Scottish Health Survey - topic report: The Glasgow Effect

Summary

The link between socio-economic circumstances and health is well known, and there is an increasing evidence base supporting the hypothesis of a 'Scottish Effect', and more specifically a 'Glasgow Effect', the terminology used to identify higher levels of mortality and poor health found in Scotland and Glasgow beyond that explained by socio-economic circumstances. The last study which investigated the existence of a 'Glasgow Effect' in a wide range of health behaviours and outcomes used data from the 1995, 1998 and 2003 Scottish Health Surveys, using the Carstairs measure of area-based deprivation, which is less spatially sensitive than the Scottish Index of Multiple Deprivation ( SIMD) now available. Additionally, that study only investigated whether socio-economic factors explained any differences between Glasgow and the rest of Scotland, and did not investigate other potential explanations. This report therefore both updates and extends that work by using the 2008 and 2009 Scottish Health Survey data. The overall aim of this work was to investigate whether residence in Glasgow was independently associated with poorer health outcomes and worse health behaviours compared to the rest of Scotland, after controlling for socio-economic, behavioural, biological and other health-related risk factors.

To accomplish this aim a series of logistic regression models were carried out for a variety of adverse health behaviours and mental and physical health outcomes, and the extent to which any observed differences between Greater Glasgow and Clyde and the rest of Scotland were explained was examined by first adjusting for age and sex, then additionally adjusting for area level deprivation using the Scottish Index of Multiple Deprivation ( SIMD), individual level socio-economic factors, behavioural, biological, relationship and social mobility variables.

This study showed that combined area and individual level socio-economic circumstances explained the differences found between Greater Glasgow and Clyde and the rest of Scotland for the majority of outcomes investigated. However four outcomes remained where differences were not explained by socio-economic factors: anxiety, doctor diagnosed heart attack, high GHQ scores, and being overweight. Of these, the latter two were explained by differences in biological factors. However there remained an unexplained 'Glasgow Effect' in relation to prevalence of anxiety and doctor diagnosed heart attack, with higher levels found in Greater Glasgow and Clyde. Therefore further research is needed into the reasons behind the increased levels of anxiety and heart attacks found in Greater Glasgow and Clyde.