Long-term monitoring of health inequalities: December 2018 report

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 inequalities (the gap between the most and least deprived areas) have narrowed over the longer term:

• Premature Mortality (under 75 years) - the gap has reduced by 17% from its peak in 2002, and is currently lower than at the start of the time series in 1997.
• CHD Mortality - the gap has more than halved since its widest point in 1998.
• Alcohol-Related Admissions - the gap has reduced by 43% since the start of the time series in 1996.
• Low Birthweight – the gap has reduced by 25% since its peak in 2004. The bulk of this reduction had taken place by 2008, with the gap fluctuating since then.
• Cancer Mortality – the gap has reduced by 22% since its widest point in 1998.

The gap for Alcohol-Related Deaths is currently 30% lower than at its peak in 2002. However, following a period where the gap narrowed, it has been increasing since 2013, and is currently 10% higher than at the start of the time series in 1997.

The gap for Limiting Long-Term Conditions has reduced by 26% since its peak in 2014/2015 and is currently slightly higher than at the start of the time series in 2008/2009.

For the other indicators in the report, there has either been little change or long term trends in the absolute gap are less clear:

• Mental Wellbeing
• Heart Attack Admissions
• Cancer Incidence
• All-Cause Mortality (aged 15-44 years)
• Healthy Birthweight
• Self-Assessed Health

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 remained highest over the longer term. Relative inequalities in heart attack admissions have decreased in the last year but remain higher than at the start of the time series, and cancer incidence inequalities have remained relatively stable.

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 ultimately the RII has increased by 10% since the start of the 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.

Of the other indicators in the report, the two indicators relating to premature mortality (under 75 and aged 15-44) have both shown increases in RII over time.