Long-term monitoring of health inequalities: March 2017

Summary

Introduction

This report presents a range of indicators selected in order to monitor health inequalities over time.

With the exception of the healthy birthweight indicator, significant health inequalities persist for each indicator covered in the report.

Changes in the gap between the most and least deprived areas in Scotland

In a number of indicators, absolute inequality (the gap between the most and least deprived areas) has narrowed over the longer term:

• Premature mortality - the gap has reduced by 16% from its peak in 2002
• CHD deaths - the gap has reduced by 47% from its peak in 1997
• First alcohol-related hospital admission - the gap has reduced by 43% since the start of the time series in 1996
• All-cause mortality in those aged 15-44 - the gap has reduced by 16% from its peak in 2001
• Low birthweight - the gap has reduced by 31% since its peak in 2004.

The gap has widened for two indicators:

• Limiting long-term conditions - the gap has increased by 39% since the start of the time series in 2008/2009.
• Self-assessed health - the gap has increased by 47% since the start of the time series in 2008/2009

For the other indicators in the report, long term trends in the absolute gap are less clear.

Relative inequalities

The relative index of inequality ( RII) indicates the extent to which health outcomes are worse in the most deprived areas compared to the average throughout Scotland. It is possible for absolute inequalities to improve, but relative inequalities to worsen.

There are three morbidity indicators for which the RII can reasonably be compared with one another: alcohol-related hospital admissions; heart attack hospital admissions; and cancer incidence.

Amongst these, relative inequalities in alcohol-related hospital admissions have declined over the long term and heart attack admissions inequalities have increased in the years since 2008. Relative inequalities have remained higher in the alcohol-related indicator however.

Inequalities in cancer incidence have remained lowest and more stable in relative terms.

Amongst the three comparable mortality indicators ( CHD deaths, alcohol-related deaths and cancer deaths), relative inequalities in CHD mortality have increased over the long term. The relative inequalities in alcohol-related deaths have shown more year to year fluctuation over the same period, but the RII for 2015 (1.88) is ultimately the same as at the start of time series in 1997.

The RII for cancer mortality has increased slightly over the longer term. However, inequalities remain wider in alcohol-related deaths and coronary heart disease deaths.

Amongst the other indicators in the report, relative inequalities in premature mortality have increased. This is in contrast with the reduction seen in absolute inequalities for the same indicator.