Socioeconomic inequality in recent adverse mortality trends in Scotland

Fenton, Lynda; Wyper, Grant M. A.; McCartney, Gerry; Minton, Jon

doi:10.1101/542472

Cited by 4 publications

(2 citation statements)

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“…The substantial slowdown, or even reversal, in the rate of improvement in life expectancies across affected high-income countries is the most urgent and important public health problem of our time 6 9. This paper sets out the protocol for the investigation of the role of austerity policies (ie, the pursuit of short-run government budget balance11 in explaining the changed trend in mortality rates among high-income countries after 2008).…”

Section: Introductionmentioning

confidence: 99%

Is austerity responsible for the recent change in mortality trends across high-income nations? A protocol for an observational study

et al. 2020

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IntroductionMortality rates in many high-income countries have changed from their long-term trends since around 2011. This paper sets out a protocol for testing the extent to which economic austerity can explain the variance in recent mortality trends across high-income countries.Methods and analysisThis is an ecological natural experiment study, which will use regression adjustment to account for differences in exposure, outcomes and confounding. All high-income countries with available data will be included in the sample. The timing of any changes in the trends for four measures of austerity (the Alesina-Ardagna Fiscal Index, real per capita government expenditure, public social spending and the cyclically adjusted primary balance) will be identified and the cumulative difference in exposure to these measures thereafter will be calculated. These will be regressed against the difference in the mean annual change in life expectancy, mortality rates and lifespan variation compared with the previous trends, with an initial lag of 2 years after the identified change point in the exposure measure. The role of underemployment and individual incomes as outcomes in their own right and as mediating any relationship between austerity and mortality will also be considered. Sensitivity analyses varying the lag period to 0 and 5 years, and adjusting for recession, will be undertaken.Ethics and disseminationAll of the data used for this study are publicly available, aggregated datasets with no individuals identifiable. There is, therefore, no requirement for ethical committee approval for the study. The study will be lodged within the National Health Service research governance system. All results of the study will be published following sharing with partner agencies. No new datasets will be created as part of this work for deposition or curation.

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Section: Introductionmentioning

confidence: 99%

Is austerity responsible for the recent change in mortality trends across high-income nations? A protocol for an observational study

et al. 2020

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“…In recent decades, there has been a substantial improvement in life expectancies at birth in the UK(1). More recently, several studies have suggested that there has been slowdown in improvements in the USA, UK, France, Germany, Sweden, the Netherlands and other Organisation for Economic Co-operation and Development countries; however, the causes are less clear, with speculation that they may arise from slowing improvements in cardiovascular disease, increased influenza mortality and/or pressure on health and social care services(1–8). Understanding trends in disease incidence and subsequent survival could illuminate such trends in mortality, and disentangling how and how much different diseases contribute has the potential to reveal whether investment in healthcare and research is directed at the most urgent diseases and most affected individuals.…”

Section: Introductionmentioning

confidence: 99%

Improvements in the incidence and survival of cancer and cardiovascular but not infectious disease have driven recent mortality improvements in Scotland: nationwide cohort study of linked hospital admission and death records 2001–2016

Timmers

Kerssens

Minton

et al. 2019

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Objectives: To identify the causes and future trends underpinning improvements in life expectancy in Scotland and quantify the relative contributions of disease incidence and survival. Design: Population-based study. Setting: Linked secondary care and mortality records across Scotland. Participants: 1,967,130 individuals born between 1905 and 1965, and resident in Scotland throughout 2001-2016. Main outcome measures: Hospital admission rates and survival in the five years following admission for 28 diseases, stratified by sex and socioeconomic status. Results: The five hospital admission diagnoses associated with the greatest burden of death were "Influenza and pneumonia", "Symptoms and signs involving the circulatory and respiratory systems", "Malignant neoplasm of respiratory and intrathoracic organs", "Symptoms and signs involving the digestive system and abdomen", and "General symptoms and signs". Using trends in disease, we modelled a mean mortality hazard ratio of 0.737 (95% CI 0.730-0.745) across decades of birth, equivalent to a life extension of ~3 years per decade. This improvement was 61% (30%-93%) accounted for by improvements in disease survival after hospitalisation (principally cancer) with the remainder accounted for by a fall in hospitalisation incidence (principally heart disease and cancer). In contrast, deteriorations in the incidence and survival of infectious diseases reduced mortality improvements by 9% (~3.3 months per decade). Overall, health-driven mortality improvements were slightly greater for men than women (due to greater falls in disease incidence), and generally similar across socioeconomic deciles. We project mortality improvements will continue over the next decade but will slow down by 21% because much of the progress in disease survival has already been achieved. Conclusion: Morbidity improvements broadly explain observed improvements in overall mortality, with progress on the prevention and treatment of heart disease and cancer making the most significant contributions. The gaps between men and women's morbidity and mortality are closing, but the gap between socioeconomic groups is not. A slowing trend in improvements in morbidity may explain the stalling in improvements of period life expectancies observed in recent studies in the UK. However, our modelled slowing of improvements could be offset if we achieve even faster improvements in the major diseases contributing to the burden of death, or if we improve prevention and survival of diseases which have deteriorated recently, such as infectious disease, in the future.

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A growing divide: Trends in social inequalities in healthy longevity in Australia, 2001–20

Xu,

Payne

2023

Population Studies

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Socioeconomic inequality in recent adverse mortality trends in Scotland

Cited by 4 publications

References 4 publications

Is austerity responsible for the recent change in mortality trends across high-income nations? A protocol for an observational study

Is austerity responsible for the recent change in mortality trends across high-income nations? A protocol for an observational study

Improvements in the incidence and survival of cancer and cardiovascular but not infectious disease have driven recent mortality improvements in Scotland: nationwide cohort study of linked hospital admission and death records 2001–2016

A growing divide: Trends in social inequalities in healthy longevity in Australia, 2001–20

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