost tripled since the start of the time series in 1996/97.

For the other indicators in the report, there has either been little change or long-term trends in the absolute gap are less clear:

• Heart attack hospital admissions
• Cancer incidence

Relative inequalities

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. Relative inequalities in heart attack admissions have increased in recent years and cancer incidence inequalities have remained relatively stable.

Amongst the two comparable mortality indicators (CHD deaths and alcohol-specific deaths), relative inequalities in CHD deaths have increased over the long term whilst the RII in alcohol-specific deaths have shown more year to year fluctuation. However, relative inequalities in alcohol-specific deaths remain higher than CHD deaths.

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) have both shown increases in RII over time.