Long-term Monitoring of Health Inequalities March 2023 report

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

This document is part of a collection


Inequalities in morbidity and mortality indicators

The 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 three causes of death.

Although relative inequalities in heart attack hospital admissions had been increasing 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 3.1: Relative Index of Inequality (RII) Selected morbidity indicators (ages <75 years) Scotland 1997-2021
Figure 3.1 shows the RII for comparable morbidity indicators from 1997 to 2021.

1. Cancer incidence data is only available up to 2020

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 similar to at the start of the time series (2.02 in 1997 vs 2.03 in 2021).

Although RII in cancer deaths has increased slightly over the longer term, inequalities remain highest in alcohol-specific and coronary heart disease deaths.

Figure 3.2: Relative Index of Inequality (RII) Mortality indicators (ages 45-74 years) Scotland 1997-2021
Figure 3.2 shows the RII for comparable mortality indicators from 1997-2021.

First ever hospital admission for heart attack aged under 75 years

Trends in heart attack hospital admissions

In 2021, over 5,100 new cases of heart attack (for those aged under 75 years) were recorded in Scottish hospitals.

The rate of admissions decreased year on year in the first 10 years of the time series, from 145.1 per 100,000 in 1997 to 80.4 per 100,000 in 2007, the lowest figure in the time series. While the rate of admissions in 2021 was 32% lower than in 1997 (99.2 in 2021), it has increased by 23% since 2007.

This indicator includes data for 2020 and 2021, the first two years of the COVID-19 pandemic. During this time there were changes to the accessibility and use of health services at various points[7] which may have impacted on the likelihood of adults suffering from[8], or presenting at hospital suffering from, a heart attack, although the exact nature of any impact is unclear.

Table 4.1: Trends in heart attack hospital admissions (aged <75), 1997-2021
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
2020 4,908 4,996,183 95.4
2021 5,140 5,001,617 99.2

Inequalities in heart attack hospital admissions, 2021

In 2021, the admission rate in Scotland's most deprived areas was more than double that of those living in the least deprived areas (145.3 cases per 100,000 compared to 65.6 per 100,000).

Figure 4.1: Hospital admissions for heart attack among those aged <75y by Income-Employment Index, Scotland 2021 (European Age-Standardised Rates per 100,000)
Figure 4.1 shows hospital admissions for heart attacks by IEI decile in 2021.

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 2021 was the same as at the start of the time series in 1997 (0.82).

Figure 4.2: Relative Index of Inequality (RII): Hospital admissions for heart attack <75y Scotland 1997-2021
Figure 4.2 shows the RII of hospital admissions for heart attacks from 1997-2021

Heart attack hospital admission rates (aged <75) have been around 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 79.7 per 100,000 in 2021. The gap has increased from 63.2 per 100,000 in 2020, which was the lowest figure since 2008.

The increase in 2021 has been driven by a 7% increase in admissions in the most deprived areas and a 10% decrease in the least deprived areas and reflects a return to pre-pandemic levels.

Figure 4.3: Absolute Gap: Hospital admissions for heart attack <75y Scotland 1997-2021 (European Age-Standardised Rates per 100,000)
Figure 4.3 shows the absolute gap for hospital admissions for heart attacks from 1997 and 2021.

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

Trends in CHD deaths

In 2021, over 2,700 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 2021, the death rate for this age group was 130.1 per 100,000. While the 2021 rate is 65% lower than the rate in 1997 (372.5 per 100,000), it is the highest level since 2013.

National Records of Scotland note that in 2020 and 2021 there more deaths than usual (when compared to the five year average of 2015-2019) from a number of causes, including heart disease[9]. The cause of this increase is not clear, however, reduced access to and availability of health services, and reluctance to use services[10], during the pandemic may have played a part.

Table 5.1: Trends in CHD deaths (aged 45-74), 1997-2021
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
2020 2,595 2,081,214 123.3
2021 2,772 2,085,703 130.1

Inequalities in CHD deaths, 2021

In 2021, the CHD mortality rate was five times higher in Scotland's most deprived areas compared to the least deprived (276.3 compared to 53.6 deaths per 100,000 population).

Figure 5.1: CHD mortality 45-74 years by Income-Employment Index, Scotland 2021 (European Age-Standardised Rates per 100,000)
Figure 5.1 shows the CHD deaths among those aged 45-75 by IEI in 2021

Trends in relative inequalities

Relative inequalities in CHD deaths have increased over the longer term. In 2021 the RII was 1.75, the highest in the time series.

Figure 5.2: Relative Index of Inequality (RII): CHD mortality 45-74years Scotland 1997-2021
Figure 5.2 shows the RII for CHD deaths for those aged 45-74 from 1997 to 2021.

In the second half of the time series, 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, the absolute gap 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 gap in 2021 is 36% lower than the start of the time series (222.6 per 100,000 in 2021 compared to 347.3 per 100,000 in 1997) but is the highest figure since 2009.

Between 2020 and 2021 the mortality rate in the most deprived areas increased by 11%, whilst the rate in the least deprived areas decreased by 14%. In 2020 there was a decrease in the rate of first hospital admission for heart attack for adults living in the most deprived areas[11], potentially as a result of non-attendance at hospital as a result of the COVID-19 pandemic, which may have contributed towards this increase in mortality seen in 2021.

Figure 5.3: Absolute Gap: CHD mortality 45-74 years, Scotland 1997-2021 (European Age-Standardised Rates per 100,000)
Figure 5.3 shows the absolute gap in CHD deaths for those aged 45-74 from 1997-2021.

Cancer incidence rate aged under 75 years

Trends in cancer incidence

In 2020, there were more than 19,500 new cases of cancer diagnosed among people aged under 75.

Cancer incidence among people aged under 75 has fluctuated over the time series ranging from 417.5 per 100,000 to 452.7 per 100,000 between 1996 and 2019. Cancer incidence in 2020 was the lowest in the time series at 383.9 per 100,000, a reduction of 14% since 2019. This reduction is likely to be a result of the impact of COVID-19 on cancer detection, rather than a genuine decrease in the incidence of cancer in Scotland in 2020.

In Public Health Scotland's (PHS) Cancer Incidence in Scotland[12] publication they note that during the COVID-19 pandemic, cancer screening programmes were paused and referrals for suspected cancer fell as patients were less likely to seek help. Some people will also have died of COVID-19 in 2020 before they were diagnosed with cancer. To quantify this, PHS undertook analysis to determine the rates of cancer that would have been expected in 2020 based on the previous decades cancer data (2010-2019) and determined that the decrease was out with what would have been expected and was therefore likely the result of the COVID-19 pandemic.

Table 6.1: Trends in cancer incidence (aged < 75), 1996-2020
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
2019 22,698 4,997,455 447.1
2020 19,663 4,996,183 383.9

Inequalities in cancer incidence, 2020

In 2020, there were 492.1 cases of cancer per 100,000 people in the most deprived areas, compared to 333.8 cases per 100,000 in the least deprived areas.

Figure 6.1: Cancer incidence amongst those aged <75y by Income-Employment Index,Scotland 2020 (European Age-Standardised Rates per 100,000)
Figure 6.1 shows cancer incidence by IEI in 2020.

Cancer incidence is more common in the most deprived areas of Scotland. However, this is not the case for all types of cancer[13]. 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 (2020 rates were 116.8 and 23.6 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 0.42. In 2020 the RII was 0.42, the highest figure in the time series.

Figure 6.2: Relative Index of Inequality (RII): Cancer incidence <75y Scotland 1996-2020
Figure 6.2 shows the RII for cancer incidence from 1996-2020.

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. The gap between the most and least deprived decile was 158.2 in 2020. Between 2019 and 2020 the rate of cancer incidence decreased in both the most and least deprived deciles (by 13% and 16% respectively), most likely as a result of the impact of the COVID-19 pandemic.

Figure 6.3: Absolute Gap: Cancer incidence <75y, Scotland 1996-2020 (European Age-Standardised Rates per 100,000)
Figure 6.3 shows the absolute gap in cancer incidence from 1996-2020.

Cancer deaths aged 45-74 years

In October 2022 Public Health Scotland (PHS) published the annual Cancer Mortality in Scotland report[14] which included data up to 2021. In the report they note that the COVID-19 pandemic resulted in the pausing of cancer screenings, a fall in urgent referrals for suspected cancer and a reduction in patients seeking help, receiving investigations and treatment for cancer.

In the publication PHS note that cancer mortality rates have fallen over time and they therefore undertook analysis to gauge the impact of the pandemic on cancer mortality rates. This analysis concluded that while cancer mortality rates in 2020 and 2021 were lower than before the pandemic, the were within the limits which would have been expected if the pandemic had not occurredxiv.

Trends in cancer deaths

In 2021 more than 7,300 adults aged 45-74 died of cancer.

The cancer mortality rate amongst those aged 45-74 years has fallen by 35% since the start of the time series (from 529.8 per 100,000 population in 1996 to 343.6 per 100,000 in 2021).

Table 7.1: Trends in cancer mortality (aged 45-74), 1996-2021
Year Number of deaths Target population size Rate per 100,000 (EASR)
1996 8,402 1,631,224 529.8
1997 8,068 1,635,590 509.1
1998 7,995 1,646,711 501.9
1999 7,904 1,658,124 494.4
2000 7,776 1,670,660 484.8
2001 7,903 1,687,422 489.2
2002 7,850 1,706,141 481.2
2003 7,706 1,727,112 467.4
2004 7,678 1,751,037 460.9
2005 7,606 1,774,865 451.8
2006 7,486 1,799,382 441.3
2007 7,569 1,827,320 439.5
2008 7,536 1,856,874 431.0
2009 7,481 1,885,693 421.2
2010 7,394 1,914,226 411.1
2011 7,428 1,941,253 408.5
2012 7,514 1,964,203 406.2
2013 7,520 1,986,202 399.8
2014 7,445 2,007,988 389.6
2015 7,621 2,026,210 392.9
2016 7,385 2,047,858 373.5
2017 7,342 2,064,612 363.6
2018 7,531 2,073,318 367.0
2019 7,487 2,078,664 360.0
2020 7,362 2,081,213 349.8
2021 7,326 2,085,703 343.6

Inequalities in cancer deaths, 2021

Of people in the 45-74 year age group, those living in Scotland's most deprived areas were more than twice as likely to die of cancer than those in the least deprived areas in 2021 (542.0 deaths per 100,000 population compared to 221.8 per 100,000 population).

Figure 7.1: Cancer mortality amongst those aged 45-74y by Income-Employment Index, Scotland 2021 (European Age-Standardised Rates per 100,000)
Figure 7.1 shows cancer mortality admissions by IEI in 2021

As is the case for cancer incidence, inequality levels vary when examining deaths by cancer type[15]. As described in the previous section, variations in screening uptake may lead to socially patterned rises in cancer incidence and, in turn, cancer survival (therefore having a possible effect on mortality) for some types of cancer.

In 2021 the largest differences between rates in the most and least deprived areas are again observed for cancer of the trachea, bronchus and lung (201.4 compared to 31.8 per 100,000 population).

Trends in relative inequalities

Relative inequalities in cancer mortality have increased over time and the RII in 2021 was the second highest recorded across the time series (0.98), higher than at the start of the time series (0.69 in 1996).

Figure 7.2: Relative Index of Inequality (RII): Cancer mortality 45-74y Scotland 1996-2021
Figure 7.2 shows the RII for cancer mortality from 1996-2021

Trends in absolute inequalities

Levels of absolute inequality for cancer deaths have fluctuated since 1996, ranging from 304.8 to 395.3. In 2021 the absolute gap between the most deprived and least deprived areas was 320.2 per 100,000.

Figure 7.3: Absolute Gap: Cancer mortality 45-74y, Scotland 1996-2021 (European Age-Standardised Rates per 100,000)
Figure 7.3 shows the absolute gap in cancer mortality from 1996-2021

Alcohol-related hospital admissions aged under 75 years

Trends in alcohol-related admissions

The first hospital admission rate for alcohol-related conditions amongst those aged under 75 years with a 10-year look-back period has shown a general downward trend over time. The rate of admissions was 201.1 per 100,000 in 2021, the lowest figure in the time series and 31% lower than at the start of the time series (289.8 per 100,000 in 1996).

Alcohol-related hospital admissions were around 11% lower in 2020 and 2021 than in 2019. Measures put in place in response to the COVID-19 pandemic impacted hospital activity from March 2020 and are likely to have contributed to the decrease[16]

Table 8.1: Trends in first alcohol-related hospital admissions 1 (aged < 75), 1996-2021 2
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 4,914,362 223.7
2015 10,466 4,935,283 216.9
2016 10,769 4,962,391 221.8
2017 10,645 4,976,829 218.1
2018 10,662 4,983,364 217.6
2019 11,186 4,997,455 227.5
2020 9,994 4,996,183 202.5
2021 9,933 5,001,617 201.1

1. Based on a 10 year look-back period

2. Figures for 2014-2020 have been revised slightly, but this does not affect the overall picture.

Inequalities in alcohol-related hospital admissions, 2021

In 2021, alcohol-related admissions were 5 times higher in the most deprived areas of Scotland compared to the least deprived (419.1 compared to 82.6 cases per 100,000).

Figure 8.1: Relative Index of Inequality (RII): Alcohol related hospital admissions <75y Scotland 1996-2021
Figure 8.1 shows alcohol-related hospital admissions by IEI in 2021

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 2021 was 1.72.

Figure 8.2: Alcohol related hospital admissions amongst those aged <75y by Income-Employment Index, Scotland 2021 (European Age-Standardised Rates per 100,000)
Figure 8.2 shows the RII for alcohol-related hospital admission from 1996-2021

Since 2003, alcohol-admission rates have been between 4 to 6 times higher in the most deprived areas compared to the least deprived areas. Prior to this, admission rates were 6-7 times higher in the most deprived areas.

Trends in absolute inequalities

Absolute inequalities in alcohol-related admissions have generally reduced over time, largely 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 2020 (322.2 per 100,000). The rate increased slightly to 336.5 per 100,000 in 2021. Rates in the most deprived areas have reduced by 41% between 1996 and 2021, compared to a reduction of 17% in the least deprived areas.

Figure 8.3: Absolute Gap: Alcohol related hospital admissions <75y Scotland 1996-2021 (European Age-Standardised Rates per 100,000)
Figure 8.3 shows the absolute gap in alcohol-related hospital admissions from 1996-2021

Alcohol-specific deaths aged 45-74 years

Trends in alcohol-specific deaths

Analysis by PHS on alcohol consumption during the COVID-19 pandemic found that, while total alcohol consumption for the population reduced, alcohol-specific deaths were 9% higher in 2020 than the 2017-19 annual average[17]. This is possibly as a result of some individuals increasing their alcohol consumption during the pandemic and a reduction in access to hospital treatment for alcohol-related conditions. This impact may have continued to have an influence on alcohol-specific death rates in 2021.

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 2012 (38.2 per 100,000) when the rate was similar to the start of the time series. Since 2013, the alcohol-specific mortality rate has increased overall and the rate in 2021 was 47.3 per 100,000, the highest rate since 2010 and higher than at the start of the time series.

Table 9.1: Trends in alcohol-specific deaths (aged 45-74), 1997-2021
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
2020 952 2,081,213 45.4
2021 997 2,085,703 47.3

Inequalities in alcohol-specific deaths, 2021

The alcohol-specific death rate (for those aged 45-74 years) in Scotland's most deprived areas is almost six times higher than that observed in the least deprived areas (113.0 compared to 19.0 per 100,000 population).

Figure 9.1: Alcohol specific mortality amongst those aged 45-74y by Income-Employment Index, Scotland 2021 (European Age-Standardised Rates per 100,000)
Figure 9.1 shows alcohol-specific deaths by IEI in 2021

Trends in relative inequalities

Relative inequalities in alcohol-specific deaths in 2021 were similar to at the start of the time series in 1997 (2.03 and 2.02 respectively). Over the time series the RII has ranged from 1.79 to 2.43.

Figure 9.2: Relative Index of Inequality (RII): Alcohol specific mortality 45-74y Scotland 1997-2021
Figure 9.2 shows the RII for alcohol-specific deaths from 1997-2021

Trends in absolute inequalities

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 the lowest rate of 71.8 per 100,000 in 2020. However, this rate increased in 2021 to 94.0 per 100,000, the highest rate since 2017

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, however, in 2021, both the most and least deprived areas showed an increase from 2020 (increases of 30% and 23% in the most and least deprived areas respectively.)

Figure 9.3: Absolute Gap: Alcohol specific mortality 45-74y Scotland 1997-2021 (European Age-Standardised Rates per 100,000)
Figure 9.3 shows the absolute gap in alcohol-specific deaths from 1997-2021

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 2021.

There was an overall decrease in the mortality rate from the start of the time series in 1997 to 2014, when rates reached a low of 96.8 per 100,000. Since then, the mortality rate of those aged 15-44 has increased and in 2021 it was similar to the start of the time series (116.8 per 100,000 and 116.3 per 100,000 respectively).

Table 10.1: Trends in all-cause mortality (aged 15-44), 1997-2021
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
2020 2,349 2,055,180 119.0
2021 2,322 2,062,184 116.8

The deaths of those age 15-44 in 2021 included: 352 probable suicides, 30 deaths from assault and 723 drug-related deaths. The rate of probable suicide in this age group in 2021 declined for the first time in three years and is lower than at the start of the time series in 1997 (17.0 per 100,000 and 23.9 per 100,000 respectively). Rates of death from assault have increased slightly to 1.5 per 100,000 in 2021 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 2021, the drug-related death rate was 36.2 per 100,000, this compares with 8.9 per 100,000 in 1997.

Table 10.2: Trends in deaths from assault, drugs and suicide (aged 15-44), 1997-2021
  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
2020 30 1.4 756 38.0 404 19.8
2021 30 1.5 723 36.2 352 17.0

Inequalities in all-cause mortality aged 15-44, 2021

The mortality rate amongst people aged 15-44 years was more than six times higher in the most deprived areas (262.5 per 100,000) compared to the least deprived (43.6 per 100,000) in 2021.

Figure 10.1: Mortality amongst those aged 15-44 years by Income-Employment Index, Scotland 2021 (European Age-Standardised Rates per 100,000)
Figure 10.1 shows all-cause mortality of those aged 15-44 by IEI in 2021

Trends in relative inequalities

There has been an overall increase in relative inequalities over time, although they have fallen in the last couple of years from a high of 2.11 in 2019 to 1.98 in 2021.

Figure 10.2: Relative index of inequality (RII): mortality aged 15-44y Scotland 1997-2021
Figure 10.2 shows the RII of all-cause mortality for those aged 15-44 from 1997-2021

Trends in absolute inequalities

The absolute gap in all-cause mortality between those living in the most and least deprived areas has fluctuated over the time series, reaching its lowest level in 2013 (a gap of 159.6 per 100,000). The gap was highest in 2019 at 257.9 per 100,000 and has fallen to 218.9 per 100,000 in 2021. This decrease has been driven by both a decrease in mortality for those living in the most deprived areas and an increase in mortality for those living in the least deprived areas.

Figure 10.3: Absolute Gap: Mortality 15-44y, Scotland 1997-2021 (European Age-Standardised Rates per 100,000)
Figure 10.3 shows the absolute gap in all-cause mortality for those aged 15-44 from 1997- 2021

Low Birthweight

Trends in low birthweight

Over 2,350 low birthweight babies were born in Scotland in 2021.

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

Table 11.1: Trends in low birthweight, 1998-2021
Year Number of low birthweight babies1 Target population size % of live singleton births
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 56,135 5.0
2011 2,948 56,038 5.3
2012 2,781 55,395 5.0
2013 2,716 53,619 5.1
2014 2,772 54,389 5.1
2015 2,819 52,842 5.3
2016 2,761 52,416 5.3
2017 2,842 50,824 5.6
2018 2,689 49,248 5.5
2019 2,626 47,379 5.5
2020 2,435 45,575 5.3
20212 2,357 45,846 5.1

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.

2. 2021 data are provisional and may be updated in future reports.

Inequalities in low birthweight 2021

In 2021, 7.8% of live singleton births in the most deprived areas were recorded as low birthweight, this compared to 3.2% in the least deprived areas.

Figure 11.1: Low birthweight babies in Scotland by Income-Employment Index 2021 (as percentage of live singleton births)
Figure 11.1 shows low birthweight babies by IEI in 2021

Trends in relative inequalities

Relative inequalities in low birthweight were lower in 2021 than those observed at the start of the time series in 1998 (0.97 and 1.03 respectively). However, the RII values have been increasing the last five years, and are higher than the lowest value in the time series (0.76 in 2013).

Figure 11.2: Relative index of inequality (RII): Low birthweight babies in Scotland 1998-2021
Figure 11.2 shows the RII for low birthweight babies from 1996-2021

Trends in absolute inequalities

The absolute gap in low birthweight between those living in the most and least deprived areas in 2021 was 4.6 percentage points, an increase from 3.4 percentage points in 2020 but lower than at the start of the time series (5.3 percentage points).

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. However, the increase between 2020 and 2021 was driven by both an increase in the most deprived areas and a decrease in the least deprived areas.

Figure 11.3: Absolute Gap: Low birthweight babies in Scotland 1998-2021 (as percentage of live singleton births)
Figure 11.3 shows the absolute gap for low birthweight babies from 1996-2021

Healthy Birthweight

Trends in healthy birthweight babies

In each year of the time series, between 79% and 81% of babies have been of healthy birthweight.

Table 12.1: Trends in healthy birthweight, 1998-2021
Year Number appropriate for gestational age1,2 Target population size1 % of live singleton births
1998 43,963 55,065 79.8
1999 41,815 52,655 79.4
2000 40,348 50,978 79.1
2001 39,412 49,666 79.4
2002 38,699 48,853 79.2
2003 39,720 49,955 79.5
2004 40,823 51,694 79.0
2005 40,616 51,303 79.2
2006 41,578 52,330 79.5
2007 43,778 55,077 79.5
2008 45,112 56,733 79.5
2009 44,456 55,907 79.5
2010 44,936 56,039 80.2
2011 44,589 55,956 79.7
2012 44,243 55,274 80.0
2013 42,849 53,424 80.2
2014 43,424 54,037 80.4
2015 42,267 52,525 80.5
2016 41,877 51,863 80.7
2017 40,417 50,246 80.4
2018 39,658 49,000 80.9
2019 38,168 47,290 80.7
2020 36,609 45,496 80.5
20213 36,573 45,778 79.9

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.

2. Babies identified as an appropriate weight for gestational age are those with a birthweight between the 10th and 90th percentile. Previously the 5th and 95th percentiles were used. See annex 2 for more information.

3. 2021 data are provisional and may be updated in future reports.

Inequalities in healthy birthweight babies 2021

In 2021, there was a marginal difference between the most and the least deprived areas in terms of the proportion of healthy birthweight babies, with a slightly higher percentage of healthy birthweight babies born to mothers living in the most deprived areas (80.3% in the most deprived areas compared with 80.0% in the least deprived areas).

Figure 12.1: Babies appropriate for gestational age in Scotland by Income-Employment index 2021 (as percentage of live singleton births)
Figure 12.1 shows healthy birthweight babies by IEI in 2021

Trends in relative inequalities

Relative inequalities have been consistently low over the times series. The RII for 2021 is -0.01, suggesting that the relative inequality for this indicator is very small.

Figure 12.2: Relative index of inequality (RII): Babies appropriate for gestational age in Scotland 1998-2021
Figure 12.2 shows the RII of healthy birthweight babies from 1996-2021

Trends in absolute inequalities

The absolute gap between the percentage of healthy birthweight babies born to mothers in the most and least deprived deciles has been consistently low across the full time series (0.3 percentage points in 2021). In some years the gap was in the opposite direction to the rest of the time series, with a slightly higher proportion of heathy weight babies born to mothers living in the most deprived areas.

Figure 12.3: Absolute Gap: Babies appropriate for gestational age in Scotland 1998-2021 (as percentage of live singleton births)
Figure 12.3 shows the absolute gap for healthy birthweight babies from 1996-2021

Drug-related hospital admissions aged under 75 years

Trends in drug-related hospital admissions

In 2021/22, just under 9,100 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 the start of the time series, increasing from 63.8 per 100,000 in 1996/97 to 224.2 per 100,000 in 2019/20 and then decreasing in 2020/21 and 2021/22, (188.0 per 100,000 in 2021/22). This fall may be due to the impact of the COVID-19 pandemic rather than a genuine reduction in drug misuse incidents requiring hospitalization.

In their annual drug-related hospital statistics in Scotland report[18], PHS note that there was a decrease in drug-related hospital stays during the COVID-19 pandemic which is inconsistent with the previous upward trend. Analysis found that the number of drug-related hospital stays in April 2020 was 29% lower than the average number of stays in April 2018 and 2019, likely due to the measures put in place in response to the COVID-19 pandemic. In May 2020, however, hospital stays were 6% higher than in May 2018 and 2019 and from May 2020 to June 2021 drug-related hospital stays were broadly similar to the 2018 and 2019 average for the same time period. From July 2021 to March 2022 drug-related hospital stays were lower than the 2018 and 2019 average, decreasing from 10% lower in July 2021 to 26% lower in March 2022.

It is unclear whether the changes in drug-related hospital stays, which coincide with the start of the pandemic, were a result of genuine differences in drug use, changes to hospital admission policies, or whether national and local restrictions in place, such as indoor physical distancing and the closure of nightclubs, may have influenced access to and use of drugs. The continuing reduction in hospital stays observed in 2021/22 could also suggest a new trend in drug admissions which is not yet fully understood[19].

Table 13.1: Trends in drug-related hospital admissions (aged <75), 1996/97-2020/21
Year Total admissions1 Population Rate per 100,000 (EASR)
1996/97 3,354 4,754,906 63.8
1997/98 3,792 4,740,269 73.4
1998/99 4,386 4,729,975 86.0
1999/00 4,728 4,721,298 94.0
2000/01 4,839 4,708,667 97.3
2001/02 5,193 4,703,661 105.4
2002/03 5,409 4,701,958 110.7
2003/04 5,121 4,702,431 105.9
2004/05 5,292 4,714,233 109.7
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 6,432 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 6,978 4,914,362 144.7
2015/16 7,830 4,935,283 162.2
2016/17 8,598 4,962,391 178.2
2017/18 9,246 4,976,829 191.7
2018/19 10,005 4,983,364 207.3
2019/20 10,860 4,997,455 224.2
2020/21 10,335 4,996,183 213.4
2021/22 9,093 5,001,617 188.0

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, 2021/22

In 2021/22 the admission rate in Scotland's most deprived areas was 19 times greater than that of the least deprived areas (589.4 cases per 100,000 compared to 31.1 per 100,000).

Figure 13.1: Drug-related hospital admissions <75 y by Income-Employment Index, Scotland 2021/22 (European Age-Standardised Rates per 100,000)
Figure 13.1 shows drug-related hospital admissions by IEI in 2021/22

Trends in relative inequalities

The RII for patients with drug-related hospital admissions has fluctuated over time. Although it has decreased from a high of 3.05 in 1998/99 the RII for 2021/22 (2.87) is higher than at the start of the time series (2.77).

Figure 13.2: Relative Index of Inequality (RII): Drug-related hospital admissions <75y Scotland 1996/97-2021/22
Figure 13.2 shows the RII for drug-related hospital admissions from 1996/97-2021/22

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 drug-related hospital admission 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 – 385.7 per 100,000 between 1999/00 and 2013/14. The gap then increased each year to reach a high of 694.3 per 100,000 in 2019/20 before falling over the last two year to 626.6 per 100,000 in 2020/21 and 558.3 in 2021/22.

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.

Between 2020/21 and 2021/22 the rate of hospital admissions for those living in the most deprived areas decreased by 11%, having fallen 10% between 2019/20 and 2020/21. These decreases go against the upward trend that was observed between 2012/13 – 2019/20 and it is therefore possible that the reduction is a result of hospital admissions policies associated with the COVID-19 pandemic, rather than a genuine decrease in the number of incidences requiring hospitalization.

Figure 13.3: Absolute Gap: Drug-related hospital admissions <75y Scotland 1996/97-2021/22 (European Age-Standardised Rates per 100,000)
Figure 13.3 shows the absolute gap in drug-related hospital admissions from 1996/97-2021/22

Contact

Email: morag.shepherd@gov.scot

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