Project Title:

Assessing the potential impact of markers of social capital on levels of ‘excess’ mortality in Scotland and Glasgow compared to elsewhere in the UK [EXTENDED]

Project Number:

2013_002

Researchers:

David Walsh (GCPH)
Chris Dibben (University of Edinburgh)
Zhiqiang Feng (University of St Andrews)
Kevin Ralston (University of Edinburgh)
Lauren Schofield (NHS)

Start Date:

24 June 2013

Summary:

A considerable amount of recent research has highlighted high levels of ‘excess’ mortality (i.e. over and above that explained by area deprivation or individual socioeconomic status (SES)) in Scotland compared to England & Wales, and in Glasgow compared to Liverpool and Manchester. New survey analyses have suggested levels of social capital (including proxies such as religious affiliation) are significantly lower in Glasgow compared to the two English cities. This study seeks to explore the extent to which Scottish levels of excess mortality are modified by social capital proxies such as religion and household composition.

A number of recent analyses (including some based on the Scottish and English Longitudinal Studies) have shown that differences in socio-economic circumstances (including individual socio-economic status and area-based measures of deprivation) do not fully explain the higher rates of mortality seen in Scotland compared to elsewhere in the UK. This is true of comparisons at national level (Scotland compared to England & Wales (Hanlon et al 2005, Popham & Boyle 2011)), regional level (West Central Scotland compared to other European post-industrial regions (Walsh et al 2010a, Taulbut et al 2011)), and city level (Glasgow compared to Liverpool and Manchester (Walsh et al 2010b)). The latter study showed that despite all three cities sharing almost identical deprivation profiles, premature mortality in Glasgow was 30% higher than in Liverpool and Manchester, with deaths at all ages around 15% higher. This excess was seen across almost all age groups, both males and females, and all types of neighbourhood (deprived and non-deprived). This finding was all the more remarkable given the otherwise striking similarities between the cities (especially Glasgow and Liverpool) across a range of economic, social and other relevant data sets (Walsh et al 2010c). However, recent analyses of new survey data for the three cities highlighted potentially important differences in levels of social capital (Walsh et al – forthcoming). These included reciprocity, trust, volunteering and religious affiliation. The latter was included as a proxy for social capital on the basis that religious participation has been shown to be an important catalyst for social connectivity among some populations, and has been shown to be significantly and independently associated with lower mortality (e.g. McCullough 2000). The study seeks to examine whether levels of ‘excess’ mortality in Scotland (compared to E&W) and Glasgow (compared to Liverpool/Manchester) are modified by social capital proxies such as religion and household composition.

We will use 1991 and 2001 combined samples, comparing mortality rates:

1. Unadjusted
2. Adjusted by age and sex
3. Adjusted by age, sex and SES
4. Adjusted by age, sex, SES and social capital proxies (religious affiliation, and household composition)

The analyses would be:

1. Carried out for Scotland v England & Wales
2. Glasgow v. Liverpool & Manchester
3. Stratified by SES – i.e. in case social capital modifies mortality risk among some groups but not others

The methodology will follow that of Popham & Boyle (2011, project 2009-004), using pooled data, but with different time periods: religion was not asked in the 1991 census, so follow-up will be from 2001 – most recent data available at time of analysis (2011/2012). Household structure (i.e. living alone) is available in 1991 and so will be followed from 1991 – most recent period. Time permitting, the project may additionally look at cause-specific mortality, as well as all-cause deaths (the focus of Popham’s project). The same age group (35-74) will be used as per Popham’s work, but will additionally examine the broader categories of 15-74 and all ages.

References:

1. Hanlon P, Lawder RS, Buchanan D, Redpath A, Walsh D, Wood R, Bain M, Brewster DH, Chalmers J. Why is mortality higher in Scotland than in England & Wales? Decreasing influence of socioeconomic deprivation between 1981 and 2001 supports the existence of a 'Scottish Effect'. Journal of Public Health, 2005; 27 (2): 199-204


2. McCullough ME, Hoyt WT, Larson DB, Koenig HG, Thoresen C. Religious involvement and mortality: a meta-analytic review. Health Psychol. 2000 May;19(3):211-22


3. Popham F., Boyle P.J. Is there a ‘Scottish effect’ for mortality? Prospective observational study of census linkage studies. J Public Health (2011) 33 (3): 453-458


4. Taulbut M., Walsh D., Parcell S., Hanlon P., Hartmann A., Poirier G., Strniskova D. Health and its determinants in Scotland and other parts of post-industrial Europe: the ‘Aftershock of Deindustrialisation’ study - phase two. Glasgow Centre for Population Health, 2011


5. Walsh D, Taulbut M, Hanlon P. The aftershock of deindustrialization – trends in mortality in Scotland and other parts of post-industrial Europe. European Journal of Public Health 2010 20: 58-64


6. Walsh D., Bendel N., Jones R., Hanlon P. It’s not ‘just deprivation’: Why do equally deprived UK cities experience different health outcomes? Public Health 124 (2010), 487-495


7. Walsh D., Bendel N., Jones R., Hanlon P. Investigating a ‘Glasgow Effect’: Why do equally deprived UK cities experience different health outcomes? Glasgow Centre for Population Health, April 2010


8. Walsh D., McCartney G., McCullough S. et al. Exploring reasons for different health outcomes in identically deprived post-industrial UK cities. Glasgow Centre for Population Health - forthcoming

Related Outputs (viewable on CALLS Hub):

• Assessing the potential impact of markers of social support on levels of ‘excess’ mortality in Scotland and Glasgow compared to elsewhere in the UK
• Excess mortality in Scotland and Glasgow compared with England and Manchester and Liverpool
• Assessing the potential impact of markers of social support on levels of ‘excess’ mortality in Scotland and Glasgow compared to elsewhere in the UK
• Do differences in religious affiliation explain high levels of excess mortality in the UK?
• Does ethnic diversity confer protective effects on population health? Intra-UK comparisons of ethnicity and mortality  
• Does ethnic diversity explain intra-UK variation in mortality? A longitudinal cohort study