Long-term monitoring of health inequalities: January 2020 report

Indicators

The indicators monitored by this report series are:

Headline indicators of health inequalities

• Healthy Life Expectancy
• Premature Mortality from all causes (aged under 75 years)
• Mental Wellbeing of adults (aged 16+)

Indicators of inequalities in morbidity and mortality

• Coronary Heart Disease: first ever hospital admission for heart attack (aged under 75 years)
• Coronary Heart Disease: deaths (aged 45-74 years)
• Cancer: incidence (aged under 75 years)
• Cancer: deaths (aged 45-74 years)
• Alcohol: first hospital admissions (aged under 75 years)
• Alcohol: deaths (aged 45-74 years)
• All-cause mortality (aged 15-44 years)
• Low birthweight
• Healthy birthweight
• Self-assessed health of adults (aged 16+)
• Limiting long-term conditions amongst adults (aged 16+)
• Drugs: hospital admissions (aged under 75 years)

This year's report does not include results for the Healthy Life Expectancy (HLE) indicator. The methodology used to calculate HLE in Scotland changed in 2018 and the data necessary for this report is not currently available. For more information about the change in methodology please see here: https://nationalperformance.gov.scot/healthy-life-expectancy.

This indicator will be included in the next report and then annually going forward.

This year's report does not include results for mental wellbeing, self-assessed health or limiting long-term conditions indicators, as these are produced every second year and were included in the previous report.

The definition of alcohol deaths included in this report has changed from previous years and is now based on alcohol-specific deaths rather than alcohol-related deaths, following the introduction of a new definition of alcohol deaths by NRS towards the end of 2017. Please see appendix 2 for more information about this change.

Following discussions with the technical advisory group a new indicator monitoring drug-related hospital admissions has been included in this report for the first time and will be included annually going forward.

Supplementary tables showing the most up-to-date trends in relative and absolute inequalities for all indicators are available in the supporting files section.

Methods

The report uses a combination of measures of health inequalities to give a fuller understanding of the different aspects of inequalities. These are:

• Scale: How big is the problem? This measure describes the underlying scale of the problem, puts it into context and presents past trends at Scotland level.

• Relative Index of Inequality (RII): How steep is the inequalities gradient? This describes the gradient of health observed across the deprivation scale, relative to the mean health of the whole population. Unless explicitly explained, the RII indicates the extent to which health outcomes are better in the least deprived areas, or worse in the most deprived areas, compared to the mean.

• Absolute range: How big is the gap? This measure describes the absolute difference between the extremes of deprivation.

Following recommendations from the expert group, an area-based index derived from the income and employment domains of the Scottish Index of Multiple Deprivation (SIMD) is used to define deprivation. This reflects the absence of individual-level data on socio-economic circumstance.

The index is referred to as the Income and Employment Index (IEI).

These indicators and measures were recommended for long-term monitoring of deprivation-related health inequalities at Scotland level. Monitoring health inequalities due to other factors, such as age, gender and ethnicity, and indicators at a local level, may require different indicators and measures. Further information on the methods is provided in Annex 1.