Objective To compare the trends in mortality inequalities by educational attainment with trends using area deprivation.
Setting Scotland and England & Wales (E&W).
Participants All people resident in Scotland and E&W between 1981 and 2011 aged 35–79 years.
Primary outcome measures Absolute inequalities (measured using the Slope Index of Inequality (SII)) and relative inequalities (measured using the Relative Index of Inequality (RII)) in all-cause mortality.
Results Relative inequalities in mortality by area deprivation have consistently increased for men and women in Scotland and E&W between 1981–1983 and 2010–2012. Absolute inequalities increased for men and women in Scotland, and for women in E&W, between 1981–1983 and 2000–2002 before subsequently falling. For men in E&W, absolute inequalities were more stable until 2000–2002 before a subsequent decline. Both absolute and relative inequalities were consistently higher in men and in Scotland. These trends contrast markedly with the reported declines in mortality inequalities by educational attainment and apparent improvement of Scotland’s inequalities with those in E&W.
Conclusions Trends in health inequalities differ when assessed using different measures of socioeconomic status, reflecting either genuinely variable trends in relation to different aspects of social stratification or varying error or bias. There are particular issues with the educational attainment data in Great Britain prior to 2001 that make these education-based estimates less certain.
- health inequalities
- England & Wales
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Contributors GM, FP, SVK and DW came up with the idea for this work. LS and FP did the data analysis. GM drafted the manuscript. All authors provided substantial edits and redrafting and approved the final draft.
Funding FP and SVK are funded by the Medical Research Council and Chief Scientist’s Office (MC_UU_12017/13 and SPHSU13), as part of the core funding for the MRC/CSO Social & Public Health Sciences Unit. In addition, SVK is funded by a NRS Senior Clinical Fellowship (SCAF/15/02).
Competing interests GM, DW and LS are employees of the National Health Service (NHS) in Scotland.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All of the available data are provided in the online supplementary appendix.
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