Equally Well: Report of the Ministerial Task Force on Health Inequalities

ANNEX 3 - ILLUSTRATIVE ASSESSMENT OF INEQUALITIES IN PREMATURE MORTALITY FROM CORONARY HEART DISEASE

The purpose of this example is to illustrate what the different measures show in terms of explaining inequalities. The detailed definitions of area deprivation to be recommended for use have yet to be finalised, so analyses published at a later date will not match this example exactly. Final analyses will also include estimates of uncertainty around the values, which will highlight whether or not changes over time are statistically significant.

Summary

Between 1997 and 2006, there has been a considerable decrease (by 45%) in deaths from coronary heart disease ( CHD) in those aged under 75 in the population as a whole. However; CHD remains one of Scotland's biggest causes of premature mortality. Premature death from CHD is more prevalent in deprived areas than in affluent areas. In 2006, adults in the most deprived decile were 3.5 times more likely to die from CHD aged under 75 years than those in the least deprived decile. Recent reductions in CHD mortality have been observed across the population. Whilst the gap between the most and least deprived has narrowed in absolute terms (as demonstrated by the absolute range), improvements observed in deprived areas have not been as great as those observed elsewhere in Scotland resulting in a widening of inequalities in relative terms, as demonstrated by the Relative Index of Inequality ( RII).

RII over time

The relative index of inequality describes the gradient of health observed across the deprivation scale, relative to the mean health of the whole population. In the case of premature mortality from coronary heart disease, there is a clear gradient of increasing mortality with increasing deprivation. A horizontal line on the chart below would indicate equality across the deprivation groups. The slope of the best fit line indicates the degree of inequality. A measure of this gradient divided by the population mean rate gives the RII.

<75 CHD mortality by deprivation (2006)

Relative index of inequality ( RII): <75 CHD mortality (1997-2006)
( RII= SII divided by population mean rate)

Absolute range over time

Absolute range: <75 CHD mortality (1997-2006)
(Absolute range = Rate in most deprived decile-rate in least deprived decile)

Scale

Under 75 CHD mortality rates at Scotland level