Why is mortality higher in Scotland than in England and Wales? Decreasing influence of socioeconomic deprivation between 1981 and 2001 supports the existence of a 'Scottish Effect'
Why is mortality higher in Scotland than in England and Wales? Decreasing influence of socioeconomic deprivation between 1981 and 2001 supports the existence of a 'Scottish Effect'
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DOI：
10.1093/pubmed/fdi002
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发表时间：
2005-06-01
影响因子：
4.4
通讯作者：
Chalmers, J
中科院分区：
文献类型：
--
作者：
Hanlon, P;Lawder, RS;Chalmers, J
目的为了确定1981年至2001年期间苏格兰和英国其他地区贫困模式的变化在多大程度上解释了苏格兰在这一时期较高的死亡率。1991年和2001年人口普查。背景大不列颠（GB）。参与者1981年统计的大不列颠人口，1991年和2001年人口普查。主要结果措施卡斯泰尔斯剥夺分数来自病房（英格兰和威尔士）和邮政编码部门（苏格兰）。死亡率调整的年龄，性别和剥夺decile.Results之间的1981年和2001年，苏格兰变得不那么剥夺相对于英国其他地区。年龄和性别标准化的全因死亡率在整个英国下降了约25%，包括苏格兰，但死亡率在1981年平均高出12%，2001年上升到15%。虽然1981年超过60%的超额死亡率可以用贫困状况的差异来解释，但1991年和2001年的超额死亡率不到一半。在调整了年龄、性别和贫困因素后，苏格兰的超额死亡率从1981年的4.7%（95%CI：3.9%至5.4%）上升到1991年的7.9%（95%CI：7.2%至8.7%）和2001年的8.2%（95%CI：7.4%至9.0%）。所有的剥夺十分位数都显示出过剩，这表明生活在苏格兰的人口与英国其他地区的人口相比，生活在类似剥夺地区的人口总是有更高的死亡率。到2001年，在苏格兰最贫困的地区发现了最大的过度现象，与英格兰和威尔士类似的贫困地区相比，最贫困的十分之一人口的死亡率高出17%。在苏格兰的超额死亡率增加最男性年龄< 65 years.Conclusions苏格兰的相对死亡率劣势相比，英国其他地区，允许剥夺后，正在恶化。到1991年，剥夺措施不再能解释苏格兰的大部分超额死亡率，而无法解释的超额死亡率在1990年代一直存在。需要更多的研究来了解是什么导致了这种“苏格兰效应”。
Objectives To determine the degree to which changing patterns of deprivation in Scotland and the rest of Great Britain between 1981 and 2001 explain Scotland's higher mortality rates over that period.Design Cross-sectional analyses using population and mortality data from around the 1981, 1991 and 2001 censuses.Setting Great Britain (GB).Participants Populations of Great Britain enumerated in the 1981, 1991 and 2001 censuses.Main outcome measures Carstairs deprivation scores derived for wards (England and Wales) and postcode sectors (Scotland). Mortality rates adjusted for age, sex and deprivation decile.Results Between 1981 and 2001 Scotland became less deprived relative to the rest of Great Britain. Age and sex standardized all-cause mortality rates decreased by approximately 25% across Great Britain, including Scotland but mortality rates were on average 12% higher in Scotland in 1981 rising to 15% higher in 2001. While over 60% of the excess mortality in 1981 could be explained by differences in deprivation profile, less than half the excess could be explained in 1991 and 2001. After adjusting for age, sex and deprivation, excess mortality in Scotland rose from 4.7% (95% CI: 3.9% to 5.4%) in 1981 to 7.9% (95% CI: 7.2% to 8.7%) in 1991 and 8.2% (95% CI: 7.4% to 9.0%) in 2001. All deprivation deciles showed excess indicating that populations in Scotland living in areas of comparable deprivation to populations in the rest of Great Britain always had higher mortality rates. By 2001 the largest excesses were found in the most deprived areas in Scotland with a 17% higher mortality rate in the most deprived decile compared to similarly deprived areas in England and Wales. Excess mortality in Scotland has increased most among males aged < 65 years.Conclusions Scotland's relative mortality disadvantage compared to the rest of Great Britain, after allowing for deprivation, is worsening. By 1991 measures of deprivation no longer explained most of the excess mortality in Scotland and the unexplained excess has persisted during the 1990s. More research is required to understand what is causing this 'Scottish effect'.