Long-term monitoring of health inequalities: December 2017

Headline indicators of Health Inequalities

Healthy Life Expectancy ( HLE)

In 2015-2016, male HLE at birth in the 10% most deprived areas in Scotland was 43.9 years, 26.0 years lower than in the least deprived areas (69.8 years).

Female HLE at birth was 49.9 years in the most deprived areas, 22.2 years lower than in the least deprived areas (72.0 years).

There have been no statistically significant changes to the gap in healthy life expectancy between the most and least deprived areas for men or women since 2009-2010.

Trends in HLE

Between 1999-2000 and 2007-2008, HLE increased by 3.0 years for males and by 2.3 years for females. In 2009, the format of the self-assessed health question, on which healthy life expectancy data is based, was changed to align with the European Union, leading to a major discontinuity in the series. The markedly lower estimates of HLE at birth from 2009 onwards are not comparable with estimates for earlier years.

In 2015-2016, HLE in Scotland was 59.6 years for males and 62.4 years for females. These values are not significantly different from the first estimates produced with the revised methodology in 2009-10 (59.9 and 62.1 for males and females respectively).

Inequalities in HLE, 2015-2016

HLE is significantly lower in the most deprived areas than in the least deprived areas.

In 2015-2016 males in the most deprived areas were, on average, expected to live 26 fewer years in good health than those in the least deprived areas (43.9 years vs 69.8 years). Females in the most deprived areas were, on average, expected to live 22 fewer years in good health than those in the least deprived areas (49.9 years vs 72.0 years).

Figure 1.1 Healthy Life Expectancy - Males - by Income-Employment Index, Scotland 2015-2016

Figure 1.2 Healthy Life Expectancy - Females - by Income-Employment Index, Scotland 2015-2016

Trends in relative inequalities

The relative index of inequalities ( RII) has shown little change in the period since 2009-2010, ranging from 0.36-0.41 for women and 0.38-0.45 for men over the period.

Although RII is lower in earlier years, the change in methodology used to calculate HLE means these figures are not comparable. Between 1999-2000 and 2007-2008, RII fluctuated in the range 0.29-0.33 for men and 0.25-0.28 for women and with no clear trend.

Figure 1.3 Relative Index of Inequality ( RII): Healthy Life Expectancy - Males, Scotland 1999-2000 to 2015-2016

Figure 1.4 Relative Index of Inequality ( RII): Healthy Life Expectancy - Females, Scotland 1999-2000 to 2015-2016

Trends in absolute inequalities

The absolute gap in male HLE has seen non-significant increases each year that the indicator has been updated since 2009-2010. The gap was 22.5 years in 2009-2010 and is 26.0 years for 2015-2016. The cumulative change from 2009-2010 is approaching statistical significance.

Among women, although there have been some fluctuations in HLE across the deprivation spectrum, recent changes have been similar in the most and least deprived areas.

Figure 1.5 Absolute Gap: Healthy Life Expectancy - Males, Scotland 1999-2000 to 2015-2016

Figure 1.6 Absolute Gap: Healthy Life Expectancy - Females, Scotland 1999-2000 to 2015-2016

Healthy Life Expectancy and Life Expectancy, 2009-2010 to 2015-2016

The difference between HLE and life expectancy ( LE) indicates the expected number of years spent in 'not good' health. In 2015-2016, men were expected to spend an average of 17.4 years in 'not good' health, compared to 18.6 years for women.

Men and women in the most deprived areas in Scotland spend more years in 'not good' health than those in the least deprived areas. In the most deprived areas, men spend on average 25.9 years in 'not good' health, compared to 12.9 years in the least deprived areas.

Females in the most deprived areas spend 26.1 years in 'not good' health, compared with 13.0 years in the least deprived areas.

Table 1.1: Trends in male healthy life expectancy and life expectancy, 2009-2010 onwards

	Male HLE in years	95% LL	95% UL	Male LE in years	95% LL	95% UL	Estimated years spent in 'not good' health
2009-2010
Scotland	59.9	59.4	60.4	76.1	76.0	76.2	16.2
Most deprived decile	47.4	45.8	49.0	68.7	68.3	69.1	21.3
Least deprived decile	69.9	68.2	71.6	82.0	81.6	82.3	12.1
2011-2012
Scotland	59.8	59.3	60.4	76.6	76.4	76.7	16.7
Most deprived decile	46.4	44.7	48.2	69.2	68.8	69.6	22.7
Least deprived decile	70.2	68.5	71.9	82.1	81.8	82.4	11.9
2013-2014
Scotland	60.6	60.0	61.2	77.2	77.0	77.3	16.6
Most deprived decile	47.6	45.8	49.4	70.2	69.8	70.6	22.6
Least deprived decile	72.7	71.0	74.5	82.5	82.2	82.9	9.8
2015-2016
Scotland	59.6	59.0	60.2	77.0	76.9	77.1	17.4
Most deprived decile	43.9	41.9	45.8	69.8	69.4	70.2	25.9
Least deprived decile	69.8	67.9	71.8	82.7	82.4	83.0	12.9

Table 1.2: Trends in female healthy life expectancy and life expectancy, 2009-2010 onwards

	Female HLE in years	95% LL	95% UL	Female LE in years	95% LL	95% UL	Estimated years spent in 'not good' health
2009-2010
Scotland	62.1	61.6	62.6	80.6	80.5	80.8	18.6
Most deprived decile	51.1	49.6	52.6	76.1	75.7	76.5	24.9
Least deprived decile	73.2	71.7	74.7	84.8	84.5	85.1	11.6
2011-2012
Scotland	62.3	61.8	62.9	80.9	80.8	81.0	18.5
Most deprived decile	50.2	48.6	51.8	76.4	76.0	76.7	26.1
Least deprived decile	72.8	71.2	74.5	84.8	84.5	85.2	12.0
2013-2014
Scotland	62.2	61.7	62.8	81.2	81.1	81.3	19.0
Most deprived decile	51.0	49.2	52.9	76.7	76.3	77.0	25.7
Least deprived decile	73.2	71.4	74.9	84.5	84.2	84.8	11.3
2015-2016
Scotland	62.4	61.9	63.0	81.1	81.0	81.2	18.6
Most deprived decile	49.9	48.0	51.8	76.0	75.6	76.3	26.1
Least deprived decile	72.0	70.2	73.9	85.0	84.7	85.3	13.0

Premature Mortality (under 75 years)

Despite increasing in each of the past three years, the gap in premature mortality rates between the most and least deprived areas has reduced overall from its widest point in 2002 and is lower than at the start of the time series in 1997.

Relative inequalities, however, have widened over the long term. In 1997, premature mortality rates were 2.7 times higher in the most deprived areas compared to the least deprived; in 2016, rates were 3.7 times higher in the most deprived areas.

Trends in premature mortality

More than 21,000 people in Scotland died before the age of 75 in 2016.

Over the long term there has been a reduction in the mortality rate among under-75s. The age-standardised mortality rate among under-75s in 2016 was 439.7 per 100,000 people, a reduction of 33 per cent since 1997 (651.9 per 100,000).

Inequalities in premature mortality, 2016

In 2016, the premature mortality rate in the 10% most deprived areas was 824.9 per 100,000, 3.7 times higher than the rate in the least deprived areas (220.4 per 100,000).

Figure 2.1 All cause mortality amongst those aged <75y by Income-Employment Index Scotland 2016 (European Age-Standardised Rates per 100,000)

Trends in relative inequalities

Over the longer term, relative inequalities have increased. The RII for 2016 is 1.39, compared with 1.00 at the start of the time series in 1997.

Between 1997 and 2016, premature mortality rates declined by 42% in the least deprived areas, but by only 20% in the most deprived areas in Scotland.

In 1997, premature mortality rates were 2.7 times higher in the most deprived areas compared to the least deprived; in 2016, premature mortality rates were 3.7 times higher in the most deprived areas.

Figure 2.2 Relative Index of Inequality ( RII): All cause mortality <75y, Scotland 1997-2016

Trends in absolute inequalities

Absolute inequalities in premature mortality reached a peak in 2002. Between 2002 and 2013 there was a general downward trend. Most notably, the absolute gap between the most and least deprived areas reduced every year between 2007 and 2013.

Since 2013 the gap has increased, although it is currently still lower than at any point prior to 2010.

Figure 2.3 Absolute Gap: All cause mortality <75y, Scotland 1997-2016 (European Age-Standardised Rates per 100,000)

In 2002, the premature mortality rate in the most deprived areas was 1,033.2 per 100,000 and 319.8 per 100,000 in the least deprived areas, a gap of 713.4 per 100,000. In 2016, the gap had reduced to 604.5 per 100,000.

Table 2.1: Trends in premature mortality, 1997-2016

Year	Number of deaths	Target population size	Rate per 100,000 ( EASR)
1997	26,081	4,740,269	651.9
1998	25,857	4,729,975	643.3
1999	25,491	4,721,298	632.5
2000	24,593	4,708,667	607.3
2001	24,168	4,703,661	593.1
2002	24,219	4,701,958	588.9
2003	23,789	4,702,431	573.4
2004	22,896	4,714,233	546.2
2005	22,441	4,735,320	530.3
2006	22,237	4,752,425	520.4
2007	22,359	4,783,452	516.8
2008	22,005	4,811,453	501.3
2009	21,229	4,835,007	477.0
2010	20,997	4,858,058	467.4
2011	20,685	4,888,316	456.1
2012	20,446	4,895,114	445.3
2013	20,344	4,903,074	437.5
2014	19,961	4,914,362	423.2
2015	20,988	4,935,283	440.5
2016	21,313	4,962,391	439.7