Publication - Statistics

Long-term monitoring of health inequalities: January 2021 report

Published: 26 Jan 2021

Annual update of the long-term monitoring of health inequalities headline indicators.

Long-term monitoring of health inequalities: January 2021 report
Headline indicator of Health Inequalities

Headline indicator of Health Inequalities

Healthy Life Expectancy (HLE)

In 2017-2019, male HLE at birth was 47.0 years for those living in the most deprived areas, 26.0 years lower than those living in the least deprived areas (73.0 years).

Female HLE at birth was 49.5 years for those living in the most deprived areas, 22.1 years lower than those living in the least deprived areas (71.6 years).

The absolute gap in HLE has increased for males 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 absolute gap in HLE for females, however, 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.

Trends in HLE

HLE at birth for males increased between 2013-2015 and 2015-2017 (from 61.8 years to 62.3 years) and has since fallen to its lowest level, 61.7 years in 2017-2019. Similarly for females, HLE increased between 2013-2015 and 2014-2016 (from 62.7 years to 63.3 years) before decreasing to its lowest level in 2017-2019 (61.9 years).

Inequalities in HLE, 2017-2019

HLE is lower for those living in the most deprived areas than for those living in the least deprived areas. In 2017-2019 males in the most deprived areas were, on average, expected to live 26.0 fewer years in good health than those in the least deprived areas (47.0 years vs 73.0 years). Females in the most deprived areas were, on average, expected to live 22.1 fewer years in good health than those in the least deprived areas (49.5 years vs 71.6 years).

Figure 1.1: Healthy Life Expectancy-Males -by Income-Employment Index Scotland 2017-2019
Figure 1.1 shows the healthy life expectancy of males by IEI in 2017-2019.
Figure 1.2: Healthy Life Expectancy-Females -by Income-Employment Index Scotland 2017-2019
Figure 1.2 shows the healthy life expectancy of females by IEI in 2017-2019.

Trends in relative inequalities

The relative index of inequalities (RII) has increased for both males and females since the start of the time series, increasing from 0.38 to 0.43 for males from 0.36 to 0.38 for females between 2013-2015 and 2017-2019.

Figure 1.3: Relative Index of Inequality (RII): Healthy Life Expectancy - Males Scotland 2013-2015 to 2017-2019
Figure 1.3 shows the RII for healthy life expectancy of males from 2013-2015 to 2017-2019.
Figure 1.4: Relative Index of Inequality (RII): Healthy Life Expectancy - Females Scotland 2013-2015 to 2017-2019
Figure 1.4 shows the RII for the healthy life expectancy of females from 2013-2015 to 2017-2019.

Trends in absolute inequalities

The absolute gap in HLE has increased for males 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 absolute gap in HLE for females, however, 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.

Figure 1.5: Absolute Gap: Healthy Life Expectancy -Males Scotland 2013-2015 to 2017-2019
Figure 1.5 shows the absolute gap in healthy life expectancy for males in 2013-2015 to 2017-2019.
Figure 1.6: Absolute Gap: Healthy Life Expectancy -Females Scotland 2013-2015 to 2017-2019
Figure 1.6 shows the absolute gap in healthy life expectancy for females in 2013-2015 to 2017-2019.

Healthy Life Expectancy and Life Expectancy, 2013-2015 to 2017-2019

Based on HLE and life expectancy (LE) we can estimate the proportion of life spent in good health. In 2017-2019 males were estimated to spend 79.9% of their life in good health, while females were estimated to spend 76.3% of their life in good health.

Males and females in the most deprived areas in Scotland are estimated to spend a lower proportion of their life in good health than those living in the least deprived areas. In 2017-2019 males living in the most deprived areas spent 67.5% of their life in good health, compared to 88.1% for males living in the least deprived areas. Similarly, in 2017-2019, females living in the most deprived areas spent 65.3% of their life in good health, compared to 83.6% for females living in the least deprived areas.

Table 1.1 Trends in male healthy life expectancy and life expectancy, 2013-2015 to 2017-2019
  Confidence Intervals Confidence Intervals Proportion of life spent in good health
  Male HLE in years 95% LL Male LE in years 95% UL 95% LL 95% UL
2013-2015
Scotland 61.8 61.4 62.2 77.1 77.0 77.2 80.2
Most deprived decile 48.8 47.3 50.3 70.2 69.9 70.6 69.5
Least deprived decile 71.3 70.0 72.7 82.5 82.2 82.8 86.5
2014-2016
Scotland 62.2 61.8 62.6 77.1 77.0 77.2 80.7
Most deprived decile 48.8 47.2 50.3 70.0 69.7 70.3 69.7
Least deprived decile 72.7 71.3 74.1 82.5 82.2 82.8 88.1
2015-2017
Scotland 62.3 61.9 62.7 77.0 76.9 77.1 80.9
Most deprived decile 49.2 47.7 50.6 69.9 69.6 70.2 70.4
Least deprived decile 71.4 69.9 72.9 82.6 82.3 82.9 86.5
2016-2018
Scotland 61.9 61.5 62.3 77.1 77.0 77.2 80.3
Most deprived decile 48.4 46.9 49.9 69.7 69.4 70.0 69.4
Least deprived decile 72.1 70.7 73.4 82.7 82.4 83.0 87.2
2017-2019
Scotland 61.7 61.3 62.1 77.2 77.2 77.1 79.9
Most deprived decile 47.0 45.4 48.6 69.6 69.3 70.0 67.5
Least deprived decile 73.0 71.7 74.3 82.9 82.6 83.1 88.1
Table 1.2: Trends in female healthy life expectancy and life expectancy, 2013-2015 to 2017-2019
Confidence Intervals Confidence Intervals Proportion of life spent in good health
Female HLE in years 95% LL 95% UL Female LE in years 95% LL 95% UL
2013-2015
Scotland 62.7 62.3 63.2 81.1 81.0 81.2 77.3
Most deprived decile 48.8 47.1 50.6 76.6 76.3 76.9 63.8
Least deprived decile 72.6 71.1 74.2 84.7 84.5 85.0 85.7
2014-2016
Scotland 63.3 62.9 63.8 81.1 81.1 81.2 78.0
Most deprived decile 50.6 48.9 52.2 76.2 75.9 76.5 66.3
Least deprived decile 73.3 71.6 74.9 84.9 84.6 85.2 86.3
2015-2017
Scotland 62.6 62.2 63.1 81.1 81.0 81.2 77.3
Most deprived decile 49.9 48.2 51.7 75.8 75.5 76.1 65.9
Least deprived decile 73.2 71.6 74.8 85.1 84.9 85.4 85.9
2016-2018
Scotland 62.2 61.7 62.7 81.1 81.0 81.2 76.7
Most deprived decile 48.5 46.5 50.4 75.8 75.5 76.1 63.9
Least deprived decile 72.8 71.3 74.3 85.2 84.9 85.5 85.5
2017-2019
Scotland 61.9 61.5 62.4 81.1 81.2 81.1 76.3
Most deprived decile 49.5 47.8 51.1 75.8 75.5 76.1 65.3
Least deprived decile 71.6 70.0 73.2 85.6 85.3 85.8 83.6

Premature mortality (under 75 years)

In 2019, the gap in premature mortality rates between the most and least deprived areas increased to its highest point since 2007 (619.4 per 100,000 and 656.2 per 100,000 respectively), although the gap remains lower than at the start of the time series (648.7 per 100,000 in 1997). Relative inequalities, however, have widened over the long term and are now at the highest point in the time series (1.49).

In 1997, premature mortality rates were 3 times higher in the most deprived areas compared to the least deprived; in 2019, rates were 4 times higher in the most deprived areas.

Trends in premature mortality

Just over 21,500 people in Scotland died before the age of 75 in 2019.

Over the long term there has been a reduction in the mortality rate among under-75s. The European Age-Standardised mortality rate (EASR) among under-75s in 2019 was 425.6 per 100,000 people, a reduction of 35 per cent since 1997 (651.9 per 100,000).

Table 2.1: Trends in premature mortality (under 75 years), 1997-2019
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
2017 20,992 4,976,829 425.2
2018 21,601 4,983,364 432.0
2019 21,501 4,997,455 425.6

Inequalities in premature mortality, 2019

In 2019, the premature mortality rate in the most deprived areas was 817.6 per 100,000, four times higher than the rate in the least deprived areas (198.2 per 100,000).

Figure 2.1: All cause mortality amongst those aged <75y by Income-Employment Index Scotland 2019 (European Age-Standardised Rates per 100,000)
Figure 2.1 shows all-cause mortality for those aged under 75 by IEI in 2019.

Trends in relative inequalities

Over the longer term, relative inequalities have increased. The RII for 2019 is the highest in the time series at 1.49, compared with 1.00 at the start of the time series in 1997.

Between 1997 and 2019, premature mortality rates declined by 48% in the least deprived areas, but by only 21% in the most deprived areas in Scotland.

Figure 2.2: Relative Index of Inequality (RII): All cause mortality <75y Scotland 1997-2019
Figure 2.2 shows the RII for all-cause mortality for those aged under 75 from 1997 to 2019.

Between 1997 and 2014, premature mortality rates were three times higher in the most deprived areas compared to the least deprived; in the last five years premature mortality rates have been four times higher in the most deprived areas.

Trends in absolute inequalities

Absolute inequalities in premature mortality reached a peak in 2002 (713.4 per 100,000). 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 (from 656.2 in 2007 to 536.0 in 2013).

Since 2013 the gap has increased, and is currently at its highest point since 2007 at 619.4 per 100,000.

Figure 2.3: Absolute Gap: All cause mortality <75y, Scotland 1997-2019 (European Age-Standardised Rates per 100,000)
Figure 2.3 shows the absolute gap in all-cause mortality for those aged under 75 from 1997-2019.

Mental wellbeing – adults aged 16+

The gap in mental wellbeing amongst adults living in the most deprived and least deprived areas has decreased since 2012/2013. There was a difference of 15 percentage points in 2018/2019, the same as the start of the time series in 2008/2009.

Adults in the most deprived areas were three times more likely to have below average wellbeing than adults in the least deprived areas at all time periods except 2012/2013, when they were five time more likely to have below average wellbeing.

Trends in mental wellbeing

The mean score on the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) was fairly static between 2008/09 and 2018/19 ranging from 49.6-49.9.

'Below average' wellbeing has been defined as WEMWBS scores of at least one standard deviation below the mean, equivalent to scores of 41 or lower in all years except 2018/2019, which was scores of 40 or lower. The proportion of adults in Scotland who have a below average WEMWBS score has remained at 15% since 2008/2009.

Table 3.1: Trends in mental wellbeing, 2008/2009-2018/2019
Mean WEMWBS Below average wellbeing (indicated by a WEMWBS score of 41 or lower1)
Year Mean WEMWBS score Lower 95% confidence limit Upper 95% confidence limit Proportion of adults with below average wellbeing (%) Lower 95% confidence limit (%) Upper 95% confidence limit (%)
2008/2009 49.8 49.6 50.0 15 14 16
2010/2011 49.9 49.7 50.1 15 14 16
2012/2013 49.9 49.7 50.2 15 14 16
2014/2015 49.9 49.7 50.2 15 14 16
2016/2017 49.8 49.6 50.1 15 14 16
2018/2019 49.6 49.4 49.9 15 14 16

1. 40 or lower in 2018/2019. 41 or lower in all other years.

Inequalities in mental wellbeing, 2018/2019

In 2018/2019, 24% of adults in the most deprived areas had below average wellbeing, indicated by a WEMWBS score of 40 or lower. This compared to 9% of adults in the least deprived areas.

Figure 3.1: Proportion of adults (16+ ) with a below average WEMWBS score by Income-Employment Index, Scotland 2018/2019
Figure 3.1 shows the proportion of adults with a below average WEMWBS score by IEI in 2018/2019.

Trends in relative inequalities

The relative index of inequality (RII) in below average wellbeing increased between 2014/2015 and 2018/2019 and is higher than at the start of the time series (1.18 in 2008/2009 compared to 1.32 in 2018/2019).

Adults in the most deprived areas were approximately 3 times more likely to have below average wellbeing compared to those in the least deprived areas at all time periods except 2012/2013, when they were 5 times more likely to have below average wellbeing.

Figure 3.2: Relative Index of Inequality (RII): Proportion of adults (16+ ) with a below average WEMWBS score Scotland, 2008/2009 - 2018/19
Figure 3.2 shows the RII of adults with a below average WEMWBS score from 2008-2009 to 2018/2019.

Trends in absolute inequalities

The gap in prevalence of below average wellbeing between those in the most and least deprived areas increased from 15 percentage points in 2008/2009 to a high of 21 percentage points in 2012/2013. It has since decreased over each time period and was 15 percentage points in 2019, the same as at the start of the time series.

Figure 3.3: Absolute Gap: Proportion of adults (16+ ) with a below average WEMWBS score Scotland, 2008/2009 - 2018/2019
Figure 3.3 shows the absolute gap for adults with a below average WEWMBS score from 2008/2009 to 2018/2019.

Inequalities in morbidity and mortality indicators

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. While comparisons of RII between indicators are possible, they should be made with some caution, in particular where absolute values are significantly higher or lower in the compared indicators or where the measurement scale differs.

The following charts group indicators in this report into broadly comparable categories: the first shows hospital admissions and incidence of conditions for people belonging to the under 75 age group; while the second shows mortality rates in the 45-74 age group for two causes of death.

Although relative inequalities in heart attack hospital admissions have increased in recent years, inequalities have remained highest in alcohol-related admissions throughout the period covered by this report. Inequalities in cancer incidence have remained relatively stable.

Figure 4.1: Relative Index of Inequality (RII)Selected morbidity indicators (ages <75 years) Scotland 1997-2019
Figure 4.1 shows the RII for comparable morbidity indicators from 1997 to 2019.

Relative inequalities in CHD deaths among adults aged 45-74 have increased over the long term. Relative inequalities for alcohol-specific deaths have shown more year on year fluctuation over the same period and are currently lower than at the start of the time series (2.02 vs 1.99).

Figure 4.2: Relative Index of Inequality (RII)Mortality indicators (ages 45-74 years) Scotland 1997-2019
Figure 4.2 shows the RII for comparable mortality indicators from 1997-2019.

Coronary Heart Disease - first ever hospital admission for heart attack aged under 75 years

Trends in heart attack hospital admissions

In 2019, just over 5,000 new cases of heart attack (for those aged under 75 years) were recorded in Scottish hospitals.

While the rate of admissions in 2019 was 32% lower than in 1997 (98.3 and 145.1 per 100,000), it has increased by 17% since 2018 (83.9 per 100,000).

Table 4.1: Trends in heart attack hospital admissions (aged <75), 1997-2019
Year Total admissions Target population size Rate per 100,000 (EASR)
1997 5,764 4,740,269 145.1
1998 5,676 4,729,975 141.5
1999 5,101 4,721,298 126.6
2000 4,812 4,708,667 118.4
2001 4,776 4,703,661 116.9
2002 4,833 4,701,958 116.6
2003 4,569 4,702,431 109.0
2004 4,413 4,714,233 103.9
2005 4,047 4,735,320 94.2
2006 3,750 4,752,425 86.4
2007 3,549 4,783,452 80.4
2008 3,655 4,811,453 81.7
2009 3,851 4,835,007 84.9
2010 4,377 4,858,058 95.4
2011 4,537 4,888,316 97.7
2012 4,747 4,895,114 100.8
2013 4,697 4,903,074 98.8
2014 4,503 4,914,362 93.4
2015 4,521 4,935,283 92.8
2016 4,521 4,962,391 91.5
2017 4,738 4,976,829 94.9
2018 4,233 4,983,364 83.9
2019 5,007 4,996,827 98.3

Inequalities in hospital heart attack hospital admissions, 2019

In 2019, the admission rate in Scotland's most deprived areas was more than twice that of those living in the least deprived (147.0 cases per 100,000 compared to 64.4 per 100,000).

Figure 5.1 Hospital admissions for heart attack among those aged <75y by Income-Employment Index, Scotland 2019 (European Age-Standardised Rates per 100,000)
Figure 5.1 shows hospital admissions for heart attacks by IEI decile in 2019.

Trends in relative inequalities

Relative inequality levels for heart attack hospital admissions have fluctuated over time, ranging from 0.69-1.01. The RII for 2019 (0.91) is higher than that at the start of the time series (0.82).

Figure 5.2: Relative Index of Inequality (RII): Hospital admissions for heart attack <75y Scotland 1997-2019
Figure 5.2 shows the RII of hospital admissions for heart attacks from 1997-2019.

Heart attack hospital admission rates (aged <75) have been 2-3 times higher in the most deprived areas compared to the least deprived areas across the time series.

Trends in absolute inequalities

The absolute gap in hospital admissions between those living in the most and least deprived areas was 82.6 per 100,000 in 2019, lower than at the start of the times series in 1997 when the gap was at its largest (114.6 per 100,000).

However, absolute inequalities have fluctuated over that time, with the gap at its narrowest between 2006 and 2008.

Figure 5.3: Absolute Gap: Hospital admissions for heart attack <75y Scotland 1997-2019 (European Age-Standardised Rates per 100,000)
Figure 5.3 shows the absolute gap for hospital admissions for heart attacks from 1997 and 2019.

Coronary Heart Disease (CHD) - deaths aged 45-74 years

Trends in CHD deaths

In 2019, over 2,300 deaths amongst those aged 45-74 years were attributed to CHD.

Since 1997, there has been a considerable decrease in CHD deaths amongst the population aged 45-74 years. In 2019, the death rate for this age group was 112.1 per 100,000, less than one third what it was in 1997 and the lowest figure on record.

Table 5.1: Trends in CHD deaths (aged 45-74), 1997-2019
Year Number of deaths Target population size Rate per 100,000 (EASR)
1997 5,887 1,635,590 372.5
1998 5,675 1,646,711 357.9
1999 5,389 1,658,124 338.9
2000 4,858 1,670,660 303.9
2001 4,483 1,687,422 279.3
2002 4,310 1,706,141 265.9
2003 4,197 1,727,112 256.3
2004 3,840 1,751,037 232.3
2005 3,721 1,774,865 222.3
2006 3,393 1,799,382 200.8
2007 3,374 1,827,320 196.6
2008 3,155 1,856,874 180.9
2009 2,857 1,885,693 160.7
2010 2,811 1,914,226 156.6
2011 2,592 1,941,253 142.6
2012 2,584 1,964,203 139.7
2013 2,515 1,986,202 133.7
2014 2,358 2,007,988 123.1
2015 2,463 2,026,210 127.4
2016 2,467 2,047,858 124.7
2017 2,476 2,064,612 122.2
2018 2,416 2,073,318 117.6
2019 2,333 2,078,411 112.1

Inequalities in CHD deaths, 2019

In 2019, the CHD mortality rate was five times greater in Scotland's most deprived areas compared to the least deprived (217.6 compared to 44.7 deaths per 100,000 population).

Figure 6.1: CHD deaths amongst those aged 45-74y by Income-Employment Index, Scotland 2019 (European Age-Standardised Rates per 100,000)
Figure 6.1 shows the CHD deaths among those aged 45-75 by IEI in 2019.

Trends in relative inequalities

Relative inequalities in CHD deaths have increased over the longer term. The RII figures for the last five years have been the highest in the time series, ranging from 1.54-1.60.

Figure 6.2: Relative Index of Inequality (RII): CHD deaths 45-74y Scotland 1997-2019
Figure 6.2 shows the RII for CHD deaths for those aged 45-74 from 1997 to 2019.

In the last ten years, CHD mortality rates have typically been 4-5 times higher in the most deprived areas compared to the least deprived areas. This is higher than at the start of the times series when CHD mortality rates were typically 3-4 times higher.

Trends in absolute inequalities

In contrast to relative inequalities, absolute inequality between those living in the most deprived areas and those living in the least deprived areas has reduced over the longer term 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).

Figure 6.3: Absolute Gap: CHD mortality 45-74 years, Scotland 1997-2019 (European Age-Standardised Rates per 100,000)
Figure 6.3 shows the absolute gap in CHD deaths for those aged 45-74 from 1997-2019

Cancer incidence rate aged under 75 years

Trends in cancer incidence

In 2018, there were over 22,500 new cases of cancer among people aged under 75.

Cancer incidence among people aged under 75 has fluctuated over the time series. It showed a general decrease from a high of 452.7 per 100,000 in 1996 to a low of 417.5 per 100,000 in 1999, before showing an overall increase until 2009 (446.6 per 100,000). Since 2009 cancer incidence rates decreased overall until 2017, before peaking in 2018 to a similar level to 1997 (449.1 per 100,000).

Table 6.1: Trends in cancer incidence (aged < 75), 1996-2018
Year Number of new cases Target population size Rate per 100,000 (EASR)
1996 18,128 4,754,906 452.7
1997 17,167 4,740,269 427.4
1998 17,109 4,729,975 424.3
1999 16,914 4,721,298 417.5
2000 17,138 4,708,667 420.6
2001 17,147 4,703,661 418.9
2002 17,530 4,701,958 423.6
2003 17,574 4,702,431 420.8
2004 18,159 4,714,233 430.3
2005 17,987 4,735,320 421.9
2006 18,167 4,752,425 423.3
2007 18,775 4,783,452 430.8
2008 19,449 4,811,453 439.7
2009 19,999 4,835,007 446.6
2010 20,015 4,858,058 441.9
2011 20,208 4,888,316 441.3
2012 20,296 4,895,114 436.8
2013 20,598 4,903,074 437.7
2014 21,064 4,914,362 442.4
2015 20,888 4,935,283 433.5
2016 20,980 4,962,391 429.2
2017 21,197 4,976,829 426.5
2018 22,549 4,983,364 449.1

Inequalities in cancer incidence, 2018

In 2018, there were 541.6 cases of cancer per 100,000 people in the most deprived areas, compared to 408.9 cases per 100,000 in the least deprived areas.

Figure 7.1: Cancer incidence amongst those aged <75y by Income-Employment Index,Scotland 2018 (European Age-Standardised Rates per 100,000)
Figure 7.1 shows cancer incidence by IEI in 2018.

Cancer incidence is more common in the most deprived areas of Scotland. However, this is not the case for all types of cancer.[1] This is driven in part by variations in screening uptake, leading to socially patterned rises in cancer incidence and, in turn, cancer survival for some types of cancer in the least deprived areas.

As has been the case in previous years, of the most common types of cancer, the absolute gap between most and least deprived areas was largest for cancer of the trachea, bronchus and lung (2018 rates were 120.9 and 32.9 per 100,000 population in the most and least deprived areas respectively).

Trends in relative inequalities

Changes in the relative index of inequality over time have been minimal and show no clear pattern, with the rate fluctuating between 0.29 and 0.40.

Figure 7.2: Relative Index of Inequality (RII): Cancer incidence <75y Scotland 1996-2018
Figure 7.2 shows the RII for cancer incidence from 1996-2018.

Trends in absolute inequalities

Absolute inequality levels in cancer incidence have fluctuated over time, ranging from 122.1 to 178.2. Rates in both the least and most deprived areas of Scotland have shown no clear pattern.

Figure 7.3: Absolute Gap: Cancer incidence <75y, Scotland 1996-2018 (European Age-Standardised Rates per 100,000)
Figure 7.3 shows the absolute gap in cancer incidence from 1996-2018.

The gap between the most and least deprived decile in 2018 (132.7 per 100,000) was the lowest it's been since 2009 (122.1 per 100,000). However, this reduction has been driven by an increase in rates in the least deprived decile.

Alcohol-related hospital admissions aged under 75 years

Trends in alcohol-related admissions

The hospital admission rate for alcohol-related conditions amongst those aged under 75 years has fluctuated over time and was lower in 2019 than at the start of the time series (224.6 cases per 100,000 in 2019, compared to 289.8 in 1996).

Table 7.1: Trends in alcohol-related hospital admissions (aged < 75), 1996-2019
Year Number of admissions Target population size Rate per 100,000 (EASR)
1996 12,787 4,754,906 289.8
1997 12,918 4,740,269 292.6
1998 13,316 4,729,975 300.7
1999 13,217 4,721,298 298.2
2000 12,786 4,708,667 286.6
2001 13,469 4,703,661 300.3
2002 13,492 4,701,958 299.9
2003 12,996 4,702,431 290.0
2004 14,084 4,714,233 312.5
2005 13,346 4,735,320 293.8
2006 13,595 4,752,425 295.3
2007 14,641 4,783,452 313.5
2008 14,222 4,811,453 302.3
2009 12,891 4,835,007 272.9
2010 12,307 4,858,058 258.7
2011 12,264 4,888,316 256.2
2012 11,556 4,895,114 240.9
2013 11,225 4,903,074 236.8
2014 10,779 4,914,362 223.6
2015 10,467 4,935,283 216.2
2016 10,770 4,962,391 219.4
2017 10,644 4,976,829 218.1
2018 10,662 4,983,364 217.6
2019 11,115 4,997,455 224.6

Inequalities in alcohol-related hospital admissions, 2019

In 2019, alcohol-related admissions were 5 times higher in the most deprived

areas of Scotland compared to the least (471.5 compared to 93.9 cases per 100,000).

Figure 8.1: Alcohol related hospital admissions amongst those aged <75y by Income-Employment Index, Scotland 2019 (European Age-Standardised Rates per 100,000)
Figure 8.1 shows alcohol related hospital admissions by IEI in 2019

Trends in relative inequalities

There has been a general downward trend observed in relative inequalities for alcohol-related hospital admissions since 1996. However, there has been some fluctuation including an increase in 2016 when the RII was 1.85, the highest rate since 2003. The figure for 2019 was 1.73.

Figure 8.2: Relative Index of Inequality (RII): Alcohol related hospital admissions <75y Scotland 1996-2019
Figure 8.2 shows the RII for alcohol related hospital admission from 1996-2019

In 1996, alcohol-related admission rates were 7 times higher in the most deprived areas compared to the least deprived. These rates have ranged between 4 and 6 times higher since 2003.

Trends in absolute inequalities

Absolute inequality in alcohol-related admissions has generally reduced over time, due to a reduction in admissions in the most deprived areas. 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 2018 (328.3 per 100,000). It increased slightly in 2019 to 377.6 per 100,000.

Figure 8.3: Absolute Gap: Alcohol related hospital admissions <75y Scotland 1996-2019 (European Age-Standardised Rates per 100,000)
Figure 8.3 shows the absolute gap in alcohol related hospital admissions from 1996-2019

Alcohol-specific deaths aged 45-74 years

Trends in alcohol-specific deaths

The alcohol-specific death rate among those aged 45-74 years has fluctuated over the time series. There was an overall increase between 1997 and 2006 (increasing from 38.5 per 100,000 to 61.3 per 100,000) followed by a general downward trend until 2013 (38.6 per 100,000) when the rate was similar to the start of the time series. Since 2013, the alcohol-specific mortality rate has increased slightly, ranging from 38.4-44.0 per 100,000. The rate in 2019 was 38.4 per 100,000, similar to the rate at the start of the time series.

Table 8.1: Trends in alcohol-specific deaths (aged 45-74), 1997-2019
Year Number of deaths Target population size Rate per 100,000 (EASR)
1997 636 1,635,590 38.5
1998 695 1,646,711 41.9
1999 761 1,658,124 45.2
2000 873 1,670,660 52.1
2001 957 1,687,422 56.7
2002 1,049 1,706,141 61.3
2003 1,053 1,727,112 60.9
2004 1,015 1,751,037 57.6
2005 1,056 1,774,865 59.3
2006 1,105 1,799,382 61.3
2007 1,002 1,827,320 54.6
2008 1,019 1,856,874 54.8
2009 905 1,885,693 47.9
2010 927 1,914,226 48.3
2011 871 1,941,253 45.1
2012 752 1,964,203 38.2
2013 769 1,986,202 38.6
2014 808 2,007,988 40.2
2015 840 2,026,210 41.4
2016 898 2,047,858 43.7
2017 910 2,064,612 44.0
2018 898 2,073,318 43.2
2019 801 2,078,664 38.4

Inequalities in alcohol-specific deaths, 2019

The alcohol-specific death rate (for those aged 45-74 years) in Scotland's most deprived areas is 9 times higher than that observed in the least deprived areas (96.0 compared to 10.2 per 100,000 population).

Figure 9.1: Alcohol-specific deaths amongst those aged 45-74y by Income-Employment Index,Scotland 2019 (European Age-Standardised Rates per 100,000)
Figure 9.1 shows alcohol-specific deaths by IEI in 2019

Trends in relative inequalities

Relative inequalities in alcohol-specific deaths have fluctuated across the time series, ranging from 1.79 to 2.43. The RII in 2019 was similar to the start of the times series in 1997 (1.99 and 2.02 respectively).

Figure 9.2: Relative Index of Inequality (RII): Alcohol-specific deaths 45-74y Scotland 1997-2019
Figure 9.2 shows the RII for alcohol-specific deaths from 1997-2019

Over time the relative range in death rates between the most and least deprived areas has fluctuated ranging from 5 to 14 times higher in the most deprived areas.

Trends in absolute inequalities

Although the rate of alcohol-specific deaths in the least deprived areas has remained reasonably static since 1997, there has been considerable change in the rate in the most deprived areas. This has largely driven changes in the absolute gap.

Following an increase in the gap between the alcohol-specific mortality rate in the most and least deprived areas of Scotland, from 93.7 to 184.7 per 100,000 between 1997 and 2002, there has been general downward trend, with a rate of 85.8 per 100,000 in 2019.

Figure 9.3: Absolute Gap: Alcohol specific deaths 45-74y Scotland 1997-2019 (European Age-Standardised Rates per 100,000)
Figure 9.3 shows the absolute gap in alcohol-specific deaths from 1997-2019

All-cause mortality aged 15-44 years

Trends in all-cause mortality aged 15-44

There were over 2,300 deaths of people aged 15-44 in Scotland in 2019.

There was an overall decrease in the mortality rate from the start of the time series to 2014, when rates reached a low of 96.8 per 100,000. Since then, the mortality rate of those aged 15-44 has risen and in 2019 it was similar to the rate in 1997 (119.8 per 100,000 and 116.3 per 100,000 respectively).

Table 9.1: Trends in all-cause mortality (aged 15-44), 1997-2019
Year Number of all-causes deaths Target population size Rate per 100,000 (EASR)
1997 2,440 2,158,030 116.3
1998 2,507 2,142,787 119.4
1999 2,507 2,129,794 119.0
2000 2,501 2,118,568 118.7
2001 2,509 2,111,242 119.0
2002 2,566 2,102,670 122.0
2003 2,461 2,094,408 116.9
2004 2,409 2,088,563 114.7
2005 2,305 2,091,415 109.3
2006 2,482 2,091,581 118.3
2007 2,461 2,097,902 117.5
2008 2,443 2,096,495 117.5
2009 2,389 2,092,065 115.1
2010 2,229 2,087,635 108.6
2011 2,262 2,092,311 110.8
2012 2,071 2,077,902 102.8
2013 1,990 2,064,867 100.1
2014 1,904 2,053,897 96.8
2015 1,976 2,053,401 101.2
2016 2,194 2,054,055 112.5
2017 2,068 2,048,063 107.1
2018 2,220 2,044,305 114.5
2019 2,331 2,053,086 119.8

The deaths of those age 15-44 in 2019 included: 404 probable suicides, 29 deaths from assault and 753 drug-related deaths. While the rates of probable suicide in this age group had generally been declining in recent years there was an increase in both 2018 and 2019, to 19.7 per 100,00 in 2019, the highest figure since 2011 (20.5 per 100,000). Rates of death from assault have increased slightly from a low of 1.0 per 100,000 in 2014, but have generally been lower in the last decade that at the start of the series. Drug-related deaths have shown large increases since the beginning of the time series in 1997. In 2019, the drug-related death rate was 38.4 per 100,000, this compares with 8.9 per 100,000 in 1997.

Table 9.2: Trends in deaths from assault, drugs and suicide (aged 15-44), 1997-2019
  Deaths from assault Drug related deaths Suicides
Year Number EASR per 100,000 Number EASR per 100,000 Number EASR per 100,000
1997 56 2.6 196 8.9 518 23.9
1998 65 3.0 227 10.6 526 24.4
1999 86 4.0 274 12.9 529 24.7
2000 60 2.9 268 12.7 541 25.6
2001 63 3.0 289 13.8 531 25.3
2002 76 3.6 345 16.7 539 25.7
2003 71 3.4 282 13.6 456 21.8
2004 78 3.8 311 15.2 475 22.7
2005 50 2.3 277 13.4 436 21.0
2006 83 4.0 350 17.1 435 20.9
2007 54 2.6 392 19.1 453 21.8
2008 53 2.5 477 23.3 480 23.4
2009 47 2.3 436 21.3 432 20.8
2010 54 2.6 384 18.9 423 20.5
2011 53 2.6 454 22.5 420 20.5
2012 37 1.9 416 20.8 375 18.3
2013 35 1.7 354 17.9 356 17.7
2014 22 1.0 416 21.1 309 15.4
2015 28 1.4 442 22.8 306 15.3
2016 34 1.7 568 29.2 329 16.2
2017 40 2.0 581 30.1 305 15.1
2018 28 1.4 723 37.3 370 18.3
2019 29 1.4 753 38.4 404 19.7

Inequalities in all-cause mortality aged 15-44, 2019

The mortality rate amongst people aged 15-44 years was 8 times higher in the most deprived areas (295.9 per 100,000) compared to the least deprived (38.0 per 100,000) in 2019.

Figure 10.1: Mortality amongst those aged 15-44 years by Income-Employment Index, Scotland 2019 (European Age-Standardised Rates per 100,000)
Figure 10.1 shows all-cause mortality of those aged 15-44 by IEI in 2019

Trends in relative inequalities

There has been an overall increase in relative inequalities over time and they are currently at their highest point in the time series (2.11).

Figure 10.2: Relative Index of Inequality (RII): mortality aged 15-44y Scotland 1997-2019
Figure 10.2 shows the RII of mortality for those aged 15-44 from 1997-2019

Between 1997 and 2017, death rates ranged from 4-7 times higher in the most deprived areas compared to the least deprived. In 2018 and 2019 deaths for those aged 15-44 years were 8 times higher in the most deprived areas compared to the least deprived areas.

Trends in absolute inequalities

The absolute gap between those living in the most and least deprived areas in all-cause mortality reached its lowest level in 2013 (a gap of 159.6 per 100,000). The gap has increased in each year since 2013 and is currently at its highest point in the time series at 257.9 per 100,000 in 2019.

Figure 10.3: Absolute Gap: Mortality 15-44y, Scotland 1997-2019 (European Age-Standardised Rates per 100,000)
Figure 10.3 shows the absolute gap in mortality for those aged 15-44 from 1997-2019

Low Birthweight

Trends in low birthweight

Over 2,600 low birthweight babies were born in Scotland in 2019.

The percentage of babies born with a low birthweight remained fairly stable across the time series, ranging from 5.0 – 6.0%

Table 10.1: Trends in low birthweight, 1996-2019
Year Number of low birthweight babies Target population size % of live singleton births
1996 3,066 55,861 5.5
1997 3,149 56,982 5.5
1998 3,108 55,152 5.6
1999 3,098 52,726 5.9
2000 2,906 51,057 5.7
2001 2,848 49,744 5.7
2002 2,910 48,950 5.9
2003 3,026 50,069 6.0
2004 3,030 51,807 5.8
2005 3,058 51,436 5.9
2006 2,939 52,467 5.6
2007 3,095 55,271 5.6
2008 3,134 56,925 5.5
2009 2,893 56,107 5.2
2010 2,816 56,123 5.0
2011 2,946 56,037 5.3
2012 2,775 55,369 5.0
2013 2,684 53,219 5.0
2014 2,773 54,396 5.1
2015 2,819 52,845 5.3
2016 2,762 52,424 5.3
2017 2,840 50,830 5.6
2018 2,690 49,259 5.5
2019 2,622 47,258 5.5

Inequalities in low birthweight 2019

In 2019, 8.5% of live singleton births in the most deprived areas were recorded as low birthweight. This is more than double the percentage in the least deprived areas (3.8%).

Figure 11.1: Low birthweight babies in Scotland by Income-Employment index 2019 (as percentage of live singleton births)
Figure 11.1 shows low birthweight babies by IEI in 2019

Trends in relative inequalities

Relative inequalities in low birthweight were higher in 2019 than those observed at the start of the time series (0.93 and 0.84 respectively). The RII values between 1997 and 2006 tended to be higher than those observed in the last decade.

Figure 11.2: Relative index of inequality (RII): Low birthweight babies in Scotland 1996-2019
Figure 11.2 shows the RII for low birthweight babies from 1996-2019

Trends in absolute inequalities

Overall, the absolute gap between the most and least deprived areas 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 narrowing and widening of the gap has tended to be driven by changes in the most deprived decile, as the least deprived decile has remained broadly stable since the beginning of the time series.

Figure 11.3: Absolute Gap:Low birthweight babies in Scotland 1996-2019 (as percentage of live singleton births)
Figure 11.3 shows the absolute gap for low birthweight babies from 1996-2019

Healthy Birthweight

Trends in healthy birthweight babies

In each year of the time series, either 89% or 90% of babies have been of healthy birthweight. For the past eight years the value has been 90%.

Table 11.1: Trends in healthy birthweight, 1996-2019
Year Number appropriate for gestational age1 Target population size1 % of live singleton births
1996 49,989 55,759 89.7
1997 51,113 56,895 89.8
1998 49,303 55,075 89.5
1999 47,048 52,655 89.4
2000 45,292 50,978 88.8
2001 44,355 49,666 89.3
2002 43,571 48,853 89.2
2003 44,539 49,956 89.2
2004 45,842 51,694 88.7
2005 45,592 51,303 88.9
2006 46,678 52,330 89.2
2007 49,059 55,080 89.1
2008 50,658 56,733 89.3
2009 49,880 55,907 89.2
2010 50,236 56,027 89.7
2011 49,997 55,958 89.3
2012 49,454 55,249 89.5
2013 47,650 53,032 89.9
2014 48,673 54,044 90.1
2015 47,285 52,528 90.0
2016 46,694 51,870 90.0
2017 45,228 50,252 90.0
2018 44,308 49,011 90.4
2019 42,568 47,169 90.2

1. This table includes records that could not be assigned an income employment decile

and are therefore not included in the rest of the analysis

Inequalities in healthy birthweight babies 2019

In 2019, there was a marginal difference between the least and the most deprived areas in terms of the proportion of healthy births (89.8% versus 90.5% respectively).

Figure 12.1: Babies appropriate for gestational age in Scotland by Income-Employment index 2019 (as percentage of live singleton births)
Figure 12.1 shows healthy birthweight babies by IEI in 2019

Trends in relative inequalities

Relative inequalities have been consistently low over the times series. The RII for 2019 is at 0.01, suggesting that there is no relative inequality for this indicator.

Figure 12.2: Relative index of inequality (RII): Babies appropriate for gestational age in Scotland 1996-2019
Figure 12.2 shows the RII of healthy birthweight babies from 1996-2019

Trends in absolute inequalities

The absolute gap between the percentage of healthy birthweight babies in the most and least deprived deciles has been consistently low across the full time series (0.8 percentage points in 2019).

Figure 12.3: Absolute Gap: Babies appropriate for gestational age in Scotland 1996-2019 (as percentage of live singleton births)
Figure 12.3 shows the absolute gap for healthy birthweight babies from 1996-2019

Self-assessed health

Trends in self-assessed health (adults aged 16+)

In 2018/2019 9% of adults rated their health as 'bad' or 'very bad', the same proportion as in 2016/2017. This is a significant increase from the start of the time series in 2008/2009 (7%).

Table 12.1
Year Proportion of adults rating general health as bad/very bad Lower 95% confidence limit (%) Upper 95% confidence limit (%)
2008/2009 7 7 8
2010/2011 8 7 8
2012/2013 9 8 9
2014/2015 8 8 9
2016/2017 9 8 9
2018/2019 9 8 9

Inequalities in self-assessed health 2018/2019

In 2018/2019, adults in the most deprived areas were seven times more likely to report poor health than those in the least deprived areas (21% versus 3%).

Figure 13.1: Proportion of adults (16+) rating their general health as bad/very bad by Income-Employment Index, Scotland 2018/2019
Figure 13.1 shows adults with poor self-assessed health by IEI in 2018/2019

Trends in relative inequalities

Relative inequalities have fluctuated over the time series, peaking in 2014/2015 at 2.14. They have since fallen to 1.85 in 2018/2019, slightly lower than at the start of the time series (1.87 in 2008/2009).

Figure 13.2: Relative Index of Inequality (RII): Proportion of adults (16+ ) rating their general health as bad/very bad Income Employment Index, Scotland, 2008/2009 -2018/2019
Figure 13.2 shows the RII for adults with poor self-assessed health from 2008/2009-2018/2019

Trends in absolute inequalities

The absolute gap in the percentage of adults reporting poor health increased steadily between those living in the most and least deprived areas between 2008/2009 and 2014/2015 (from 13 percentage points to 19 percentage points). However, it decreased to 18 percentage points in 2016/2017 and 2018/2019.

Figure 13.3: Relative Index of Inequality (RII): Proportion of adults (16+ ) rating their general health as bad/very bad Income Employment Index, Scotland, 2008/2009 -2018/2019
Figure 13.3 shows the absolute gap for adults with poor self-assessed health in 2008/2009-2018/2019

Limiting long term conditions

Trends in limiting long-term conditions (adults aged 16+)

A limiting long-term condition is defined as a physical or mental health condition or illness lasting 12 months or more that reduces an individual's ability to carry-out day-to-day activities.

In 2018/2019 34% of adults reported a limiting long-term condition. This is a significant increase from the start of the time series in 2008/2009 (26%).

Table 13.1
Year Proportion of adults with a limiting long-term condition Lower 95% confidence limit Upper 95% confidence limit
2008/2009 26 25 27
2010/2011 28 27 29
2012/2013 32 30 33
2014/2015 32 30 33
2016/2017 32 30 33
2018/2019 34 33 35

Inequalities in limiting long-term conditions 2018/2019

In 2018/2019, adults in the most deprived areas were nearly twice as likely to report a limiting long-term condition than those in the least deprived areas (47% versus 24%).

Figure 14.1: Proportion of adults (16+ ) with a limiting long term condition by Income-Employment Index, Scotland 2018/2019
Figure 14.1 shows adults with a limiting long-term condition by IEI in 2018/2019

Trends in relative inequalities

Relative inequalities in limiting long-term conditions decreased between 2008/2009 and 2018/2019 from 0.83 to 0.72.

Figure 14.2: Relative Index of Inequality (RII): Proportion of adults (16+ ) with a limiting long-term condition Scotland, 2008/2009 -2018/2019
Figure 14.2 shows the RII for adults with a limiting long-term condition from 2008/2009-2018/2019

Trends in absolute inequalities

The absolute gap in the prevalence of limiting long-term conditions between the most and least deprived areas increased steadily between 2008/2009 and 2014/2015 (from 21 to 29 percentage points) before decreasing in 2016/2017 to levels similar to those seen at the start of the time series. It has since increased in 2018/2019 to 23 percentage points.

Figure 14.3: Absolute Gap: Proportion of adults (16+ ) with a limiting long-term condition Scotland, 2008/2009 -2018/2019
Figure 14.3 shows the absolute gap for adults with a limiting long-term condition in 2008/2009-2018/2019

Drug-related hospital admissions aged under 75 years

Trends in drug-related hospital admissions

In 2018/19, over 10,000 individuals under the age of 75 were admitted to hospital for drug-related issues.

The rate of drug-related hospital admissions, which is based on the number of patients admitted to general acute and psychiatric specialties for drug misuse in each financial year, has shown a general upward trend since 1996/97 and is currently the highest it has been in the time series with 207.6 admissions per 100,000 population, compared to 64.0 admission per 100,000 in 1996/97.

Table 14.1: Trends in drug-related hospital admissions (aged <75), 1996/97-2018/19
Year Total admissions1 Population Rate per 100,000 (EASR)
1996/97 3,366 4,754,906 64.0
1997/98 3,801 4,740,269 73.6
1998/99 4,395 4,729,975 86.1
1999/00 4,734 4,721,298 94.1
2000/01 4,851 4,708,667 97.6
2001/02 5,205 4,703,661 105.7
2002/03 5,412 4,701,958 110.7
2003/04 5,124 4,702,431 106.0
2004/05 5,292 4,714,233 109.8
2005/06 5,019 4,735,320 104.0
2006/07 5,262 4,752,425 108.8
2007/08 5,790 4,783,452 119.3
2008/09 6,120 4,811,453 125.9
2009/10 6,009 4,835,007 124.0
2010/11 6,435 4,858,058 132.6
2011/12 6,384 4,888,316 131.1
2012/13 6,033 4,895,114 124.5
2013/14 6,624 4,903,074 137.5
2014/15 6,981 4,914,362 144.7
2015/16 7,836 4,935,283 162.3
2016/17 8,607 4,962,391 178.4
2017/18 9,258 4,976,829 191.9
2018/19 10,017 4,983,364 207.6

1. Total admissions counts the number of individuals who have been admitted to

hospital for drug misuse in each financial year. Individuals admitted to hospital multiple

times in the same financial year will only be included once per year.

Inequalities in drug-related hospital admissions, 2017/18

In 2018/19, the admission rate in Scotland's most deprived areas was 18 times greater than that of the least deprived (644.0 cases per 100,000 compared to 35.2 per 100,000).

Figure 15.1: Drug-related hospital admissions <75 y by Income-Employment Index, Scotland 2018/19 (European Age-Standardised Rates per 100,000)
Figure 15.1 shows drug-related hospital admissions by IEI in 2018/19

Trends in relative inequalities

Relative inequality levels for patients with drug-related hospital admissions have fluctuated over time. Although they have decreased from a high of 3.06 in 1998/99 the RII for 2018/19 (2.83) is higher than at the start of the time series (2.77).

Figure 15.2: Relative Index of Inequality (RII): Drug-related hospital admissions <75y Scotland 1996/97-2018/19
Figure 15.2 shows the RII for drug-related hospital admissions from 1996/97-2018/19

Since 1996/97 admission rates (aged <75) have ranged from 15-28 times higher in the most deprived areas compared to the least deprived areas.

Trends in absolute inequalities

The absolute gap in rates between those living in the most deprived areas and the least deprived areas has increased overall since the start of the time series. After an initial increase between 1996/97 and 1998/99 the absolute gap remained relatively stable, ranging from 309.6 – 384.7 per 100,000 between 1999/00 and 2012/13 before increasing in each of the past six years. In 2018/19 the absolute gap was at its highest level at 608.8 per 100,000. These fluctuations have mainly been driven by changes in drug-related hospital admissions in the most deprived areas, with drug-related hospital admissions in the least deprived areas also increasing but at a much lower scale.

Figure 15.3: Absolute Gap: Drug-related hospital admissions <75y Scotland 1996/97-2018/19 (European Age-Standardised Rates per 100,000)
Figure 15.3 shows the absolute gap in drug-related hospital admissions from 1996/97-2018/19

Contact

Email: scottishhealthsurvey@gov.scot