Long-term monitoring of health inequalities: December 2018 report

Headline indicators of Health Inequalities

Premature Mortality (under 75 years)

In 2017, the gap in premature mortality rates between the most and least deprived areas reduced for the first time in three years 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 3 times higher in the most deprived areas compared to the least deprived; in 2017, rates were 4 times higher in the most deprived areas.

Trends in premature mortality

Around 21,000 people in Scotland died before the age of 75 in 2017.

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 2017 was 425.2 per 100,000 people, a reduction of 35 per cent since 1997 (651.9 per 100,000).

Inequalities in premature mortality, 2017

In 2017, the premature mortality rate in the most deprived areas was 812.1 per 100,000, 4 times higher than the rate in the least deprived areas (218.9 per 100,000).

Figure 1.1

Trends in relative inequalities

Over the longer term, relative inequalities have increased. The RII for 2017 is the highest on record at 1.44, compared with 1.00 at the start of the time series in 1997.

Between 1997 and 2017, premature mortality rates declined by 43% in the least deprived areas, but by only 21% in the most deprived areas in Scotland.

In 1997, premature mortality rates were 3 times higher in the most deprived areas compared to the least deprived; in the last three years premature mortality rates have been 4 times higher in the most deprived areas.

Figure 1.2

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 lower than at any point prior to 2010.

Figure 1.3

Table 1.1: Trends in premature mortality (under 75 years), 1997-2017

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
2017	20,992	4,976,829	425.2

Mental Wellbeing – adults aged 16+

The gap in mental wellbeing amongst adults living in the most deprived and least deprived areas has decreased over the last two time periods from 20.9 percentage points in 2012/2013 to 17.2 percentage points in 2016/2017, however, it remains higher than at the start of the time series (15.5 percentage points in 2008/2009).

Adults in the most deprived areas were three times more likely to have below average wellbeing than adults in the least deprived areas at all time periods except 2012/2013, when they were five time more likely to have below average wellbeing.

Trends in mental wellbeing

The mean score on the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) was fairly static between 2008/09 and 2016/17 ranging from 49.8-49.9.

‘Below average’ wellbeing has been defined as WEMWBS scores of at least one standard deviation below the mean, equivalent to scores of 41 or lower in all years. The proportion of adults in Scotland who have a below average WEMWBS score has remained at 15% since 2008/2009.

Inequalities in mental wellbeing, 2016/17

In 2016/17, 24% of adults in the most deprived areas had below average wellbeing, indicated by a WEMWBS score of 41 or lower. This compared to 7% of adults in the least deprived areas.

Figure 2.1

Trends in relative inequalities

The relative index of inequality (RII) in below average wellbeing increased slightly between 2014/2015 and 2016/2017 (from 1.13 to 1.16) but remained below the 2008/2009 figure of 1.18.

Adults in the most deprived areas were approximately 3 times more likely to have below average wellbeing compared to those in the least deprived areas at all time periods except 2012/2013, when they were 5 times more likely to have below average wellbeing.

Figure 2.2

Trends in absolute inequalities

The gap in prevalence of below average wellbeing between those in the most and least deprived areas increased until 2012/2013 before decreasing over the last two time periods. However, the gap in 2016/2017 (17.2 percentage points) is higher than at the start of the time series (15.5 percentage points in 2008/2009).

Figure 2.3

Table 2.1: Trends in mental wellbeing, 2008/2009-2016/2017

Year	Mean WEMWBS			Below average wellbeing (indicated by a WEMWBS score of 41 or lower)
	Mean WEMWBS score	Lower 95% confidence limit	Upper 95% confidence limit	Proportion of adults with below average wellbeing (%)	Lower 95% confidence limit (%)	Upper 95% confidence limit (%)
2008/2009	49.8	49.6	50.0	14.8	14.1	15.6
2010/2011	49.9	49.7	50.1	15.0	14.2	15.8
2012/2013	49.9	49.7	50.2	14.9	13.9	15.8
2014/2015	49.9	49.7	50.2	14.7	13.7	15.7
2016/2017	49.8	49.6	50.1	15.1	14.1	16.2