Scottish Longitudinal Study
Development & Support Unit
Does equality legislation reduce intergroup differences? Religious affiliation, socio-economic status and mortality in Scotland and Northern Ireland: A cohort study of 400,000 people
Wright, D., Rosato, M., Raab, G., Dibben, C., Boyle, P. & O'Reilly, D. (2017) Health and Place, 45 (May), 32 - 38 [SLS][NILS]
Religion frequently indicates membership of socio-ethnic groups with distinct health behaviours and mortality risk. Determining the extent to which interactions between groups contribute to variation in mortality is often challenging. We compared socio-economic status (SES) and mortality rates of Protestants and Catholics in Scotland and Northern Ireland, regions in which interactions between groups are profoundly different. Crucially, strong equality legislation has been in place for much longer and Catholics form a larger minority in Northern Ireland. Drawing linked Census returns and mortality records of 404,703 people from the Scottish and Northern Ireland Longitudinal Studies, we used Poisson regression to compare religious groups, estimating mortality rates and incidence rate ratios. We fitted age-adjusted and fully adjusted (for education, housing tenure, car access and social class) models. Catholics had lower SES than Protestants in both countries; the differential was larger in Scotland for education, housing tenure and car access but not social class. In Scotland, Catholics had increased age-adjusted mortality risk relative to Protestants but variation among groups was attenuated following adjustment for SES. Those reporting no religious affiliation were at similar mortality risk to Protestants. In Northern Ireland, there was no mortality differential between Catholics and Protestants either before or after adjustment. Men reporting no religious affiliation were at increased mortality risk but this differential was not evident among women. In Scotland, Catholics remained at greater socio-economic disadvantage relative to Protestants than in Northern Ireland and were also at a mortality disadvantage. This may be due to a lack of explicit equality legislation that has decreased inequality by religion in Northern Ireland during recent decades.
Available online: Health and Place,
Output from project: 2011_005 (SLS), 071 (NILS)
Do differences in religious affiliation explain high levels of excess mortality in the UK?
Ralston, K., Walsh, D., Feng, Z., Dibben, C., McCartney, G. & O'Reilly, D. (2017) Journal of Epidemiology & Community Health (Online First), 7 March 2017. [SLS][ONS LS]
Background High levels of mortality not explained by differences in socioeconomic status (SES) have been observed for Scotland and its largest city, Glasgow, compared with elsewhere in the UK. Previous cross-sectional research highlighted potentially relevant differences in social capital, including religious social capital (the benefits of social participation in organised religion). The aim of this study was to use longitudinal data to assess whether religious affiliation (as measured in UK censuses) attenuated the high levels of Scottish excess mortality.
Methods The study used the Scottish Longitudinal Study (SLS) and the ONS Longitudinal Study of England and Wales. Risk of all-cause mortality (2001–2010) was compared between residents aged 35 and 74 years of Scotland and England and Wales, and between Glasgow and Liverpool/Manchester, using Poisson regression. Models adjusted for age, gender, SES and religious affiliation. Similar country-based analyses were undertaken for suicide.
Results After adjustment for age, gender and SES, all-cause mortality was 9% higher in Scotland than in England and Wales, and 27% higher in Glasgow than in Liverpool or Manchester. Religious affiliation was notably lower across Scotland; but, its inclusion in the models did not attenuate the level of Scottish excess all-cause mortality, and only marginally lowered the differences in risk of suicide.
Conclusions Differences in religious affiliation do not explain the higher mortality rates in Scotland compared with the rest of the UK. However, it is possible that other aspects of religion such as religiosity or religious participation which were not assessed here may still be important.
Pathways between Socioeconomic Disadvantage and Childhood Growth in the Scottish Longitudinal Study, 1991–2001
Silverwood, R.J., Williamson, L., Grundy, E.M. & De Stavola, B.L. (2016) PLOS One 11 (10), e0164853 [SLS]
Socioeconomically disadvantaged children are more likely to be of shorter stature and overweight, leading to greater risk of obesity in adulthood. Disentangling the mediatory pathways between socioeconomic disadvantage and childhood size may help in the development of appropriate policies aimed at reducing these health inequalities. We aimed to elucidate the putative mediatory role of birth weight using a representative sample of the Scottish population born 1991–2001 (n = 16,628). Estimated height and overweight/obesity at age 4.5 years were related to three measures of socioeconomic disadvantage (mother’s education, Scottish Index of Multiple Deprivation, synthetic weekly income). Mediation was examined using two approaches: a ‘traditional’ mediation analysis and a counterfactual-based mediation analysis. Both analyses identified a negative effect of each measure of socioeconomic disadvantage on height, mediated to some extent by birth weight, and a positive ‘direct effect’ of mother’s education and Scottish Index of Multiple Deprivation on overweight/obesity, which was partly counterbalanced by a negative ‘indirect effect’. The extent of mediation estimated when adopting the traditional approach was greater than when adopting the counterfactual-based approach because of inappropriate handling of intermediate confounding in the former. Our findings suggest that higher birth weight in more disadvantaged groups is associated with reduced social inequalities in height but also with increased inequalities in overweight/obesity.
Gender, Occupation and First Birth: Do ‘Career Men’ Delay First Birth Too?
Ralston, K., Gayle, V. & Lambert, P. (2016) Sociological Research Online, 21 (1), 3. 28 February 2016. [SLS]
In the period following the turn of the Century European total fertility rates (TFR) dropped to well below replacement. Work examining this highlights that cohort postponement in births contributes to low TFRs. It is generally recognised that women in more advantaged occupations often postpone childbearing in contrast to those in less advantaged occupational groups. However, relatively little research has been conducted on men in similar terms. This paper contrasts the timing of first birth by occupational class between men and women using individual level data in a case study of Scotland. The data are an extract from the Scottish Longitudinal Study (SLS). This provides a 5.3% sample of the population of Scotland from the 1991 Census. The research applies the Cox proportional hazard model to estimate the speed to first birth during a period of observation between 1991 and 2006. Class is measured using NS-SEC 8 class analytic version. The model controls marital status, educational attainment, raised religion and urban-rural geography. It is found that 'career men' who occupy more advantaged occupational positions do not delay first birth in contrast to men in other occupational categories. This is in contrast to the well-known phenomenon of career women who have later childbearing. Our analysis shows that gender inequalities in how the social structure influences childbearing offer an avenue of explanation for wider patterns of social inequality.
Parental socioeconomic influences on filial educational outcomes in Scotland: patterns of school-level educational performance using administrative data
Playford, C., Gayle, V., Connelly, R. & Murray, S. (2016) Contemporary Social Science: Journal of the Academy of Social Sciences. 16 May 2016. [SLS]
In Britain there have been manifest changes in the management and organisation of education, but despite these developments there are still persistent inequalities in pupils’ educational outcomes. These inequalities are consequential because school qualifications are known to influence both pupils’ immediate continuation in education, and their later educational and occupational outcomes. The Scottish school system is similar to the system in England and Wales but there are a distinctive set of qualifications. From the mid-1980s until 2013 the final years of compulsory schooling led up to Standard Grade qualifications. Standard Grades were similar to the General Certificates of Secondary Education (GCSEs) and are worthy of detailed sociological examination because they were the first major branching point in the Scottish education system. A specialist dataset using administrative records was constructed for this project. The dataset comprises young people who undertook Standard Grades in Scottish schools between 2007 and 2011, who were members of the Scottish Longitudinal Study (SLS). We analyse pupils’ subject-area outcomes using a latent variable modelling approach, and explore characteristics associated with the membership of latent educational groups. The analyses uncovered four main latent educational groups. One group had very positive outcomes and pupils were generally more socially advantaged; another group had very poor outcomes and were generally more socially disadvantaged. There were two ‘middle’ groups, which both had similar moderate overall Standard Grade outcomes, but notably different subject-area-level outcomes. We conclude that during school hours these pupils are unlikely to be found drinking Iron Brew WKD in their local parks or at home playing on their Xbox; however, they are also unlikely to be filling out university application forms in the next couple of years.
Available online: Contemporary Social Science: Journal of the Academy of Social Sciences.
Output from project: 2014_005
Comments on four papers on synthetic data in Volume 32 Issue 1 the Statistical Journal of the IAOS
Raab, G. (2016) Statistical Journal of the IAOS 32, 267 - 269 [SLS]
Available online: Statistical Journal of the IAOS
Do young people not in education, employment or training experience long-term occupational scarring? A longitudinal analysis over 20 years of follow-up
Ralston, K., Feng, Z., Everington, D. & Dibben, C. (2016) Contemporary Social Science: Journal of the Academy of Social Sciences. [SLS]
Not in education, employment or training (NEET) is a contested concept in the literature. However, it is consistently used by policy-makers and shown in research to be associated with negative outcomes. In this paper we examine whether NEET status is associated with subsequent occupational scarring using the Scottish Longitudinal Study which provides a 5.3% sample of Scotland, based on the censuses of 1991, 2001 and 2011. We model occupational position, using CAMSIS, controlling for the influence of sex, limiting long-term illness, educational attainment and geographical deprivation. We find the NEET categorisation to be a strong marker of subsequent negative outcomes at the aggregate level. This appears to be redolent of a Matthew effect, whereby disadvantage accumulates to the already disadvantaged. Our results also show that negative NEET effects are variable when stratifying by educational attainment and are different for men and women. These findings confirm that there are negative effects on occupational position associated with prior NEET status but that outcomes are heterogeneous depending on levels of education and gender.
Available online: Contemporary Social Science: Journal of the Academy of Social Sciences.
Output from project: 2013_005
Living in stressful neighbourhoods during pregnancy: an observational study of crime rates and birth outcomes
Clemens, T. & Dibben, C. (2016) European Journal of Public Health, early access version [SLS]
Background: Patterns of adverse birth outcomes vary spatially and there is evidence that this may relate to features of the physical environment such as air pollution. However, other social characteristics of the environment such as levels of crime are relatively understudied. This study examines the association between crime rates and birth weight and prematurity. Methods: Maternity inpatient data recorded at birth, including residential postcode, was linked to a representative 5% sample of Scottish Census data and small area crime rates from Scottish Police forces. Coefficients associated with crime were reported from crude and confounder adjusted models predicting low birth weight (< 2500 g), mean birthweight, small for gestational age and prematurity for all singleton live births. Results: Total crime rates were associated with strong and significant reductions in mean birth weight and increases in the risks of both a small for gestational age baby and premature birth. These effects, with the exception of prematurity, were robust to adjustment for individual characteristics including smoking, ethnicity and other socio-economic variables as well as area based confounders including air pollution. Mean birth weight was robust to additional adjustment for neighbourhood income deprivation. Conclusion: The level of crime in a mother’s area of residence, which may be a proxy for the degree of threat felt and therefore stress experienced, appears to be an important determinant of the risk of adverse birth outcomes.
A synthetic Longitudinal Study dataset for England and Wales
Dennett, A., Norman, P., Shelton, N. & Stuchbury, R. (2016) Data in Brief [SLS][ONS LS][NILS][CALLS]
This article describes the new synthetic England and Wales Longitudinal Study ‘spine’ dataset designed for teaching and experimentation purposes. In the United Kingdom, there exist three Census-based longitudinal micro-datasets, known collectively as the Longitudinal Studies. The England and Wales Longitudinal Study (LS) is a 1% sample of the population of England and Wales (around 500,000 individuals), linking individual person records from the 1971 to 2011 Censuses. The synthetic data presented contains a similar number of individuals to the original data and accurate longitudinal transitions between 2001 and 2011 for key demographic variables, but unlike the original data, is open access.
SLS project page ONS LS project page NILS project page
Inequalities in mental health: geographical perspectives
Curtis, S., Everington, D. & Niedzwiedz, C. (2016) The Geographer, Summer, 2016. Royal Scottish Geographical Society. [SLS]
When discussing health inequalities, it is important to consider mental as well as physical health. Mental health issues affect a large proportion of the population in countries around the globe. For example, NHS Health Scotland reported that ~15% of the adult Scotland population who participated in the Scottish Health Survey reported common mental health problems in response to the General Health Questionnaire.
The pattern of mental disorders is socially uneven, and people in more disadvantaged groups tend to be more likely to suffer from problems with their mental health. The places where we live are important for mental health inequalities, as well as individual and family factors.
Available online: https://rsgs.org/wp-content/uploads/2016/09/RSGS-The-Geographer-summer-2016.pdf
Output from project: 2015_015
Place of work and residential exposure to ambient air pollution and birth outcomes in Scotland, using geographically fine pollution climate mapping estimates
Dibben, C. & Clemens, T. (2015) Environmental Research, 140 (July), 535 - 541 [SLS]
A relationship between ambient air pollution and adverse birth outcomes has been found in a large number of studies that have mainly used a nearest monitor methodology. Recent research has suggested that the effect size may have been underestimated in these studies. This paper examines associations between birth outcomes and ambient levels of residential and workplace sulphur dioxide, particulates and Nitrogen Dioxide estimated using an alternative method – pollution climate mapping.
Risk of low birthweight and mean birthweight (for n=21,843 term births) and risk of preterm birth (for n=23,086 births) were modelled against small area annual mean ambient air pollution concentrations at work and residence location adjusting for potential confounding factors for singleton live births (1994–2008) across Scotland.
Odds ratios of low birthweight of 1.02 (95% CI, 1.01–1.03) and 1.07 (95% CI, 1.01–1.12) with concentration increases of 1 µg/m3 for NO2 and PM10 respectively. Raised but insignificant risks of very preterm birth were found with PM10 (relative risk ratio=1.08; 95% CI, 1.00 to 1.17 per 1 µg/m3) and NO2 (relative risk ratio=1.01; 95% CI, 1.00 to 1.03 per 1 µg/m3). An inverse association between mean birthweight and mean annual NO2(−1.24 g; 95% CI, −2.02 to −0.46 per 1 µg/m3) and PM10 (−5.67 g; 95% CI, −9.47 to −1.87 per 1 µg/m3). SO2 showed no significant associations.
This study highlights the association between air pollution exposure and reduced newborn size at birth. Together with other recent work it also suggests that exposure estimation based on the nearest monitor method may have led to an under-estimation of the effect size of pollutants on birth outcomes.
Mortality differences and inequalities within and between ‘protected characteristics’ groups, in a Scottish Cohort 1991–2009
Millard, A.D., Raab, G., Lewsey, J., Eaglesham, P., Craig, P., Ralston, K. & McCartney, G. (2015) International Journal for Equity in Health, 14: 142 [SLS]
Background Little is known about the interaction between socio-economic status and ‘protected characteristics’ in Scotland. This study aimed to examine whether differences in mortality were moderated by interactions with social class or deprivation. The practical value was to pinpoint population groups for priority action on health inequality reduction and health improvement rather than a sole focus on the most deprived socioeconomic groups.
Methods We used data from the Scottish Longitudinal Study which captures a 5.3 % sample of Scotland and links the censuses of 1991, 2001 and 2011. Hazard ratios for mortality were estimated for those protected characteristics with sufficient deaths using Cox proportional hazards models and through the calculation of European age-standardised mortality rates. Inequality was measured by calculating the Relative Index of Inequality (RII).
Results The Asian population had a polarised distribution across deprivation deciles and was more likely to be in social class I and II. Those reporting disablement were more likely to live in deprived areas, as were those raised Roman Catholic, whilst those raised as Church of Scotland or as ‘other Christian’ were less likely to. Those aged 35-54 years were the least likely to live in deprived areas and were most likely to be in social class I and II. Males had higher mortality than females, and disabled people had higher mortality than non-disabled people, across all deprivation deciles and social classes. Asian males and females had generally lower mortality hazards than majority ethnic (‘White’) males and females although the estimates for Asian males and females were imprecise in some social classes and deprivation deciles. Males and females who reported their raised religion as Roman Catholic or reported ‘No religion’ had generally higher mortality than other groups, although the estimates for ‘Other religion’ and ‘Other Christian’ were less precise.Using both the area deprivation and social class distributions for the whole population, relative mortality inequalities were usually greater amongst those who did not report being disabled, Asians and females aged 35-44 years, males by age, and people aged <75 years. The RIIs for the raised religious groups were generally similar or too imprecise to comment on differences.
Conclusions Mortality in Scotland is higher in the majority population, disabled people, males, those reporting being raised as Roman Catholics or with ‘no religion’ and lower in Asians, females and other religious groups. Relative inequalities in mortality were lower in disabled than nondisabled people, the majority population, females, and greatest in young adults. From the perspective of intersectionality theory, our results clearly demonstrate the importance of representing multiple identities in research on health inequalities.
Inequalities in Alcohol-Related Mortality in 17 European Countries: A Retrospective Analysis of Mortality Registers
Mackenbach, J.P., Kulhánová, I., Bopp, M., Borrell, C., Deboosere, P., Kovács, K., Looman, C.W.N., Leinsalu, M., Mäkelä, P., Martikainen, P., Menvielle, G., Rodríguez-Sanz, M., Rychtaříková, J. & de Gelder, R. (2015) PLOS Medicine, e1001909, 1 December 2015. [SLS]
Background Socioeconomic inequalities in alcohol-related mortality have been documented in several European countries, but it is unknown whether the magnitude of these inequalities differs between countries and whether these inequalities increase or decrease over time.
Methods and Findings We collected and harmonized data on mortality from four alcohol-related causes (alcoholic psychosis, dependence, and abuse; alcoholic cardiomyopathy; alcoholic liver cirrhosis; and accidental poisoning by alcohol) by age, sex, education level, and occupational class in 20 European populations from 17 different countries, both for a recent period and for previous points in time, using data from mortality registers. Mortality was age-standardized using the European Standard Population, and measures for both relative and absolute inequality between low and high socioeconomic groups (as measured by educational level and occupational class) were calculated.
Rates of alcohol-related mortality are higher in lower educational and occupational groups in all countries. Both relative and absolute inequalities are largest in Eastern Europe, and Finland and Denmark also have very large absolute inequalities in alcohol-related mortality. For example, for educational inequality among Finnish men, the relative index of inequality is 3.6 (95% CI 3.3–4.0) and the slope index of inequality is 112.5 (95% CI 106.2–118.8) deaths per 100,000 person-years. Over time, the relative inequality in alcohol-related mortality has increased in many countries, but the main change is a strong rise of absolute inequality in several countries in Eastern Europe (Hungary, Lithuania, Estonia) and Northern Europe (Finland, Denmark) because of a rapid rise in alcohol-related mortality in lower socioeconomic groups. In some of these countries, alcohol-related causes now account for 10% or more of the socioeconomic inequality in total mortality.
Because our study relies on routinely collected underlying causes of death, it is likely that our results underestimate the true extent of the problem.
Conclusions Alcohol-related conditions play an important role in generating inequalities in total mortality in many European countries. Countering increases in alcohol-related mortality in lower socioeconomic groups is essential for reducing inequalities in mortality. Studies of why such increases have not occurred in countries like France, Switzerland, Spain, and Italy can help in developing evidence-based policies in other European countries.
Obesity and the potential reduction of social inequalities in mortality: evidence from 21 European populations
Hoffman, R., Eikemo, T.A., Kulhánová, I., Kulik, M.C., Looman, C., Menvielle, G., Deboosere, P., Martikainen, P., Regidor, E. & Mackenbach, J.P. (2015) European Journal of Public Health, 25 (5), 849 - 856. 25 May 2015. [SLS]
Background: Obesity contributes considerably to the problem of health inequalities in many countries, but quantitative estimates of this contribution and to what extent it is modifiable are scarce. We identify the potential for reducing educational inequalities in all-cause and obesity-related mortality in 21 European populations, by modifying educational differences in obesity and overweight. Methods: Prevalence data and mortality data come from 21 European populations. Mortality rate ratios come from literature reviews. We use the population attributable fraction (PAF) to estimate the impact of scenario-based changes in the social distribution of obesity on educational inequalities in mortality. Results: An elimination of differences in obesity between educational groups would decrease relative inequality in all-cause mortality between those with high and low education by up to 12% for men and 42% for women. About half of the relative inequality in mortality could be reduced for some causes of death in several countries, often in southern Europe. Absolute inequalities in all-cause mortality would be reduced by up to 69 (men) and 67 (women) deaths per 100 000 person-years. Conclusion: The potential reduction of health inequality by an elimination of social inequalities in obesity might be substantial. The reductions differ by country, cause of death and gender, suggesting that the priority given to obesity as an entry-point for tackling health inequalities should differ between countries and gender.
What is the effect of unemployment on all-cause mortality? A cohort study using propensity score matching
Clemens, T., Popham, F. & Boyle, P. (2015) European Journal of Public Health, 25 (1), 115 - 121 [SLS]
Background: There is a strong association between unemployment and mortality, but whether this relationship is causal remains debated. This study utilizes population-level administrative data from Scotland within a propensity score framework to explore whether the association between unemployment and mortality may be causal.
Methods: The study examined a sample of working men and women aged 25–54 in 1991. Subsequent employment status in 2001 was observed (in work or unemployed) and the relative all-cause mortality risk of unemployment between 2001 and 2010 was estimated. To account for potential selection into unemployment of those in poor health, a propensity score matching approach was used. Matching variables were observed prior to unemployment and included health status up to the year of unemployment (hospital admissions and self-reported limiting long-term illness), as well as measures of socioeconomic position.
Results: Unemployment was associated with a significant all-cause mortality risk relative to employment for men (hazard ratio [HR] 1.85; 95% confidence interval [CI] 1.33–2.55). This effect was robust to controlling for prior health and sociodemographic characteristics. Effects for women were smaller and statistically insignificant (HR 1.51; 95% CI 0.68–3.37).
Conclusion: For men, the findings support the notion that the often-observed association between unemployment and mortality may contain a significant causal component; although for women, there is less support for this conclusion. However, female employment status, as recorded in the census, is more complex than for men and may have served to underestimate any mortality effect of unemployment. Future work should examine this issue further.
Association between Socioeconomic Factors and Cancer Risk: A Population Cohort Study in Scotland (1991-2006)
Sharpe, K.H., McMahon, A.D., Raab, G.M., Brewster, D.H. & Conway, D.I. (2014) PLoS ONE 9 (2), e89513. 27 February 2014. [SLS]
Background Lung and upper aero-digestive tract (UADT) cancer risk are associated with low socioeconomic circumstances and routinely measured using area socioeconomic indices. We investigated effect of country of birth, marital status, one area deprivation measure and individual socioeconomic variables (economic activity, education, occupational social class, car ownership, household tenure) on risk associated with lung, UADT and all cancer combined (excluding non melanoma skin cancer).
Methods We linked Scottish Longitudinal Study and Scottish Cancer Registry to follow 203,658 cohort members aged 15+ years from 1991–2006. Relative risks (RR) were calculated using Poisson regression models by sex offset for person-years of follow-up.
Results 21,832 first primary tumours (including 3,505 lung, 1,206 UADT) were diagnosed. Regardless of cancer, economically inactivity (versus activity) was associated with increased risk (male: RR 1.14, 95% CI 1.10–1.18; female: RR 1.06, 95% CI 1.02–1.11). For lung cancer, area deprivation remained significant after full adjustment suggesting the area deprivation cannot be fully explained by individual variables. No or non degree qualification (versus degree) was associated with increased lung risk; likewise for UADT risk (females only). Occupational social class associations were most pronounced and elevated for UADT risk. No car access (versus ownership) was associated with increased risk (excluding all cancer risk, males). Renting (versus home ownership) was associated with increased lung cancer risk, UADT cancer risk (males only) and all cancer risk (females only). Regardless of cancer group, elevated risk was associated with no education and living in deprived areas.
Conclusions Different and independent socioeconomic variables are inversely associated with different cancer risks in both sexes; no one socioeconomic variable captures all aspects of socioeconomic circumstances or life course. Association of multiple socioeconomic variables is likely to reflect the complexity and multifaceted nature of deprivation as well as the various roles of these dimensions over the life course.
A simplified approach to generating synthetic data for disclosure control
Raab, G., Nowok, B. & Dibben, C. (2014) arXiv.org (arXiv:1409.0217v2), [SLS]
We describe results on the creation and use of synthetic data that were derived in the context of a project to make synthetic extracts available for users of the UK Longitudinal Studies. Contrary to the existing literature we show that there are circumstances when inferences can be made from fully synthetic data generated from fitted parameters without sampling from their posterior distributions (simple synthesis). The condition that allows this, which we describe as "common-sampling", is that the original sample and the synthetic data can be considered as sampled in the same way from their respective populations. New variance estimators for the analysis of synthetic data are derived when the common-sampling condition is met. It is shown that simple synthesis, with these estimators, provide better estimates than the methods suggested in the literature for fully synthetic data. The results are confirmed by simulations and are illustrated with an example from the Scottish Longitudinal Study.
Population ageing and healthcare expenditure projections: new evidence from a time to death approach
Gaue, C., Briggs, A., Lewsey, J. & Lorgelly, P. (2014) European Journal of Health Economics, 15 (8), 885 - 896 [SLS]
Health care expenditure (HCE) is not distributed evenly over a person’s life course. How much is spent on the elderly is important as they are a population group that is increasing in size. However other factors, such as death-related costs that are known to be high, need be considered as well in any expenditure projections and budget planning decisions.
This article analyses, for the first time in Scotland, how expenditure projections for acute inpatient care are influenced when applying two different analytical approaches: (1) accounting for healthcare (HC) spending at the end of life and (2) accounting for demographic changes only. The association between socioeconomic status and HC utilisation and costs at the end of life is also estimated.
A representative, longitudinal data set is used. Survival analysis is employed to allow inclusion of surviving sample members. Cost estimates are derived from a two-part regression model. Future population estimates were obtained for both methods and multiplied separately by cost estimates.
Time to death (TTD), age at death and the interaction between these two have a significant effect on HC costs. As individuals approach death, those living in more deprived areas are less likely to be hospitalised than those individuals living in the more affluent areas, although this does not translate into incurring statistically significant higher costs. Projected HCE for acute inpatient care for the year 2028 was approximately 7 % higher under the demographic approach as compared to a TTD approach.
The analysis showed that if death is postponed into older ages, HCE (and HC budgets) would not increase to the same extent if these factors were ignored. Such factors would be ignored if the population that is in their last year(s) of life were not taken into consideration when obtaining cost estimates.
A Longitudinal Study of Migration Propensities for Mixed-Ethnic Unions in England and Wales
Feng, Z., van Ham, M., Boyle, P. & Raab, G. (2014) Journal of Ethnic and Migration Studies, 40 (3), 384-403. 4 March 2014. ISSN: 1369-183X [SLS][ONS LS]
Most studies investigating residential segregation of ethnic minorities ignore the fact that the majority of adults live in couples. In recent years there has been a growth in the number of mixed-ethnic unions that involve a minority member and a white member. To our knowledge, hardly any research has been undertaken to explicitly examine whether the ethnic mix within households has an impact on the residential mobility of households in terms of the ethnic mix of destination neighbourhoods. Our study addresses this research gap and examines the tendencies of mobility among mixed- ethnic unions in comparison with their co-ethnic peers. We used data from the Longitudinal Study for England and Wales. Our statistical analysis supports the spatial assimilation theory; ethnic minorities move towards less deprived areas and to a lesser extent also towards less ethnically concentrated areas. However, the types of destination neighbourhood of minority people living in mixed-ethnic unions varied greatly with the ethnicity of the ethnic minority partner.
Occupational Class Inequalities in All-Cause and Cause-Specific Mortality among Middle-Aged Men in 14 European Populations during the Early 2000s
Toch-Marquardt, M., Menvielle, G., Eikemo, T.A., Kulhánová, I., Kulik, M.C., Bopp, M., Esnaola, S., Jailionis, D., Mäki, N., Martikainen, P., Regidor, E., Lundberg, O. & Mackenback, J.P. (2014) PLOS One, 9 (9), e108072 30 September 2014. [SLS]
This study analyses occupational class inequalities in all-cause mortality and four specific causes of death among men, in Europe in the early 2000s, and is the most extensive comparative analysis of occupational class inequalities in mortality in Europe so far. Longitudinal data, obtained from population censuses and mortality registries in 14 European populations, from around the period 2000–2005, were used. Analyses concerned men aged 30–59 years and included all-cause mortality and mortality from all cancers, all cardiovascular diseases (CVD), all external, and all other causes. Occupational class was analysed according to five categories: upper and lower non-manual workers, skilled and unskilled manual workers, and farmers and self-employed combined. Inequalities were quantified with mortality rate ratios, rate differences, and population attributable fractions (PAF). Relative and absolute inequalities in all-cause mortality were more pronounced in Finland, Denmark, France, and Lithuania than in other populations, and the same countries (except France) also had the highest PAF values for all-cause mortality. The main contributing causes to these larger inequalities differed strongly between countries (e.g., cancer in France, all other causes in Denmark). Relative and absolute inequalities in CVD mortality were markedly lower in Southern European populations. We conclude that relative and absolute occupational class differences in all-cause and cause specific mortality have persisted into the early 2000's, although the magnitude differs strongly between populations. Comparisons with previous studies suggest that the relative gap in mortality between occupational classes has further widened in some Northern and Western European populations.
How can inequalities in mortality be reduced? A quantitative analysis of 6 risk factors in 21 European populations
Eikemo, T.A., Hoffman, R., Kulik, M.C., Kulhánová, I., Toch-Marquardt, M., Menvielle, G., Looman, C., Jasilionis, D., Martikainen, P., Lundberg, O. & Mackenbach, J. (2014) PLOS One, 9 (11), e110952. 4 November 2014. [SLS]
BACKGROUND: Socioeconomic inequalities in mortality are one of the greatest challenges for health policy in all European countries, but the potential for reducing these inequalities is unclear. We therefore quantified the impact of equalizing the distribution of six risk factors for mortality: smoking, overweight, lack of physical exercise, lack of social participation, low income, and economic inactivity.
METHODS: We collected and harmonized data on mortality and risk factors by educational level for 21 European populations in the early 2000s. The impact of the risk factors on mortality in each educational group was determined using Population Attributable Fractions. We estimated the impact on inequalities in mortality of two scenarios: a theoretical upward levelling scenario in which inequalities in the risk factor were completely eliminated, and a more realistic best practice scenario, in which inequalities in the risk factor were reduced to those seen in the country with the smallest inequalities for that risk factor.
FINDINGS: In general, upward levelling of inequalities in smoking, low income and economic inactivity hold the greatest potential for reducing inequalities in mortality. While the importance of low income is similar across Europe, smoking is more important in the North and East, and overweight in the South. On the basis of best practice scenarios the potential for reducing inequalities in mortality is often smaller, but still substantial in many countries for smoking and physical inactivity.
INTERPRETATION: Theoretically, there is a great potential for reducing inequalities in mortality in most European countries, for example by equity-oriented tobacco control policies, income redistribution and employment policies. Although it is necessary to achieve substantial degrees of upward levelling to make a notable difference for inequalities in mortality, the existence of best practice countries with more favourable distributions for some of these risk factors suggests that this is feasible.
Assessing the potential impact of increased participation in higher education on mortality: evidence from 21 European populations
Kulhánova, I., Hoffman, R., Judge, K., Looman, C.W., Eikemo, T.A., Bopp, M., Deboosere, P., Leinsalu, M., Martikainen, P., Rychtariková, J., Wojtyniak, B., Menvielle, G. & Mackenbach, J.P. (2014) Social Science & Medicine, 117 (September), 142 - 149. 30 September 2014. [SLS]
Although higher education has been associated with lower mortality rates in many studies, the effect of potential improvements in educational distribution on future mortality levels is unknown. We therefore estimated the impact of projected increases in higher education on mortality in European populations. We used mortality and population data according to educational level from 21 European populations and developed counterfactual scenarios. The first scenario represented the improvement in the future distribution of educational attainment as expected on the basis of an assumption of cohort replacement. We estimated the effect of this counterfactual scenario on mortality with a 10–15-year time horizon among men and women aged 30–79 years using a specially developed tool based on population attributable fractions (PAF). We compared this with a second, upward levelling scenario in which everyone has obtained tertiary education. The reduction of mortality in the cohort replacement scenario ranged from 1.9 to 10.1% for men and from 1.7 to 9.0% for women. The reduction of mortality in the upward levelling scenario ranged from 22.0 to 57.0% for men and from 9.6 to 50.0% for women. The cohort replacement scenario was estimated to achieve only part (4–25% (men) and 10–31% (women)) of the potential mortality decrease seen in the upward levelling scenario. We concluded that the effect of on-going improvements in educational attainment on average mortality in the population differs across Europe, and can be substantial. Further investments in education may have important positive side-effects on population health.
DataSHIELD: taking the analysis to the data, not the data to the analysis
Gaye, A., Marcon, Y., Isaeva, J., LaFlamme, P., Turner, A., Jones, E.M., Minion, J., Boyd, A.W., Newby, C.J., Nuotio, M., Wilson, R., Butters, O., Murtagh, B., Demir, I., Doiron, D., Giepmans, L., Wallace, S.E., Budin-Ljøsne, I., Schmidt, C.O., Boffetta, P., Boniol, M., Bota, M., Carter, K.W., deKlerk, N., Dibben, C., Francis, R.W., Hiekkalinna, T., Hveem, K., Kvaløy, K., Millar, S., Perry, I.J., Peters, A., Phillips, C.M., Popham, F., Raab, G., Reischl, E., Sheehan, N., Waldenberger, M., Perola, M., van den Heuvel, E., Macleod, J., Knoppers, B.M., Stolk, R.P., Fortier, I., Harris, J.R., Woffenbuttel, B.H.R., Murtagh, M.J., Ferretti, V. & Burton, P.R. (2014) International Journal of Epidemiology 43 (6), 1929 - 1944 26 September 2014. [SLS]
Background: Research in modern biomedicine and social science requires sample sizes so large that they can often only be achieved through a pooled co-analysis of data from several studies. But the pooling of information from individuals in a central database that may be queried by researchers raises important ethico-legal questions and can be controversial. In the UK this has been highlighted by recent debate and controversy relating to the UK’s proposed ‘care.data’ initiative, and these issues reflect important societal and professional concerns about privacy, confidentiality and intellectual property. DataSHIELD provides a novel technological solution that can circumvent some of the most basic challenges in facilitating the access of researchers and other healthcare professionals to individual-level data.
Methods: Commands are sent from a central analysis computer (AC) to several data computers (DCs) storing the data to be co-analysed. The data sets are analysed simultaneously but in parallel. The separate parallelized analyses are linked by non-disclosive summary statistics and commands transmitted back and forth between the DCs and the AC. This paper describes the technical implementation of DataSHIELD using a modified R statistical environment linked to an Opal database deployed behind the computer firewall of each DC. Analysis is controlled through a standard R environment at the AC.
Results: Based on this Opal/R implementation, DataSHIELD is currently used by the Healthy Obese Project and the Environmental Core Project (BioSHaRE-EU) for the federated analysis of 10 data sets across eight European countries, and this illustrates the opportunities and challenges presented by the DataSHIELD approach.
Conclusions: DataSHIELD facilitates important research in settings where: (i) a co-analysis of individual-level data from several studies is scientifically necessary but governance restrictions prohibit the release or sharing of some of the required data, and/or render data access unacceptably slow; (ii) a research group (e.g. in a developing nation) is particularly vulnerable to loss of intellectual property—the researchers want to fully share the information held in their data with national and international collaborators, but do not wish to hand over the physical data themselves; and (iii) a data set is to be included in an individual-level co-analysis but the physical size of the data precludes direct transfer to a new site for analysis.
Available online: International Journal of Epidemiology
Smoking and the potential for reduction of inequalities in mortality in Europe
Kulik, M.C., Hoffmann, R., Judge, K., Looman, C., Menvielle, G., Kulhánová, I., Toch, M., Östergren, O., Martikainen, P., Borrell, C., Rodríguez-Sanz, M., Bopp, M., Leinsalu, M., Jasilionis, D., Eikemo, T.A. & Mackenbach, J.P. (2013) European Journal of Epidemiology, 28 (12), 959 - 971 [SLS]
Socioeconomic inequalities in health and mortality remain a widely recognized problem. Countries with smaller inequalities in smoking have smaller inequalities in mortality, and smoking plays an important part in the explanation of inequalities in some countries. We identify the potential for reducing inequalities in all-cause and smoking-related mortality in 19 European populations, by applying different scenarios of smoking exposure. Smoking prevalence information and mortality data come from 19 European populations. Prevalence rates are mostly taken from National Health Surveys conducted around the year 2000. Mortality rates are based on country-specific longitudinal or cross-sectional datasets. Relative risks come from the Cancer Prevention Study II. Besides all-cause mortality we analyze several smoking-related cancers and chronic obstructive pulmonary disease/asthma. We use a newly-developed tool to quantify the changes in population health potentially resulting from modifying the population distribution of exposure to smoking. This tool is based on the epidemiological measure of the population attributable fraction, and estimates the impact of scenario-based distributions of smoking on educational inequalities in mortality. The potential reduction of relative inequality in all-cause mortality between those with high and low education amounts up to 26 % for men and 32 % for women. More than half of the relative inequality may be reduced for some causes of death, often in countries of Northern Europe and in Britain. Patterns of potential reduction in inequality differ by country or region and sex, suggesting that the priority given to smoking as an entry-point for tackling health inequalities should differ between countries.
Population ageing in Scotland: Time for a re-think?
Spijker, J. & MacInnes, J. (2013) Scottish Affairs, 85 (autumn 2013), 53 - 74 [SLS]
Population ageing: the timebomb that isn’t?
Spijker, J. & MacInnes, J. (2013) BMJ, 347 (6598), [SLS]
Population ageing is a concern in all developed countries. For the first time, there are now more people over the age of 65 in the United Kingdom than there are children under 15 years. Over the past century, the proportion of over 65s has grown from about one in 20 to around one in six. Although declining birth rates and infant mortality formed the basis for this growth from the end of the 19th century until the second world war, since the 1970s increasing life expectancy has been an additional driving force. This population ageing has worried policy makers because for every worker paying tax and national insurance there are more older citizens, who make greater demands on social insurance, health, and welfare systems and have increasing morbidity and disability.
The standard indicator of population ageing is the old age dependency ratio. It takes the number of people who have reached the state pension age and divides it by the number of working age (16-64 years) adults in order to estimate the proportion of older people relative to those who pay for them. Although the phased raising of the state pension age (from 65 for men and 60 for women) to 68 for both sexes, which will keep 3.5 million people in the working age, will initially cause the ratio to decline from today’s 31% in England and Wales, by 2035 it will have risen to 37%.
However, the old age dependency ratio is a poor measure of the burden of an ageing population. It counts neither the number of dependent older people nor the number who sustain them. It merely takes a cut-off point (the state pension age) and assigns adults to the two sides of the ratio accordingly. This might be a useful rule of thumb if the relative size of these two age groups tracked the volume of old age dependency, but it does not. We propose an alternative measure that gives a more accurate and very different picture and consider the implications of our results for health policy.
Educational Inequalities in Three Smoking-Related Causes of Death in 18 European Populations
Kulik, M.C., Menvielle, G., Eikemo, T.A., Bopp, M., Jasilionis, D., Kulhánová, I., Leinsalu, M., Martikainen, P., Östergren, O. & Mackenbach, J.P. (2013) Nicotine & Tobacco Research, 16 (5), 507 - 518. 9 November 2013. [SLS]
Introduction: Smoking is an important determinant of socioeconomic inequalities in mortality in many countries. As the smoking epidemic progresses, updates on the development of mortality inequalities attributable to smoking are needed. We provide estimates of relative and absolute educational inequalities in mortality from lung cancer, aerodigestive cancers, and chronic obstructive pulmonary disease (COPD)/asthma in Europe and assess the contribution of these smoking-related diseases to inequalities in all-cause mortality.
Methods: We use data from 18 European populations covering the time period 1998–2007. We present age-adjusted mortality rates, relative indices of inequality, and slope indices of inequality. We also calculate the contribution of inequalities in smoking-related mortality to inequalities in overall mortality.
Results: Among men, relative inequalities in mortality from the 3 smoking-related causes of death combined are largest in the Czech Republic and Hungary and smallest in Spain, Sweden, and Denmark. Among women, these inequalities are largest in Scotland and Norway and smallest in Italy and Spain. They are often larger among men and tend to be larger for COPD/asthma than for lung and aerodigestive cancers. Relative inequalities in mortality from these conditions are often larger in younger age groups, particularly among women, suggesting a possible further widening of inequalities in mortality in the coming decades. The combined contribution of these diseases to inequality in all-cause mortality varies between 13% and 32% among men and between −5% and 30% among women.
Conclusion: Our results underline the continuing need for tobacco control policies, which take into account socioeconomic position.
How spatial segregation changes over time: sorting out the sorting processes
Bailey, N. (2012) Environment and Planning A, 44 (3), 705-722. [SLS]
Although there is strong evidence that segregation on socioeconomic lines has risen in many countries over the last few decades, comparatively little is known about the processes by which this happens. While it is often assumed that selective migration is the dominant process, this has rarely been demonstrated. This paper proposes a more comprehensive framework to analyse processes driving changes in segregation—a ‘neighbourhood accounts’ framework. The framework is tested using data from the Scottish Longitudinal Study for 1991 – 2001, focusing on the working-age population. Contrary to what many have assumed, selective migration is shown to have only a very weak impact on changes in spatial segregation, and is certainly not the dominant factor—at least in this particular context. The effects of ageing or cohort replacement and of uneven rates of status change or social mobility appear much more important. This raises important issues for policies to tackle segregation.
Socio-demographic and health characteristics of individuals left behind in deprived and declining areas in Scotland
Brown D., O'Reilly D., Gayle V., Macintyre S., Benzeval M., & Leyland A.H. (2012) Health & Place, 18 (2), 440-444. [SLS]
Deprived and declining areas in Scotland have poorer health than other areas in the rest of Scotland. Using data from the Scottish Longitudinal Study, this paper examines whether differential migration over a one year period can explain these differences. Compared with migrants to and from deprived and declining areas, stable residents in those areas were generally older, less well educated and less affluent. Continued disproportionate loss of more affluent and better educated individuals could result in deprived and declining areas becoming even more deprived over time. Migrants appeared to be in better health; however, this finding was reversed on adjustment for age. It may be that while the relationship between migration and socio-economic status is immediately apparent, the relationship between migration and health could take longer to develop.
Sectarianism: Myth or Social Reality? Inter-sectarian partnerships in Scotland, evidence from the Scottish Longitudinal Study
Raab, G. & Holligan, C. (2012) Ethnic and Racial Studies, 35 (11), 1934-1954. [SLS]
This article explores the contested issue of whether sectarianism divides Catholics and Protestants in Scotland. The conclusions are based on an analysis of 111,627 couples from the 2001 Census. The proportions with no religious upbringing and currently belonging to no religion decrease steeply with year of birth for the members of couples. This is largely due to a decline in the Protestant group, while the proportion of Catholics remains fairly stable with year of birth. For the oldest cohort those with a Catholic upbringing are disadvantaged compared to Protestants, in terms of educational qualifications and membership of the professional classes, but this difference has eroded so that there are few differences at the youngest ages. Those with no religious upbringing are disadvantaged on these measures at all ages. Catholics are more likely than Protestants to form couples outside their religious group, and this is not simply a consequence of their minority status, which would restrict the number of available partners. The trend towards secularism could be influenced by inter-sectarian coupling because those in mixed relationships are less likely to practise their religion of upbringing. The high proportion of inter-sectarian marriages may give rise to many Protestants in Scotland having practising Catholics among their extended families, and this should contribute to undermining sectarian divisions.
Migration, occupational mobility, and regional escalators in Scotland
van Ham, M., Findlay, A., Manley, D. & Feijten, P. (2012) Urban Studies Research, 2012 (Article ID 827171), 15 pages. [SLS]
This paper seeks to unpick the complex relationship between an individual’s migration behaviour, their place of residence, and their occupational performance in the Scottish labour market between 1991 and 2001. We investigate whether Edinburgh has emerged as an occupational escalator region and whether individuals moving there experience more rapid upward occupational mobility than those living and moving elsewhere. Using country of birth, we also control for an individual’s propensity to make long distance moves during earlier periods of their life course. Using data from the Scottish Longitudinal Study, linking 1991 and 2001 individual census records, and logistic regressions, we show that those who migrate over long distances within or to Scotland are most likely to achieve upward occupational mobility. We also found that Edinburgh is by far the most important regional escalator in Scotland; those moving to Edinburgh are the most likely to experience upward occupational mobility from low to high occupational status jobs. This is an important finding as most of the literature on escalator regions focuses on international mega cities.
Are mixed unions more likely to dissolve than co-ethnic unions? New evidence from Britain
Feng Z., Boyle, P., van Ham, M. & Raab, G. (2012) European Journal of Population, 28 (2), 159-176. [SLS][ONS LS]
The increasing proportion of ethnic minorities in Britain has been paralleled by an increase in the occurrence of mixed-ethnic marriages between one White partner and an ethnic minority partner. Such marriages are thought to be at higher risk of divorce, but empirical studies so far have been inconclusive. This paper uses the Office for National Statistics longitudinal study for England and Wales to investigate whether mixed-ethnic unions are more likely to end in divorce than co-ethnic unions. We followed married couples in 1991–2001 and examined their risks of divorce. We found evidence that mixed-ethnic unions have a higher risk of dissolution than co-ethnic unions. However, after controlling for partners’ characteristics, most importantly the younger ages of people in mixed-ethnic unions, the risk of divorce for mixed-ethnic unions was no longer elevated, but lay close to the higher risk found for the two constituent co-ethnic unions.
Available online: European Journal of Population,
Output from project: 2007_016 (SLS), 30092 (ONS LS)
Does widowhood increase mortality risk? Comparing different causes of spousal death to test for selection effects
Boyle, P., Feng, Z. & Raab, G. (2011) Epidemiology, 22, 1-5. [SLS]
Background: We consider whether widowhood increases mortality risk. Although commonly observed, this “widowhood effect” could be due to selection effects, as married couples share various characteristics related to the risk of death. We therefore consider the widowhood effect by various causes of spousal death; some causes of death are correlated with shared characteristics in couples, while others are not.
Methods: Using data from the Scottish Longitudinal Study, we compare outcomes for men and women by the causes of death of their spouse, controlling for a range of individual- and household-level characteristics.
Results: The widowhood effect in these data is greater than has been found in other recent studies, with adjusted hazard ratios of 1.40 (95% confidence interval = 1.33–1.47) for men and 1.36 (1.30–1.44) for women. The risk is highest shortly after widowhood, but remains raised for at least 10 years. There was little evidence that these hazard ratios differed by any classification of the cause of death of the spouse, but interactions were found for those with pre-existing illness or other risk factors. The hazard ratios for widowhood were lower for persons with preexisting risks.
Conclusions: Our analysis of the widowhood effect uses 3 methods of classifying the causes of spousal death in an attempt to control for potential selection effects. Our results are highly consistent and suggest that this is a causal effect, rather than a result of selection.
Is there a ‘Scottish effect’ for mortality? Prospective observational study of census linkage studies
Popham, F., & Boyle, P.J. (2011) Journal of Public Health, 33 (3), 453-458. [SLS][ONS LS]
Background Scotland's mortality rate is higher than England and Wales’ and this difference cannot be explained by differences in area-level socio-economic deprivation. However, studies of this ‘Scottish effect' have not adjusted for individual-level measures of socio-economic position nor accounted for country of birth; important as Scottish born living in England and Wales also have high mortality risk.
Methods Data sets (1991–2001 and 2001–2007) were obtained from the Scottish Longitudinal Study and the Office for National Statistics England and Wales Longitudinal Study that both link census records to subsequent mortality. Analysis was limited to those aged 35–74 at baseline with people followed to emigration, death or end of follow-up.
Results Those born in Scotland living in either England and Wales or Scotland had a higher mortality rate than the English born living in England and Wales that was not fully attenuated by adjustment for car access and housing tenure.
Conclusion Adjusting for household-level differences in socio-economic deprivation does not fully explain the Scottish excess mortality that is seen for those born in Scotland whether living in England and Wales or Scotland. Taking a life course approach may reveal the cause of the ‘Scottish effect’.
Available online: Journal of Public Health,
Output from project: 2009_004 (SLS), 30117 (ONS LS)
Selective internal migration. Does it explain Glasgow’s worsening mortality record?
Popham, F., Boyle, P., O'Reilly, D. & Leyland, A.H. (2011) Health & Place, 17 (6), 1212-1217. [SLS]
The mortality difference between Glasgow and the rest of Scotland has been increasing and mortality rates are higher than Glasgow's excess deprivation would suggest. One plausible explanation for this excess is selective migration. A sample of 137,073 individuals aged 15 to 64 in 1991 from the Scottish Longitudinal Study was used to test this explanation. Three geographic areas were compared: Glasgow; Aberdeen, Dundee and Edinburgh cities combined and the rest of Scotland. The impact of selective migration was assessed by calculating age and sex standardised mortality rates for 2001/03 by residence in 2001 and by residence in 1991. Glasgow experienced the greatest loss of population (−7.1%) between 1991 and 2001 but this was not strongly related to deprivation. It had the highest mortality at baseline and the difference between it and the other areas increased over the ten years. This pattern was not significantly affected by calculating death rates according to area of residence at 1991 or in 2001. Our results suggest that the increasing difference in mortality rates between Glasgow and the rest of Scotland over this period was probably not caused by selective migration.
To what extent can deprivation inequalities in mortality and heart disease incidence amongst the working aged in Scotland be explained by smoking? Relative and absolute approaches
Popham, F. (2011) Health & Place, 17 (5), 1132-1136. [SLS]
Smoking is important for both population health and inequalities in health. There is a growing recognition that its impact on inequalities can be assessed both by standardising smoking rates across socio-economic groups and by assessing the effect of reducing the prevalence of smoking in all groups, so-called relative and absolute approaches. While national level studies (such as census-linkage studies) give vital information on the socio-economic gradient in health they often lack smoking data. Here, small area smoking estimates are linked to a national level longitudinal study to overcome this problem. Results confirm that in relative and especially absolute terms smoking plays an important role in inequalities.
Increased Mortality in Parents Bereaved in the First Year of Their Child’s Life
Harper, M., O'Connor, R.C. & O'Carroll, R.E. (2011) British Medical Journal (Supportive and Palliative Care), 1, 306-309. [SLS]
Objective To identify the relative risk (RR) of mortality in bereaved parents compared with non-bereaved counterparts.
Design Retrospective data linkage study.
Setting United Kingdom, 1971–2006.
Participants A random sample from death registrations (5%) of parents who had a live birth where the infant lived beyond its first year of life (non-bereaved parents) and parents who had experienced a stillbirth or the death of a child in its first year of life (bereaved parents) between 1971 and 2006.
Main outcome measures Death or widowhood of the parent.
Results Bereaved parents in Scotland (n=738) were more than twice as likely to die in the first 15 years after their child's death than non-bereaved parents (n=50 132), p<0.005. Bereaved mothers in England and Wales (n=481) were more than four times as likely to die in the first 15 years after their child's birth than non-bereaved parents (n=30 956), p<0.001. The mortality risk for bereaved mothers compared with non-bereaved mothers, followed up for 25 years after death, was 1.5 (bereaved n=745, non-bereaved n=36 434), p<0.005. When followed up for 35 years, the risk of mortality for bereaved mothers (n=1120) was 1.2 times that of non-bereaved mothers (n=36 062), p<0.005.
Conclusions Bereaved parents who experience stillbirth or infant death have markedly increased mortality compared with non-bereaved parents, up to 25 years (mean) after the death of their child. However, the RR reduces over time.
Available online: British Medical Journal (Supportive and Palliative Care),
Output from project: 2008_003
The Scottish excess in mortality compared to the English and Welsh: is it a country of residence or country of birth excess?
Boyle, P.J., Popham, F. & Norman, P. (2010) Health & Place, 16 (4), 759-762. [SLS]
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.
The effect of neighbourhood housing tenure mix on labour market outcomes: a longitudinal investigation of neighbourhood effects
van Ham, M. & Manley, D. (2010) Journal of Economic Geography, 10 (2), 257-282. [SLS]
This article investigates the effect of different levels of neighbourhood housing tenure mix and deprivation on transitions from unemployment to employment and the probability of staying in employment for those with a job. We used multiple regression models and unique individual level data from the Scottish Longitudinal Study. We found that high correlations between the percentage of social renting in a neighbourhood and labour market outcomes disappeared when controlling for neighbourhood deprivation, individual level education and tenure. The results show that living in a deprived neighbourhood is negatively correlated with labour market performance, but predominantly for homeowners and not for social renters. We suggest that selection effects and not causation are behind the neighbourhood effects found.
Self-rated health and mortality in the UK: results from the first comparative analysis of the England and Wales, Scotland, and Northern Ireland Longitudinal Studies
Young, H., Grundy, E., O'Reilly, D. & Boyle, P. (2010) Population Trends, 139 (Spring), 11-36. [SLS][ONS LS][NILS]
Previous studies have shown that self-reported health indicators are predictive of subsequent mortaity, but that this association varies between populations and population sub-groups. For example, self-reported health is less predictive of mortality at older ages, has a stronger association with mortality for men than for women and is more predictive of mortality for those of lower than those of higher socio-economic status, particularly among middle aged working adults.
This article explores this association using individual level, rather than ecological, data to see whether there are differences between the constituent countries of the UK in the relationship between self-reported health and subsequent mortality, and to investigate socio-economic inequalities in mortality more generally. Data are used from the three Census based longitudinal studies now available for England and Wales, Scotland and Northern Ireland.
Cohort Profile: The Scottish Longitudinal Study (SLS)
Boyle, P., Feijten, P., Feng, Z., Hattersley, L., Huang, Z., Nolan, J. & Raab, G. (2009) International Journal of Epidemiology, 38 (2), 385-392. [SLS]
This article describes the establishment of the Scottish Longitudinal Study (SLS). The study is similar in design to the Office for National Statistics (ONS) Longitudinal Study (LS), which has been running for over 30 years and the Northern Ireland Longitudinal Study (NILS), which has been established only recently. However, the SLS differs from the LS and NILS is a number of ways. Subsequently, we describe the details of the SLS, paying particularly attention to how it compares with the LS upon which is was originally based. ...
Available online: International Journal of Epidemiology,
Unemployment, mortality and the problem of health-related selection: Evidence from the Scottish and England & Wales (ONS) Longitudinal Studies
Clemens, T., Boyle, P. & Popham, F. (2009) Health Statistics Quarterly, 43, 7-13. Office for National Statistics. [SLS][ONS LS]
The potential for unemployment to negatively affect an individual’s health status has been the focus of much research. Associations between a spectrum of health outcomes and unemployment have been empirically borne out in the literature including mental health, substance use and teenage pregnancy, suicidal behaviours and limiting long-term illness (LLTI). In addition to these outcomes much work has sought to investigate associations between unemployment and mortality.
While many of these studies report statistically strong associations between unemployment and poor health, establishing this as a causal relationship poses a greater challenge as they rely on observational rather than experimental studies. ...
The Creation of “Consistent Areas Through Time” (CATTs) in Scotland, 1981-2001
Exeter, D.J., Boyle, P., Feng, Z., Flowerdew, R. & Schierloh, N. (2005) Population Trends, 119 (Spring 2005), 28-36. Office for National Statistics. [SLS]
...[A] number of methods exist that enable two or more geographies to be combined into a common geography. Most approaches use an areal interpolation process that involves the proportional redistribution of information from the source geographies to the target geography, based on a pre-defined weighting scheme. Necessarily, however, these techniques introduce error, which varies depending on the procedure that is used.
￼Here we present an alternative approach, which uses 1981 EDs in Scotland as the base geography from which ‘Consistent Areas Through Timeʼ (CATTs) can be derived. It is possible to extract small area census data outputs from 1981, 1991 and 2001 for these areas without the need for areal interpolation methods. The method presented here is only possible because the General Register Office for Scotland (GROS) has endeavoured to maintain comparability between census areas since 1981. For the first time in Scotland, therefore, CATTs are available which allow for the reliable analysis of changing demographic, social and economic circumstances at the local level. ...
Shrinking areas and mortality: an artefact of deprivation effects?
Exeter, D.J., Feng, Z., Flowerdew, R. & Boyle, P. (2005) Journal of Epidemiology & Community Health, 59, 924-926. [SLS]
There is evidence that mortality rates are highest in areas that are experiencing population decline, and researchers have recommended that this should be accounted for in health resource allocation. This research finds a significant negative association between population change and mortality for small areas in Scotland, which remains when low social class is accounted for. However, this relation disappears when the area deprivation is accounted for. It is suggested that it is more important to account for deprivation than population change in health resource allocation.
Available online: Journal of Epidemiology & Community Health,
Population geography: migration and inequalities in mortality and morbidity
Boyle, P. (2004) Progress in Human Geography, 28, 767-776. [SLS]
This is my third, and final, Progress in Human Geography review paper for population geography where I turn to mortality – the third of the core areas of the subdiscipline. There has, it seems to me, been a gradual decline in interest among population geographers in the geography of mortality. This is not to ignore some important and interesting mortality research conducted by population geographers but it is evident that, compared to migration research, interest in mortality has diminished. Thus, in perusing the back issues of the International Journal of Population Geography (now Population, Space and Place), I find only seven articles which focus explicitly on mortality in the last nine years (Garrett and Reid,1995; Root,1999; Gupta and Baghel, 2000; Ramiro-Fariñas and Sanz-Gimeno, 2000; Congdon et al., 2001; Reher, 2001; Mooney, 2002) and most of these are historical or based in the developing world. This is despite the fact that there is a number of contemporary mortality-based research questions that should fall much more squarely within the interests of population geographers. ...
Available online: Progress in Human Geography,
Guest editorial: the 2001 UK census: remarkable resource or bygone legacy of the ‘pencil and paper era’?
Boyle, P. & Dorling, D. (2004) Area, 36 (2), 101-110. 22 June 2004. [SLS][ONS LS][NILS]
National censuses are expensive. They are conducted infrequently. They collect information that some feel infringes their human rights, and people are required by law to complete them. The outputs are not perfect, and in some situations may be misleading. Some suggest that censuses hark back to a period when regularly collected administrative data were not available. These are some of the views held about national censuses. Why, then, would others argue that they are an essential resource? In this paper, we consider some of the pros and cons of conducting national censuses, before introducing a series of papers that draw on early data available from the 2001 UK census. We argue that these papers, and the wealth of research that will be conducted in the future with 2001 census data, make a strong case for supporting the compulsory collection of personal information about the ‘entire’ population every ten years.
Available online: Area,
The role of population change in widening the mortality gap in Scotland
Boyle, P., Exeter, D. & Flowerdew, R. (2004) Area, 36 (2), 164-173. [SLS]
The social gradient in health and mortality has been acknowledged for some time and, more recently, there is some evidence that the gap between the richer and poorer is widening in Britain. Other studies have also shown that health and mortality outcomes are worse in places that are experiencing population decline and better in places that are growing. This analysis examines, first, whether there is a mortality gap between the least and most deprived people in Scotland, second, whether this gap has widened since the 1980s and, third, whether the gap can be explained by patterns of population change. Our results demonstrate that the widening mortality gap in Scotland cannot be explained simply as an artefact of population change, even though it is widening most in those places that are experiencing population decline. This type of research is made possible by the reliable denominator population information provided in the 1981 and 2001 censuses.
Available online: Area,
Scotland’s demographic regime: Population and the politics of devolution
Graham, E. & Boyle, P. (2003) Scottish Geographical Journal, 119 (4), 361-382. [SLS]
Scotland, with just over 5 million inhabitants, is a small country relative to most of its neighbours in Europe, including England. Under the recently (re)established Scottish Parliament in Edinburgh, devolved responsibilities have provided a new context within which the characteristics of its demographic regime have come to be seen as problematic. In this paper we review the empirical evidence underpinning political perceptions of a population ‘crisis’ in Scotland and argue that spatial comparisons have been particularly influential in this politicisation of population. We then examine the dimensions of the population debate through the voices of politicians and the media. We conclude with a brief consideration of the relationships between population and devolved politics, suggesting a direction for policy‐relevant research to which population geographers could make a major contribution.
Available online: Scottish Geographical Journal,