Long-term Monitoring of Health Inequalities March 2023 report

Annex 2: Data sources and quality

Data quality

Aggregate data is provided by National Records of Scotland (NRS) for the mortality indicators, and by Public Health Scotland (PHS) for all other indicators in this report. Scottish Government statisticians carry out quality assurance checks on the aggregate data, comparing it with past trends and against other published data, such as national level data published by NRS or PHS.

PHS and NRS are responsible for the quality assurance of their own datasets. Detailed information on the quality control of the relevant PHS datasets is available online^[20]. National Records of Scotland have published detailed information on the quality of data on deaths^[21]. Analysts at both PHS and NRS are provided with income-employment decile-datazone lookups and population estimates before a request for aggregate data is submitted.

Indicators

Healthy Life Expectancy (HLE)

Responsibility for production of Healthy Life Expectancy (HLE) data passed to National Records of Scotland (NRS) in 2018 as part of a programme of work to harmonise life expectancy and healthy life expectancy estimates across the UK. The indicator used in this report has been updated to reflect this change. Details of the new definition are outlined below.

New definition

Source: National Records of Scotland (NRS). HLE is derived by combining the estimates of life expectancy (LE) with data on self-assessed health (which comes from the Annual Population Survey). The previous indicator, produced by ScotPHO, used self-assessed health estimates from the Scottish Household Survey and the Scottish Health Survey.

As the healthy life expectancy methodology has changed, data presented in this report are not comparable to data previously published in this report series prior to January 2021.

Definition: Healthy life expectancy (HLE) is the estimated number of years that a new born baby could be expected to live in good health, based on how individuals perceive their general health.

Life Expectancy: The average number of years that a new born baby could expect to survive if the current mortality rates for each age group, sex and geographic area remain constant throughout their life.

Based on HLE and LE we can estimate the proportion of the average lifetime that adults can expect to live in good health.

Estimates of HLE are less robust than estimates of LE due to the use of survey data. As the number of people responding to the survey are fewer than in the total population, sample size for HLE is smaller than for LE and therefore the 95% confidence intervals are wider.

Premature Mortality (from all causes, aged under 75 years)

Source: National Records of Scotland.

Definition: European age-standardised rates of deaths from any cause amongst those aged under 75 years.

First ever hospital admission for heart attack aged under 75 years

Source: Public Health Scotland (PHS); SMR01 records (all inpatient and daycase discharges).

Definition: European age-standardised rates of first ever hospital admission for acute myocardial infarction (heart attack) amongst those aged under 75 years. The following World Health Organisation International Classification of Disease coding was used: ICD10 'I21-I22'; ICD9 '410'.

Coronary Heart Disease - deaths aged 45-74 years

Source: Public Health Scotland (PHS); using deaths data from National Records of Scotland.

Definition: European age-standardised rates of death from coronary heart disease amongst those aged 45-74 years. The following World Health Organisation International Classification of Disease coding was used: ICD10 'I20-I25'; ICD9 '410-414'. Because of the dynamic nature of the linked database, previous years' data are sometimes updated in subsequent publications.

Cancer - incidence rate aged under 75 years

Source: Public Health Scotland (PHS); Scottish Cancer Registry.

Definition: European age-standardised rates of new cases of cancer amongst those aged under 75 years.

All Cancers- cancer defined as all malignant neoplasms excluding non-melanoma skin cancer. The following World Health Organisation International Classification of Disease coding was used: ICD10 'C00-C96' excluding 'C44' (the Scottish Cancer Registry does not use code 'C97').

Prostate cancer (males only) - ICD-10 C61

Breast cancer (females only) - ICD-10 C50

Cancer of the trachea, bronchus and lung- ICD-10 C33-C34

Colorectal cancer- ICD-10 C18-C20

Cancer - deaths aged 45-74 years

Source: Public Health Scotland (PHS); Scottish Cancer Registry.

Definition: European age-standardised rates of deaths from cancer amongst those aged under 45-74 years.

All cancers- cancer defined as all malignant neoplasms excluding non-melanoma skin cancer. The following World Health Organisation International Classification of Disease coding was used: ICD10 (2000 onwards) 'C00-C97' excluding 'C44'.

Prostate cancer (males only) - ICD-10 C61

Breast cancer (females only) - ICD-10 C50

Cancer of the trachea, bronchus and lung- ICD-10 C33-C34

Colorectal cancer- ICD-10 C18-C20

Alcohol - first hospital admission aged under 75 years

Source: Public Health Scotland (PHS).

Definition: European age-standardised rates of first hospital admission for alcohol-related conditions amongst those aged under 75 years. These rates include hospitals discharges where alcohol-related problems are recorded as either primary or secondary reasons for admission to hospital and will cover first admission in the last ten years. These figures exclude private hospitals, mental illness hospitals, psychiatric units and maternity hospitals and include Scottish residents only. Caution is necessary when interpreting these figures. The recording of alcohol misuse may vary from hospital to hospital. Where alcohol misuse is suspected but unconfirmed it may not be recorded by the hospital. The following revised World Health Organisation International Classification of Disease coding was used: ICD10: F10, K70, X45, X65, Y15, Y90, Y91, E244, E512, G312, G621, G721, I426, K292, K860, O354, P043, Q860, T510, T511, T519, Y573, R780, Z502, Z714, Z721.

Alcohol- specific deaths aged 45-74 years

Source: National Records of Scotland.

Definition: This indicator changed from alcohol-related deaths to alcohol-specific deaths from 2020 following the introduction of a new definition of alcohol deaths by NRS towards the end of 2017.

Alcohol-specific deaths

European age-standardised rates of death from alcohol-specific conditions amongst those aged 45-74 years. The definition of alcohol- specific deaths includes deaths which are known to be a direct consequence of alcohol misuse. The following World Health Organisation International Classification of Disease coding was used: ICD10 E24.4, F10, G31.2, G62.1, G72.1 I42.6, K29.2, K70, K85.2, K86.0, Q86.0, R78.0, X45, X65, Y15; ICD9 291, 303, 305.0, 357.5, 425.5, 535.3, 571.0, 571.1, 571.2, 571.3, 790.3, E860.

The figures for alcohol deaths do not include all deaths which may be caused by alcohol – for example, they do not include deaths:

• As a result of road accidents, falls, fires, suicide or violence involving people who had been drinking; or
• From some medication conditions which are considered partly attributable to alcohol, such as certain forms of cancer.

Alcohol-related deaths – definition used in previous reports

The definition of alcohol- related deaths included deaths where there was any mention of alcohol-related conditions on the death certificate, rather than just as the main cause of death. The following World Health Organisation International Classification of Disease coding was used: ICD10 F10, G31.2, G62.1, I42.6, K29.2, K70, K73, K74.0, K74.1, K74.2, K74.6, K86.0, X45, X65, Y15; ICD9 291, 303, 305.0, 425.5, 571.0, 571.1, 571.2, 571.3, 571.4, 571.5, 571.8, 571.9, E860.

The numbers produced using the two definitions show broadly similar patterns of change over the period from 2000 to 2016, with the new definition's figures for Scotland tending to be very roughly 10% lower. For more information about the change of definition please see the Alcohol-Specific deaths report on the NRS website^[22].

All-cause mortality aged 15-44 years

Source: National Records of Scotland.

Definition: European age-standardised rates of death from any cause amongst those aged 15-44 years. Specific breakdowns for deaths from assault, drug related deaths and suicide are also provided, as the major causes of death for which there are large inequalities amongst young people. There may be some double counting in these breakdowns. The following World Health Organisation International Classification of Disease coding was used: Assault ICD10 'X85-Y09', 'Y87.1' ICD9 'E960-969'; Drug-related ICD10 'F11-16', 'F19', 'X40-44', 'X60-64', 'X85', 'Y10-Y14'; Suicide (intentional self-harm + undetermined intent) ICD10 'X60-84', 'Y87.0' ICD9 'E950-959', 'E980-989'.

Low Birthweight

Source: Public Health Scotland (PHS); SMR02 maternity dataset.

Definition: The figures are presented as a percentage of all live singleton births (not including home births, births in non-NHS hospitals and multiple births) where the birthweight is known. Low birthweight is defined as <2,500g - the standard World Health Organisation definition.

Healthy Birthweight

Source: Public Health Scotland (PHS); SMR02 maternity dataset.

Definition: The figures are presented as a percentage of all live singleton births (not including home births, births in non-NHS hospitals and multiple births) where the birthweight is known. A baby is considered to be of healthy birthweight (a weight appropriate for its gestational age) when it lies between the 10th and 90th centile for weight at its gestational age. Gestational age is a way of expressing the age or development of a baby. It is typically based on an antenatal ultrasound scan. However, it may also be estimated from the number of weeks since the mother's last normal menstrual period.

Prior to this publication, the 5^th and 95^th percentiles were used instead of the 10^th and 90^th. This change was made to align with the more commonly used method that has been adopted by PHS in their Births in Scotland publication, for additional information please see the Births in Scotland technical report^[23].

Data on appropriate birthweight for gestational age are produced using tables based on the UK-WHO child growth standards developed by the Royal College of Paediatrics and Child Health^[24].

Drug-related hospital admission aged under 75 years

Source: Public Health Scotland (PHS).

Definition: European age-standardised rates of hospital admissions for drug misuse amongst those aged under 75 years. These rates are based on inpatients and day cases discharged from general acute and psychiatric specialties in Scotland, where drug misuse was mentioned in the records at some point during the patient's hospital stay. Patients admitted to hospital multiple times in the same financial year will only be counted once per year. Patients admitted in multiple financial years will be included once in each year they are admitted. These figures include SMR01 records (general/acute inpatient and day cases) and SMR04 records (mental health inpatient and day cases). Some caution is necessary when interpreting these figures as drug misuse may only be suspected and may not always be recorded by the hospital. The following revised World Health Organisation International Classification of Disease coding was used: ICD10: F11, F12, F13, F14, F15, F16, F17, F18, F19, T40.0, T40.1, T40.3, T40.5, T40.6, T40.7, T40.8, T40.9. For the following T-codes a continuous inpatient stay (CIS) is counted if there is a presence in the same CID of at least one of the ICD-10 Mental and Behavioural Disorder codes F11-F16, F18 or F19: T40.2, T40.4, T42.3, T43.6, T52.