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BackgroundThe contribution of increasing numbers of deaths from suicide, alcohol-related and drug-related causes to changes in overall mortality rates has been highlighted in various countries. In Scotland, particular vulnerable cohorts have been shown to be most at risk; however, it is unclear to what extent this applies elsewhere in Britain. The aim here was to compare mortality rates for different birth cohorts between Scotland and England and Wales (E&W), including key cities.MethodsMortality and population data (1981–2017) for Scotland, E&W and 10 cities were obtained from national statistical agencies. Ten-year birth cohorts and cohort-specific mortality rates (by age of death, sex, cause) were derived and compared between countries and cities.ResultsSimilarities were observed between countries and cities in terms of peak ages of death, and the cohorts with the highest death rates. However, cohort-specific rates were notably higher in Scotland, particularly for alcohol-related and drug-related deaths. Across countries and cities, those born in 1965–1974 and 1975–1984 had the highest drug-related mortality rates (peak age at death: 30–34 years); the 1965–1974 birth cohort also had the highest male suicide rate (peak age: 40–44 years). For alcohol-related causes, the highest rates were among earlier cohorts (1935–1944, 1945–1954, 1955–1964)—peak age 60–64 years.ConclusionsThe overall similarities suggest common underlying influences across Britain; however, their effects have been greatest in Scotland, confirming greater vulnerability among that population. In addressing the socioeconomic drivers of deaths from these causes, the cohorts identified here as being at greatest risk require particular attention.

BackgroundWithin the UK, there has been debate on whether life expectancy is increasing or decreasing in particular single or 3-year periods, but there has been less thinking whether overall trends have changed. This paper considers the extent to which the trends in life expectancy for the UK and its nations have changed before and after 2011.MethodsWe used the Office for National Statistics period life expectancy data for the UK and its nations. We used Lee’s approach to project life expectancy based on repeated sampling of year-to-year change in the baseline periods (1990–2011 and 1980–2011) and applied that to 2012 onwards.FindingsImprovements in period life expectancy were substantially and consistently lower between 2012 and 2018 than predicted from the trends from 1980 and, especially, from 1990. By 2018, life expectancy was lower than projected for females and males, respectively, by 1.22 and 1.52 years (England), 1.44 and 0.95 years (Northern Ireland), 1.30 and 1.44 years (Scotland), 1.53 and 1.63 years (Wales) and 1.24 and 1.49 years (UK overall), based on the 1990–2011 baseline period. Using a longer baseline period, which includes the slower rates of improvement during the 1980s, slightly reduces the gap between the current life expectancies and the projected medians.InterpretationFuture academic and policy focus should be on the deviation of the life expectancy trends from the baseline projection rather than on year-to-year variation. Concerted policy focus to return life expectancy to the projected trends is now urgently required.

ObjectiveWe aimed to explore whether age, period or cohort effects explain the trends and inequalities in ischaemic heart disease (IHD) and cerebrovascular disease (CeVD) mortality in Scotland.MethodsWe analysed IHD and CeVD deaths for 1974–2015 by sex, age and area deprivation, visually explored the data using heatmaps and dotplots and built regression models.ResultsCeVD mortality improved steadily over time while IHD mortality improved more rapidly from the late 1980s. Age effects were evident; both outcomes showed an exponential relationship with age for all except males for IHD in the 1980s and 1990s. The mortality profiles by age became older, although improvement was slower for those aged <50 years for IHD, especially for males, and faster for CeVD in females aged <65 years. Rates were higher, and inequalities greater, among males, especially for IHD. For IHD, increased risk for males over females reduced with age (incidence rate ratio for 41–50 year old males=4.28 (95% CI 4.12 to 4.44) and 1.17 (95% CI 1.16 to 1.18) for 71–80 year olds). Inequalities in IHD mortality by area deprivation persisted over time, increasing from around 10% to around 25% higher risk in the most deprived areas between 1974 and 1986 before declining in absolute terms from around 2000. Inequalities for CeVD increased after the late 1980s.ConclusionsIHD and CeVD mortality in Scotland exhibit age but not recent distinct period or cohort effects. The improvements in mortality rates have been more sustained for CeVD and inequalities greater for IHD.

BackgroundGains in life expectancies have stalled in Scotland, as in several other countries, since around 2012. The relationship between stalling mortality improvements and socioeconomic inequalities in health is unclear.MethodsWe calculate the difference, as percentage change, in all-cause, all-age, age-standardised mortality rates (ASMR) between 2006 and 2011 (period 1) and between 2012 and 2017 (period 2), for Scotland overall, by sex, and by Scottish Index of Multiple Deprivation (SIMD) quintile. Linear regression is used to summarise the relationship between SIMD quintile and mortality rate change in each period.ResultsBetween 2006 and 2011, the overall ASMR fell by 10.6% (138/100 000), by 10.1% in women, and 11.8% in men, but between 2012 and 2017 the overall ASMR fell by only 2.6% (30/100 000), by 3.5% in women, and by 2.0% in men. Within the most deprived quintile, the overall ASMR fell by 8.6% (143/100 000) from 2006 to 2011 (7.2% in women; 9.8% in men), but rose by 1.5% (21/100 000) from 2012 to 2017 (0.7% in women; 2.1% in men).The socioeconomic gradient in ASMR improvement more than quadrupled, from 0.4% per quintile in period 1, to 1.7% per quintile in period 2.ConclusionFrom 2012 to 2017, socioeconomic gradients in mortality improvement in Scotland were markedly steeper than over the preceding 6 years. As a result, there has not only been a slowdown in overall reductions in mortality, but a widening of socioeconomic mortality inequalities.

ABSTRACTThis paper tracks changes in relative centralisation and relative concentration of poverty for the 25 largest British cities, analysing change for poor and non-poor groups separately, and examining parallel changes in spatial segregation. The paper confirms that poverty is suburbanising, at least in the larger cities, although poverty remains over-represented in inner locations. Suburbanisation is occurring through both the reduction in low income populations in inner locations and the growth non-poor groups in these places, consistent with a process of displacement. Relative centralisation of poverty has fallen more stronglythan relative concentration of poverty, as the outward shift of poorer groups leaves them still living in denser neighbourhoods on average. The paper also shows that spatial segregation (unevenness) declined at the same time although it remains to be seen whether this indicates a long-term shift to less segregated urban forms or a transitional outcome before new forms of segregation emerge around suburban poverty concentrations.

BackgroundMortality rates are higher in Scotland relative to England and Wales, even after accounting for deprivation. This ‘excess’ mortality is partly due to higher mortality from alcohol-related and drug-related deaths, violence and suicide (particularly in young adults). This study investigated whether cohort effects from exposure to neoliberal politics from the 1980s might explain the recent trends in suicide in Scotland.MethodsWe analysed suicide deaths data from 1974 to 2013 by sex and deprivation using shaded contour plots and intrinsic estimator regression modelling to identify and quantify relative age, period and cohort effects.ResultsSuicide was most common in young adults (aged around 25–40 years) living in deprived areas, with a younger peak in men. The peak age for suicide fell around 1990, especially for men for whom it dropped quickly from around 50 to 30 years. There was evidence of an increased risk of suicide for the cohort born between 1960 and 1980, especially among men living in the most deprived areas (of around 30%). The cohort at highest risk occurred earlier in the most deprived areas, 1965–1969 compared with 1970–1974.ConclusionsThe risk of suicide increased in Scotland for those born between 1960 and 1980, especially for men living in the most deprived areas, which resulted in a rise in age-standardised rates for suicide among young adults during the 1990s. This is consistent with the hypothesis that exposure to neoliberal politics created a delayed negative health impact.

BackgroundScotland has higher mortality rates than the rest of Western Europe (rWE), with more cardiovascular disease and cancer among older adults; and alcohol-related and drug-related deaths, suicide and violence among younger adults.MethodsWe obtained sex, age-specific and year-specific all-cause mortality rates for Scotland and other populations, and explored differences in mortality both visually and numerically.ResultsScotland's age-specific mortality was higher than the rest of the UK (rUK) since 1950, and has increased. Between the 1950s and 2000s, ‘excess deaths’ by age 80 per 100 000 population associated with living in Scotland grew from 4341 to 7203 compared with rUK, and from 4132 to 8828 compared with rWE. UK-wide mortality risk compared with rWE also increased, from 240 ‘excess deaths’ in the 1950s to 2320 in the 2000s. Cohorts born in the 1940s and 1950s throughout the UK including Scotland had lower mortality risk than comparable rWE populations, especially for males. Mortality rates were higher in Scotland than rUK and rWE among younger adults from the 1990s onwards suggesting an age–period interaction.ConclusionsWorsening mortality among young adults in the past 30 years reversed a relative advantage evident for those born between 1950 and 1960. Compared with rWE, Scotland and rUK have followed similar trends but Scotland has started from a worse position and had worse working age–period effects in the 1990s and 2000s.