Increasing inequality in age of death at shared levels of life expectancy: A comparative study of Scotland and England and Wales

Abstract

There is a strong negative correlation between increasing life expectancy and decreasing lifespan variation, a measure of inequality. Previous research suggests that countries achieving a high level of life expectancy later in time generally do so with lower lifespan variation than forerunner countries. This may be because they are able to capitalise on lessons already learnt. However, a few countries achieve a high level of life expectancy later in time with higher inequality. Scotland appears to be such a country and presents an interesting case study because it previously experienced lower inequality when reaching the same level of life expectancy as its closest comparator England and Wales. We calculated life expectancy and lifespan variation for Scotland and England and Wales for the years 1950 to 2012, comparing Scotland to England and Wales when it reached the same level of life expectancy later on in time, and assessed the difference in the level of lifespan variation. The lifespan variation difference between the two countries was then decomposed into age-specific components. Analysis was carried out for males and females separately. Since the 1950s Scotland has achieved the same level of life expectancy at least ten years later in time than England and Wales. Initially it did so with lower lifespan variation. Following the 1980s Scotland has been achieving the same level of life expectancy later in time than England and Wales and with higher inequality, particularly for males. Decomposition revealed that higher inequality is partly explained by lower older age mortality rates but primarily by higher premature adult age mortality rates when life expectancy is the same. Existing studies suggest that premature adult mortality rates are strongly associated with the social determinants of health and may be amenable to social and economic policies. So addressing these policy areas may have benefits for both inequality and population health in Scotland.

Deprivation in relation to urgent suspicion of head and neck cancer referrals in Glasgow

“…Deprivation is one of the main causative agents identified for health inequalities, increased comorbidities and early death . A study on Scottish life expectancy has furthermore identified that not only total life expectancy (TLE) but also healthy life expectancy (HLE) decreases in deprived areas.…”

“…Scotland has the lowest life expectancy in Western Europe . It has been shown that mortality rates in Scotland are 40% higher than in England, and even after adjusting for multiple factors including socioeconomic circumstances, the Scottish excess mortality remains at 29% .…”

“…The mortality rate in Scotland is high and improving only slowly, with one of the central problems being premature working age mortality. Life expectancy in Scotland is the lowest in Western Europe, and population health is poor …”

Socioeconomic inequality in recent adverse mortality trends in Scotland

“…5,6 High levels of inequality in mortality, especially in the working-age population, have been suggested as an explanation for why overall life expectancy in Scotland has historically lagged behind comparable countries. 7 The degree to which the recent stalling improvement in mortality rates is associated with changes in health inequalities is unclear.…”

On mean decomposition for summarizing conditional distributions

“…This feature is of convenience in numerous settings, where interests focus on how specific fractions of a variable influence its average. Examples include how premature adult‐age deaths affect life expectancy (Seaman, Leyland, & Popham, ), how extreme warmth raises average temperature (Meehl, Zwiers, Evans, Knutson, Mearns, & Whetton, ), or how the most skilled increase average intelligence quotient (Wai & Putallaz, ).…”