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Long-term monitoring of health inequalities: March 2022 report

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

This document is part of a collection


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

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

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, 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.

Contact

Email: morag.shepherd@gov.scot

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