Recent adverse mortality trends in Scotland: comparison with other high-income countries

Fenton, Lynda; Minton, Jon; Ramsay, Julie; Kaye-Bardgett, Maria; Fischbacher, Colin; Wyper, Grant M. A.; McCartney, Gerry

doi:10.1136/bmjopen-2019-029936

Cited by 59 publications

(51 citation statements)

References 27 publications

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“…Drivers for this are complex and multifactorial (with government austerity measures and rising inequality described cited as possible factors). [16][17][18][19] Our results highlight that younger adults with multimorbidity represent an important group at risk of premature mortality. It has been highlighted that reductions in life expectancy are more marked among poorer socioeconomic groups.…”

Section: Open Accessmentioning

confidence: 61%

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Prevalence of secondary care multimorbidity in mid-life and its association with premature mortality in a large longitudinal cohort study

et al. 2020

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ObjectivesMultimorbidity is the coexistence of two or more health conditions in an individual. Multimorbidity in younger adults is increasingly recognised as an important challenge. We assessed the prevalence of secondary care multimorbidity in mid-life and its association with premature mortality over 15 years of follow-up, in the Aberdeen Children of the 1950s (ACONF) cohort.MethodA prospective cohort study using linked electronic health and mortality records. Scottish ACONF participants were linked to their Scottish Morbidity Record hospital episode data and mortality records. Multimorbidity was defined as two or more conditions and was assessed using healthcare records in 2001 when the participants were aged between 45 and 51 years. The association between multimorbidity and mortality over 15 years of follow-up (to ages 60–66 years) was assessed using Cox proportional hazards regression. There was also adjustment for key covariates: age, gender, social class at birth, intelligence at age 7, secondary school type, educational attainment, alcohol, smoking, body mass index and adult social class.ResultsOf 9625 participants (51% males), 3% had multimorbidity. The death rate per 1000 person-years was 28.4 (95% CI 23.2 to 34.8) in those with multimorbidity and 5.7 (95% CI 5.3 to 6.1) in those without. In relation to the reference group of those with no multimorbidity, those with multimorbidity had a mortality HR of 4.5 (95% CI 3.4 to 6.0) over 15 years and this association remained when fully adjusted for the covariates (HR 2.5 (95% CI 1.5 to 4.0)).ConclusionMultimorbidity prevalence was 3% in mid-life when measured using secondary care administrative data. Multimorbidity in mid-life was associated with premature mortality.

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Section: Open Accessmentioning

confidence: 61%

“…Open access countries has stalled and in some cases reversed. [16][17][18][19] Further to this, non-communicable diseases are a significant source of premature mortality, 15 17 indicating that exploration of this for multimorbidity is important.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of secondary care multimorbidity in mid-life and its association with premature mortality in a large longitudinal cohort study

et al. 2020

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“…Life expectancy growth between 2000-2002 and 2012-2014 and between 2012-2014 and 2015-2017 was decomposed into age and cause components using Arriaga's method with the aid of syntax developed by Auger et al 18 19 The break between the two periods was selected on the basis of the previously identified change in mortality trend which showed that the best estimate of when mortality rates changed to a slower rate of improvement was the year to 2012 quarter 4 for men and the year to 2014 quarter 2 for women. 2 As life expectancy data is based on 3-year rolling periods, 2012-2014 was chosen to most accurately reflect this breakpoint. Life expectancy change and decomposition results are presented as annualised change in life expectancy (in weeks) to account for the different length of the two time periods.…”

Section: Methodsmentioning

confidence: 99%

How have changes in death by cause and age group contributed to the recent stalling of life expectancy gains in Scotland? Comparative decomposition analysis of mortality data, 2000–2002 to 2015–2017

et al. 2020

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ObjectiveAnnual gains in life expectancy in Scotland were slower in recent years than in the previous two decades. This analysis investigates how deaths in different age groups and from different causes have contributed to annual average change in life expectancy across two time periods: 2000–2002 to 2012–2014 and 2012–2014 to 2015–2017.SettingScotland.MethodsLife expectancy at birth was calculated from death and population counts, disaggregated by 5 year age group and by underlying cause of death. Arriaga’s method of life expectancy decomposition was applied to produce estimates of the contribution of different age groups and underlying causes to changes in life expectancy at birth for the two periods.ResultsAnnualised gains in life expectancy between 2012–2014 and 2015–2017 were markedly smaller than in the earlier period. Almost all age groups saw worsening mortality trends, which deteriorated for most cause of death groups between 2012–2014 and 2015–2017. In particular, the previously observed substantial life expectancy gains due to reductions in mortality from circulatory causes, which most benefited those aged 55–84 years, more than halved. Mortality rates for those aged 30–54 years and 90+ years worsened, due in large part to increases in drug-related deaths, and dementia and Alzheimer’s disease, respectively.ConclusionFuture research should seek to explain the changes in mortality trends for all age groups and causes. More investigation is required to establish to what extent shortcomings in the social security system and public services may be contributing to the adverse trends and preventing mitigation of the impact of other contributing factors, such as influenza outbreaks.

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“…The upward trend in life expectancy (LE) across the UK nations stalled around 2012–2014. 1 This stalling presents one the greatest challenges to population health since the 1940s, 2 with the lost gains in LE being similar to the worst case scenario of pandemic COVID-19. 3 4 While a slowdown in improving LE was observed across many high-income countries, it was not seen everywhere, with the UK nations and USA among the worst affected.…”

Section: Introductionmentioning

confidence: 99%

The contribution of changes to tax and social security to stalled life expectancy trends in Scotland: a modelling study

Richardson

Taulbut²,

Robinson

et al. 2020

J Epidemiol Community Health

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BackgroundLife expectancy (LE) improvements have stalled, and UK tax and welfare ‘reforms’ have been proposed as a cause. We estimated the effects of tax and welfare reforms from 2010/2011 to 2021/2022 on LE and inequalities in LE in Scotland.MethodsWe applied a published estimate of the cumulative income impact of the reforms to the households within Scottish Index of Multiple Deprivation (SIMD) quintiles. We estimated the impact on LE by applying a rate ratio for the impact of income on mortality rates (by age group, sex and SIMD quintile) and calculating the difference between inflation-only changes in benefits and the reforms.ResultsWe estimated that changes to household income resulting from the reforms would result in an additional 1041 (+3.7%) female deaths and 1013 (+3.8%) male deaths. These deaths represent an estimated reduction of female LE from 81.6 years to 81.2 years (−20 weeks), and male LE from 77.6 years to 77.2 years (−23 weeks). Cuts to benefits and tax credits were modelled to have the most detrimental impact on LE, and these were estimated to be most severe in the most deprived areas. The modelled impact on inequalities in LE was widening of the gap between the most and least deprived 20% of areas by a further 21 weeks for females and 23 weeks for males.InterpretationThis study provides further evidence that austerity, in the form of cuts to social security benefits, is likely to be an important cause of stalled LE across the UK.

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Recent adverse mortality trends in Scotland: comparison with other high-income countries

Cited by 59 publications

References 27 publications

Prevalence of secondary care multimorbidity in mid-life and its association with premature mortality in a large longitudinal cohort study

Prevalence of secondary care multimorbidity in mid-life and its association with premature mortality in a large longitudinal cohort study

How have changes in death by cause and age group contributed to the recent stalling of life expectancy gains in Scotland? Comparative decomposition analysis of mortality data, 2000–2002 to 2015–2017

The contribution of changes to tax and social security to stalled life expectancy trends in Scotland: a modelling study

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