Short ReportThe Scottish excess in mortality compared to the English and Welsh. Is it a country of residence or country of birth excess?
Introduction
It is well established that the mortality rate in Scotland is higher than in neighbouring England and Wales (Hanlon et al., 2005). It is also known that those born in Scotland but living in England and Wales have a higher mortality rate than those born in England and Wales (Wild et al., 2007, Wild and Mckeigue, 1997). Recently it has also been shown for the period around the 2001 Census that within Scotland those born in England and Wales (Scotland’s largest immigrant group) have a lower mortality rate than the Scottish born (Fischbacher et al., 2007). These findings raise the question of whether the Scottish excess in mortality may actually be a country of birth excess rather than a country of residence excess. To date there has been no study jointly comparing mortality in both countries by country of birth and country of residence to test this hypothesis.
Section snippets
Methods
We obtained from the Office for National Statistics (ONS) in England and Wales and the General Register Office for Scotland (GROS) death registration counts and census population counts by combinations of country of birth and country of residence by 5-year age groups (up to 85 and then 85 and over) and sex. All aforementioned studies have also been based on such death registration (numerator) and census population counts (denominator).
To describe the mortality differences separately and jointly
Results
Model A (Table 1) shows that, as expected, the risk of death is higher for those born in Scotland than for persons born in England and Wales. By country of current residence Model B shows those living in Scotland have a higher risk of death than those living in England. Jointly accounting for country of birth and residence sees a clear attenuation of the relative risk for country of residence rather than country of birth (Model C).
Model D groups country of residence and country of birth and
Discussion
Our results suggest that the Scottish excess is considerably more strongly related with country of birth than country of residence. There are at least two explanations for this. First, the results could be an artefact: it is well recognised that country of birth analyses that rely on data from two unlinked sources (death registration and census) may be subject to numerator/denominator bias (Marmot et al., 1984) and in this case we are comparing data across two contexts where there may be
Ethical approval
The project was approved by the Geography and Geosciences School Ethics Committee of the University Teaching and Research Ethics Committee of the University of St Andrews.
Competing interests
None.
Funding
The project was funded by the Scottish Collaboration for Public Health Research and Policy. The opinions expressed in this paper are those of the authors alone.
Acknowledgements
Many thanks to our colleague Zhiqiang Feng for providing the Scotland and England and Wales level Carstairs score. Many thanks to the General Register Office for Scotland and the Office for National Statistics for supplying the data used in this study. Census output is Crown copyright and is reproduced with the permission of the Controller of HMSO and the Queen’s Printer for Scotland.
References (16)
- et al.
Lessons from the study of immigrant mortality
Lancet
(1984) - et al.
A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives
International Journal of Epidemiology
(2002) - et al.
Deprivation: explaining differences in mortality between Scotland and England and Wales
BMJ
(1989) - et al.
Variations in all cause and cardiovascular mortality by country of birth in Scotland, 1997–2003
Scottish Medical Journal
(2007) - et al.
Childhood socioeconomic circumstances and cause-specific mortality in adulthood: systematic review and interpretation
Epidemiologic Reviews
(2004) - et al.
Effect of in utero and early-life conditions on adult health and disease
The New England Journal of Medicine
(2008) - et al.
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’
Journal of Public Health
(2005) - et al.
Mortality of third generation Irish people living in England and Wales: longitudinal study
BMJ
(2001)
Cited by (20)
History, politics and vulnerability: explaining excess mortality in Scotland and Glasgow
2017, Public HealthCitation Excerpt :Much of this is explained by recent experiences of deindustrialisation, deprivation and poverty, the latter being root causes of poor health in all societies, not just Scotland.4,8–12 However, in addition, high levels of excess mortality—that is, higher mortality over and above that explained by differences in socioeconomic deprivation—have been observed for Scotland compared with England & Wales,13–17 as well as for Glasgow compared with similar post-industrial UK cities such as Liverpool, Manchester and Belfast.18,19 The scale of this excess is considerable.
Comparing levels of social capital in three northern post-industrial UK cities
2015, Public HealthCitation Excerpt :Despite the well-established and profound links between poverty and poor health, a considerable amount of recent research has shown high levels of ‘excess’ mortality (i.e. higher mortality seemingly not explained by differences in socio-economic deprivation) in Scotland compared to England & Wales,1–4 and, in particular, in its largest city, Glasgow, compared to the similar postindustrial English cities of Liverpool and Manchester.
Applications and limitations of the concept of 'avoidable mortality' among immigrant groups in Europe: A scoping review
2015, Public HealthCitation Excerpt :Summary characteristics of the studies are listed in Appendices 1 and 2. They were included, as they provide important information about how researchers used the concept, as well as other important research parameters and conditions.15–51 More specifically, selected characteristics captured (where possible) what data were available for their country case(s); reference to specific population groups and sub-groups of migrants; as well as specific challenges faced by health care systems in the organization of care according to morbidity-specific or group-specific services.
"The Glasgow effect?"- The result of the geographical patterning of deprived areas?
2014, Health and PlaceCitation Excerpt :This excess mortality has in the past been attributed to higher levels of deprivation (Carstairs and Morris, 1989;Scottish Council Foundation, 1998;Scottish Executive, 2000;Scottish Office, 1999). However, more recent research indicates that deprivation does not account for all the excess mortality (Hanlon et al., 2005;Popham et al., 2010;Popham and Boyle, 2011). Much of this excess mortality is concentrated in the West of Scotland, and in Glasgow in particular (Hanlon et al., 2005).
The general and mental health of movers to more- and less-disadvantaged socio-economic and physical environments within the UK
2014, Social Science and Medicine