Diversity in causes of mortality in the measurement of population health in Scotland

Measuring diversity in causes of mortality offers an insight into variation in health outcomes within a population. Increased diversity in causes of mortality indicates that deaths have occurred from more varied causes. This may increase diagnostic uncertainty and means health care, promotion, and prevention resources must be spread wider and these sectors must adopt a more comprehensive approach. Diversity in mortality causes has not been measured in Scotland, despite poor health outcomes relative to European comparators. Further, limited previous examination exists of differences in mortality cause diversity in sub‐national population groups, divided by socioeconomic or geographic factors. Health inequalities in Scotland are large and understanding tendencies in mortality cause diversity may be valuable to addressing differential health patterns. Mortality cause diversity has been shown to be associated with increasing life expectancy and falling lifespan variation over time across nations. This relationship has not been examined between different subpopulations within a nation. Finally, the effect of the COVID‐19 pandemic on diversity in causes of mortality has not been examined and this analysis may be a valuable tool to assess the ongoing impact caused by this unprecedented upheaval in population health. In this thesis I calculate diversity in underlying and contributory causes of mortality as well as lifespan diversity using observed data and distributions extracted from multiple‐decrement life tables. I propose novel methods for assessing the contribution of causes of mortality to diversity and a novel method for the measurement of lifespan diversity. I find that diversity in underlying and contributory causes of mortality increased in Scotland from 2001 to the mid 2010s when trends diverge. Trends in variation are shown to be similar across subpopulations, meaning despite socioeconomic or geographic differences reductions in the proportion of individuals who die of the most common causes and a redistribution to a wider variety of causes has occurred at similar rates. Confirming previous research, diversity in causes of mortality is found to increase as the population of Scotland lived longer and to more equal ages. However, higher diversity in causes of mortality is not necessarily found among subpopulations who live to older and more equal ages. I suggest falling mortality rates associated with the most common causes, especially at premature ages, have driven increasing diversity in causes of mortality and life expectancy and falling lifespan diversity. Diversity in causes of mortality, with COVID‐19 deaths are excluded from analysis, is shown to have remained consistent with trends in previous years during the COVID‐19 pandemic. Monitoring diversity in mortality causes has the potential to expand knowledge around patterns of mortality and to provide valuable insight into pressures on public health and healthcare systems

FAIR Data Pipeline: provenance-driven data management for traceable scientific workflows

Modern epidemiological analyses to understand and combat the spread of disease depend critically on access to, and use of, data. Rapidly evolving data, such as data streams changing during a disease outbreak, are particularly challenging. Data management is further complicated by data being imprecisely identified when used. Public trust in policy decisions resulting from such analyses is easily damaged and is often low, with cynicism arising where claims of "following the science" are made without accompanying evidence. Tracing the provenance of such decisions back through open software to primary data would clarify this evidence, enhancing the transparency of the decision-making process. Here, we demonstrate a Findable, Accessible, Interoperable and Reusable (FAIR) data pipeline developed during the COVID-19 pandemic that allows easy annotation of data as they are consumed by analyses, while tracing the provenance of scientific outputs back through the analytical source code to data sources. Such a tool provides a mechanism for the public, and fellow scientists, to better assess the trust that should be placed in scientific evidence, while allowing scientists to support policy-makers in openly justifying their decisions. We believe that tools such as this should be promoted for use across all areas of policy-facing research

Trends in the diversity of mortality causes and age-standardised mortality rates among subpopulations within Scotland, 2001-2019

No abstract available