Elsevier

Health & Place

Volume 16, Issue 4, July 2010, Pages 759-762
Health & Place

Short Report
The Scottish excess in mortality compared to the English and Welsh. Is it a country of residence or country of birth excess?

https://doi.org/10.1016/j.healthplace.2010.03.007Get rights and content

Abstract

Scotland has a higher mortality rate than England and Wales, which is only partially explained by differences in socio-economic deprivation. Within Scotland those born in England and Wales have a lower mortality rate than the Scottish born. Within England and Wales, Scottish born immigrants have a higher mortality rate than those born in England and Wales. These results raise the question of whether the greater Scottish mortality is a country of birth rather than a country of residence excess. Our analysis, around the 2001 Census, suggests that country of birth is more important than country of residence, indicating that early life factors may be important for the Scottish 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.

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