A small area analysis of mortality inequalities in Scotland, 1980-2001

This thesis examines the changing patterns of mortality in Scotland, with particular emphasis on whether there are widening mortality inequalities among small areas in Scotland. The annual number of deaths in Scotland has decreased steadily since the 1950s, yet mortality rates in Scotland are amongst the highest in Europe for many causes. Furthermore, mortality from some causes, such as suicide, has been increasing over time, particularly among young adults. Evidence suggests that inequalities in mortality have widened over time in Scotland, despite substantial investment in policies aimed at reducing inequalities. Therefore, it is important to seek geographical clues that might help explain what causes these high mortality rates. The changing patterns in Scottish mortality between 1980 and 2001 were examined for small areas, created by the author, known as Consistent Areas Through Time (CATTs). These areas have the same boundaries for each census, so that direct comparisons over time are possible. In this study, CATTs have been used to investigate three aspects of the mortality gap in Scotland. First, the widening mortality gaps between 1980-1982 and 1999-2001 are examined for the total population and for premature mortality (<65 years). Second, the influence that geographic scale and deprivation have on the relationship between population change and premature mortality are assessed. Third, suicide inequalities are examined for the younger (15-44 years), older (45+) and total population, using mortality ratios and statistical modelling. The research found that inequalities in premature mortality (<65) have widened for all causes of death studied, particularly for suicide. The negative association between mortality and population change was affected by geographic scale, but this relationship could not be fully explained by deprivation. Small area analyses found that the Highlands and Islands had higher suicide rates than elsewhere in Scotland for males, but not females, when social variables were controlled for

Measuring area-level disadvantage in Australia : Development of a locally sensitive indicator

Background In Australia, the Socio-Economic Indexes for Areas (SEIFA), which includes the Index of Relative Socioeconomic Disadvantage (IRSD), captures the socioeconomic characteristics of areas. Because SEIFA rankings are relative to the country or state, the decile categorisations may not reflect an area’s socioeconomic standing relative to areas nearby. Aims The aim of the research was to explore whether IRSD rankings could be re-ranked to become locally sensitive. Data and methods Using existing SEIFA data to redistribute the membership of current decile IRSD groups, we tested three methods to re-rank all SA1 areas relative to the nearest areas capped at: (1) the nearest 99 neighbours, (2) a population threshold of 50,000 (3) a distance threshold of 10 km. Results The reclassification of SEIFA IRSD deciles was largest (up to 8 decile points of change) when comparing the nearest neighbour and population threshold local methods to current state-based rankings. Moreover, compared to using current national and state SEIFA IRSD rankings, the use of local rankings resulted in more evenly distributed deciles between cities, regional, and remote areas. Conclusions Because SEIFA IRSD rankings are used to allocate resources and health services, we encourage the combined use of a state and local ranking to refine areas considered the most disadvantaged

Cardiac Screening of Young Athletes: a Practical Approach to Sudden Cardiac Death Prevention.

PURPOSE OF REVIEW: We aim to report on the current status of cardiovascular screening of athletes worldwide and review the up-to-date evidence for its efficacy in reducing sudden cardiac death in young athletes. RECENT FINDINGS: A large proportion of sudden cardiac death in young individuals and athletes occurs during rest with sudden arrhythmic death syndrome being recognised as the leading cause. The international recommendations for ECG interpretation have reduced the false-positive ECG rate to 3% and reduced the cost of screening by 25% without compromising the sensitivity to identify serious disease. There are some quality control issues that have been recently identified including the necessity for further training to guide physicians involved in screening young athletes. Improvements in our understanding of young sudden cardiac death and ECG interpretation guideline modification to further differentiate physiological ECG patterns from those that may represent underlying disease have significantly improved the efficacy of screening to levels that may make screening more attractive and feasible to sporting organisations as a complementary strategy to increased availability of automated external defibrillators to reduce the overall burden of young sudden cardiac death

Deprivation (im)mobility and cause-specific premature mortality in Scotland

A common approach for measuring geographical inequalities in health has been to calculate deprivation scores for small areas and then to aggregate these into quintiles. Mortality rates may then be compared for the highest and lowest deprivation quintiles at two points in time and the change in the difference between the rates determines the extent to which inequalities have widened or narrowed. This 'period-specific' approach to measuring inequalities is problematic both because deprivation calculated at different points in time is not directly comparable, and because the boundaries of the areas used for such analyses often change during the study period. Using 10,058 small areas for Scotland whose boundaries do not change between 1981 and 2001 we examine the deprivation (im)mobility of areas, identifying those that are persistently well-off, stable or deprived and those that improved or worsened during the period. We focus particularly on the 638 persistently most deprived areas. We demonstrate, first and importantly, that premature mortality rates increased significantly over this twenty year period in these areas. Second, we examine which causes of death are mainly responsible for this increase; the risk of death from chronic liver disease, mental disorders due to alcohol, suicide and 'other' causes increased considerably. The geographical approach we describe here is novel and provides new insights into the relationship between deprivation and premature mortality. We suggest that these persistently most deprived Scottish areas deserve special attention and may be particularly appropriate sites for public health interventions related to these causes of premature death.Deprivation Premature mortality Scotland Consistent Areas Through Time (CATTs) Social mobility Health inequalities

Shrinking areas and mortality: An artefact of deprivation effects in the West of Scotland?

A number of studies have shown that mortality rates are highest in areas that are experiencing population decline. A recent study suggests that this relationship disappears when area deprivation is accounted for. We extend this research to consider the relationship between population change and mortality in five Health Boards in the West of Scotland-a region with some of the worst mortality rates in Europe. For the area as a whole and all five Health Boards separately, we find a significant negative association between population change and mortality, but in each case this relationship disappears when small area deprivation is accounted for. This confirms our previous conclusion that it is more important to account for deprivation than population decline in health resource allocation