Long-term monitoring of health inequalities: January 2020 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:

• Coronary Heart Disease (CHD) Mortality - the gap is currently the lowest across the time series and less than half what it was at its peak in 1998.
• Alcohol-Related Admissions - the gap has reduced by 46% since the start of the time series in 1996 and is currently at its lowest level.
• Alcohol-Specific Mortality – the gap has reduced by 60% since its peak in 2002 and is currently the third lowest in the time series.

The gap in premature mortality rates has increased to its highest point since 2008, although the gap remains lower than at the start of the time series.

Whilst the gap for all-cause mortality (aged 15-44) reduced to its lowest level in 2013, it has increased in each of the last five years and is currently 34% higher than at the start of the time series in 1997.

The gap for drug-related hospital admissions has increased in each of the last five years and it has almost tripled since the start of the time series in 1996/97.

The gap for low birthweight has reduced from its widest point in 2004. However, the gap has fluctuated in recent years, and is currently only 8% lower than at the start of the time series in 1996.

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

• Heart attack Admissions
• Cancer Incidence
• Cancer Mortality
• Healthy Birthweight

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 increased in recent years and cancer incidence inequalities have remained relatively stable.

Amongst the three comparable mortality indicators (CHD deaths, alcohol-specific deaths, and cancer deaths), relative inequalities in both CHD mortality and cancer mortality have increased over the long term whilst the RII in alcohol-specific deaths have shown more year to year fluctuation and is currently the lowest in the time series. However, relative inequalities in alcohol-specific deaths remain higher than the other comparable mortality indicators.

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.