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Explaining the excess mortality in Scotland compared with England: pooling of 18 cohort studies

Background Mortality in Scotland is higher than in the rest of west and central Europe and is improving more slowly. Relative to England and Wales, the excess is only partially explained by area deprivation. We tested the extent to which sociodemographic, behavioural, anthropometric and biological f... Full description

Journal Title: Journal of epidemiology and community health (1979) 2015, Vol.69 (1), p.20-27
Main Author: McCartney, Gerry
Other Authors: Russ, Tom C , Walsh, David , Lewsey, Jim , Smith, Michael , Smith, George Davey , Stamatakis, Emmanuel , Batty, G David
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: England: BMJ Publishing Group
ID: ISSN: 0143-005X
Link: https://www.ncbi.nlm.nih.gov/pubmed/25216666
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title: Explaining the excess mortality in Scotland compared with England: pooling of 18 cohort studies
format: Article
creator:
  • McCartney, Gerry
  • Russ, Tom C
  • Walsh, David
  • Lewsey, Jim
  • Smith, Michael
  • Smith, George Davey
  • Stamatakis, Emmanuel
  • Batty, G David
subjects:
  • 1506
  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Alcohol
  • Analysis
  • Cardiovascular disease
  • Cardiovascular Diseases - ethnology
  • Cardiovascular Diseases - mortality
  • Cause of Death - trends
  • Cohort analysis
  • Cohort Studies
  • Comparative analysis
  • Cross-Cultural Comparison
  • Educational attainment
  • England
  • England - epidemiology
  • Female
  • Health behavior
  • Health Behavior - ethnology
  • Health Surveys
  • Humans
  • Hypotheses
  • Life Expectancy
  • Male
  • Middle Aged
  • MORTALITY
  • Mortality and Life Expectancy
  • Neoplasms - ethnology
  • Neoplasms - mortality
  • Polls & surveys
  • Population
  • Proportional Hazards Models
  • PUBLIC HEALTH
  • Scotland
  • Scotland - epidemiology
  • Sex Distribution
  • SOCIAL CLASS
  • Social classes
  • SOCIAL EPIDEMIOLOGY
  • Social networks
  • Socioeconomic Factors
  • Studies
  • Substance-Related Disorders - ethnology
  • Substance-Related Disorders - mortality
  • Usage
  • Young Adult
ispartof: Journal of epidemiology and community health (1979), 2015, Vol.69 (1), p.20-27
description: Background Mortality in Scotland is higher than in the rest of west and central Europe and is improving more slowly. Relative to England and Wales, the excess is only partially explained by area deprivation. We tested the extent to which sociodemographic, behavioural, anthropometric and biological factors explain the higher mortality in Scotland compared with England. Methods Pooled data from 18 nationally representative cohort studies comprising the Health Surveys for England (HSE) and the Scottish Health Survey (SHS). Cox regression analysis was used to quantify the excess mortality risk in Scotland relative to England with adjustment for baseline characteristics. Results A total of 193 873 participants with a mean of 9.6 years follow-up gave rise to 21 345 deaths. The age-adjusted and sex-adjusted all-cause mortality HR for Scottish respondents compared with English respondents was 1.40 (95% CI 1.34 to 1.47), which attenuated to 1.29 (95% CI 1.23 to 1.36) with the addition of the baseline socioeconomic and behavioural characteristics. Cause-specific mortality HRs attenuated only marginally to 1.43 (95% 1.28 to 1.60) for ischaemic heart disease, 1.37 (95% CI 1.15 to 1.63) for stroke, 1.41 (95% CI 1.30 to 1.53) for all cancers, 3.43 (95% CI 1.85 to 6.36) for illicit drug-related poisoning and 4.64 (95% CI 3.55 to 6.05) for alcohol-related mortality. The excess was greatest among young adults (16–44 years) and was observed across all occupational social classes with the greatest excess in the unskilled group. Conclusions Only a quarter of the excess mortality among Scottish respondents could be explained by the available baseline risk factors. Greater understanding is required on the lived experience of poverty, the role of social support, and the historical, environmental, cultural and political influences on health in Scotland.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0143-005X
fulltext: fulltext
issn:
  • 0143-005X
  • 1470-2738
url: Link


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titleExplaining the excess mortality in Scotland compared with England: pooling of 18 cohort studies
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creatorcontribMcCartney, Gerry ; Russ, Tom C ; Walsh, David ; Lewsey, Jim ; Smith, Michael ; Smith, George Davey ; Stamatakis, Emmanuel ; Batty, G David
descriptionBackground Mortality in Scotland is higher than in the rest of west and central Europe and is improving more slowly. Relative to England and Wales, the excess is only partially explained by area deprivation. We tested the extent to which sociodemographic, behavioural, anthropometric and biological factors explain the higher mortality in Scotland compared with England. Methods Pooled data from 18 nationally representative cohort studies comprising the Health Surveys for England (HSE) and the Scottish Health Survey (SHS). Cox regression analysis was used to quantify the excess mortality risk in Scotland relative to England with adjustment for baseline characteristics. Results A total of 193 873 participants with a mean of 9.6 years follow-up gave rise to 21 345 deaths. The age-adjusted and sex-adjusted all-cause mortality HR for Scottish respondents compared with English respondents was 1.40 (95% CI 1.34 to 1.47), which attenuated to 1.29 (95% CI 1.23 to 1.36) with the addition of the baseline socioeconomic and behavioural characteristics. Cause-specific mortality HRs attenuated only marginally to 1.43 (95% 1.28 to 1.60) for ischaemic heart disease, 1.37 (95% CI 1.15 to 1.63) for stroke, 1.41 (95% CI 1.30 to 1.53) for all cancers, 3.43 (95% CI 1.85 to 6.36) for illicit drug-related poisoning and 4.64 (95% CI 3.55 to 6.05) for alcohol-related mortality. The excess was greatest among young adults (16–44 years) and was observed across all occupational social classes with the greatest excess in the unskilled group. Conclusions Only a quarter of the excess mortality among Scottish respondents could be explained by the available baseline risk factors. Greater understanding is required on the lived experience of poverty, the role of social support, and the historical, environmental, cultural and political influences on health in Scotland.
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subject1506 ; Adolescent ; Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Alcohol ; Analysis ; Cardiovascular disease ; Cardiovascular Diseases - ethnology ; Cardiovascular Diseases - mortality ; Cause of Death - trends ; Cohort analysis ; Cohort Studies ; Comparative analysis ; Cross-Cultural Comparison ; Educational attainment ; England ; England - epidemiology ; Female ; Health behavior ; Health Behavior - ethnology ; Health Surveys ; Humans ; Hypotheses ; Life Expectancy ; Male ; Middle Aged ; MORTALITY ; Mortality and Life Expectancy ; Neoplasms - ethnology ; Neoplasms - mortality ; Polls & surveys ; Population ; Proportional Hazards Models ; PUBLIC HEALTH ; Scotland ; Scotland - epidemiology ; Sex Distribution ; SOCIAL CLASS ; Social classes ; SOCIAL EPIDEMIOLOGY ; Social networks ; Socioeconomic Factors ; Studies ; Substance-Related Disorders - ethnology ; Substance-Related Disorders - mortality ; Usage ; Young Adult
ispartofJournal of epidemiology and community health (1979), 2015, Vol.69 (1), p.20-27
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3Copyright: 2014 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
4Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions 2014
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descriptionBackground Mortality in Scotland is higher than in the rest of west and central Europe and is improving more slowly. Relative to England and Wales, the excess is only partially explained by area deprivation. We tested the extent to which sociodemographic, behavioural, anthropometric and biological factors explain the higher mortality in Scotland compared with England. Methods Pooled data from 18 nationally representative cohort studies comprising the Health Surveys for England (HSE) and the Scottish Health Survey (SHS). Cox regression analysis was used to quantify the excess mortality risk in Scotland relative to England with adjustment for baseline characteristics. Results A total of 193 873 participants with a mean of 9.6 years follow-up gave rise to 21 345 deaths. The age-adjusted and sex-adjusted all-cause mortality HR for Scottish respondents compared with English respondents was 1.40 (95% CI 1.34 to 1.47), which attenuated to 1.29 (95% CI 1.23 to 1.36) with the addition of the baseline socioeconomic and behavioural characteristics. Cause-specific mortality HRs attenuated only marginally to 1.43 (95% 1.28 to 1.60) for ischaemic heart disease, 1.37 (95% CI 1.15 to 1.63) for stroke, 1.41 (95% CI 1.30 to 1.53) for all cancers, 3.43 (95% CI 1.85 to 6.36) for illicit drug-related poisoning and 4.64 (95% CI 3.55 to 6.05) for alcohol-related mortality. The excess was greatest among young adults (16–44 years) and was observed across all occupational social classes with the greatest excess in the unskilled group. Conclusions Only a quarter of the excess mortality among Scottish respondents could be explained by the available baseline risk factors. Greater understanding is required on the lived experience of poverty, the role of social support, and the historical, environmental, cultural and political influences on health in Scotland.
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25Life Expectancy
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30Neoplasms - ethnology
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titleExplaining the excess mortality in Scotland compared with England: pooling of 18 cohort studies
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abstractBackground Mortality in Scotland is higher than in the rest of west and central Europe and is improving more slowly. Relative to England and Wales, the excess is only partially explained by area deprivation. We tested the extent to which sociodemographic, behavioural, anthropometric and biological factors explain the higher mortality in Scotland compared with England. Methods Pooled data from 18 nationally representative cohort studies comprising the Health Surveys for England (HSE) and the Scottish Health Survey (SHS). Cox regression analysis was used to quantify the excess mortality risk in Scotland relative to England with adjustment for baseline characteristics. Results A total of 193 873 participants with a mean of 9.6 years follow-up gave rise to 21 345 deaths. The age-adjusted and sex-adjusted all-cause mortality HR for Scottish respondents compared with English respondents was 1.40 (95% CI 1.34 to 1.47), which attenuated to 1.29 (95% CI 1.23 to 1.36) with the addition of the baseline socioeconomic and behavioural characteristics. Cause-specific mortality HRs attenuated only marginally to 1.43 (95% 1.28 to 1.60) for ischaemic heart disease, 1.37 (95% CI 1.15 to 1.63) for stroke, 1.41 (95% CI 1.30 to 1.53) for all cancers, 3.43 (95% CI 1.85 to 6.36) for illicit drug-related poisoning and 4.64 (95% CI 3.55 to 6.05) for alcohol-related mortality. The excess was greatest among young adults (16–44 years) and was observed across all occupational social classes with the greatest excess in the unskilled group. Conclusions Only a quarter of the excess mortality among Scottish respondents could be explained by the available baseline risk factors. Greater understanding is required on the lived experience of poverty, the role of social support, and the historical, environmental, cultural and political influences on health in Scotland.
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