How much of the difference in life expectancy between Scottish cities does deprivation explain?

Seaman, R., Mitchell, R. , Dundas, R. , Leyland, A.H. and Popham, F. (2015) How much of the difference in life expectancy between Scottish cities does deprivation explain? BMC Public Health, 15, 1057. (doi:10.1186/s12889-015-2358-1) (PMID:26474578) (PMCID:PMC4608116)

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Abstract

Background: Glasgow’s low life expectancy and high levels of deprivation are well documented. Studies comparing Glasgow to similarly deprived cities in England suggest an excess of deaths in Glasgow that cannot be accounted for by deprivation. Within Scotland comparisons are more equivocal suggesting deprivation could explain Glasgow’s excess mortality. Few studies have used life expectancy, an intuitive measure that quantifies the between-city difference in years. This study aimed to use the most up-to-date data to compare Glasgow to other Scottish cities and to (i) evaluate whether deprivation could account for lower life expectancy in Glasgow and (ii) explore whether the age distribution of mortality in Glasgow could explain its lower life expectancy. Methods: Sex specific life expectancy was calculated for 2007–2011 for the population in Glasgow and the combined population of Aberdeen, Dundee and Edinburgh. Life expectancy was calculated for deciles of income deprivation, based on the national ranking of datazones, using the Scottish Index of Multiple Deprivation. Life expectancy in Glasgow overall, and by deprivation decile, was compared to that in Aberdeen, Dundee and Edinburgh combined, and the life expectancy difference decomposed by age using Arriaga’s discrete method. Results: Life expectancy for the whole Glasgow population was lower than the population of Aberdeen, Dundee and Edinburgh combined. When life expectancy was compared by national income deprivation decile, Glasgow’s life expectancy was not systematically lower, and deprivation accounted for over 90 % of the difference. This was reduced to 70 % of the difference when carrying out sensitivity analysis using city-specific income deprivation deciles. In both analyses life expectancy was not systematically lower in Glasgow when stratified by deprivation. Decomposing the differences in life expectancy also showed that the age distribution of mortality was not systematically different in Glasgow after accounting for deprivation. Conclusions: Life expectancy is not systematically lower across the Glasgow population compared to Aberdeen, Dundee and Edinburgh combined, once deprivation is accounted for. This provides further evidence that tackling deprivation in Glasgow would probably reduce the health inequalities that exist between Scottish cities. The change in the amount of unexplained difference when carrying out sensitivity analysis demonstrates the difficulties in comparing socioeconomic deprivation between populations, even within the same country and when applying an established ecological measure. Although the majority of health inequality between Glasgow and other Scottish cities is explained by deprivation, the difference in the amount of unexplained inequality depending on the relative context of deprivation used demonstrates the challenges associated with attributing mortality inequalities to an independent ‘place effect’.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Popham, Dr Timothy and Mitchell, Professor Richard and Leyland, Professor Alastair and Dundas, Ms Ruth and Seaman, Rosie
Authors: Seaman, R., Mitchell, R., Dundas, R., Leyland, A.H., and Popham, F.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO Unit
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
College of Social Sciences
Journal Name:BMC Public Health
Publisher:BioMed Central
ISSN:1471-2458
Copyright Holders:Copyright © 2015 Seaman et al.
First Published:First published in BMC Public Health 15:1057
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
656601Measuring Health, Variations in Health and Determinants of HealthAlastair LeylandMedical Research Council (MRC)MC_UU_12017/5IHW - MRC/CSO SPHU
656621Social Patterning of Health over the LifecourseTimothy PophamMedical Research Council (MRC)MC_UU_12017/7IHW - MRC/CSO SPHU
727651SPHSU Core Renewal: Measuring and Analysing Socioeconomic Inequalities in Health Research ProgrammeAlastair LeylandMedical Research Council (MRC)MC_UU_12017/13IHW - MRC/CSO SPHU