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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Public Health 1/2015

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

Zeitschrift:
BMC Public Health > Ausgabe 1/2015
Autoren:
R. Seaman, R. Mitchell, R. Dundas, AH Leyland, F. Popham
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12889-015-2358-1) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

RS contributed to the Literature search, figures, data management, data analysis, data interpretation, and writing. RD contributed to the data interpretation, data analysis and writing. AL contributed to the study design, data interpretation, data management and writing. RM contributed to the study design, data interpretation and writing. FP contributed to the study design, data interpretation, data analysis, and writing. All authors read and approved of the manuscript.

Authors’ information

RS MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
RD MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
AL MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
RM Centre for Research on Environment, Society and Health (CRESH), Section of Public Health and Health Policy, Faculty of Medicine, University of Glasgow.
FP MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.

Abstract

Background

Glasgow’s low life expectancy and high levels of deprivation are well documented. Studies comparing Glasgow to similarly deprived cities in England suggest an excess of deaths in Glasgow that cannot be accounted for by deprivation. Within Scotland comparisons are more equivocal suggesting deprivation could explain Glasgow’s excess mortality. Few studies have used life expectancy, an intuitive measure that quantifies the between-city difference in years. This study aimed to use the most up-to-date data to compare Glasgow to other Scottish cities and to (i) evaluate whether deprivation could account for lower life expectancy in Glasgow and (ii) explore whether the age distribution of mortality in Glasgow could explain its lower life expectancy.

Methods

Sex specific life expectancy was calculated for 2007–2011 for the population in Glasgow and the combined population of Aberdeen, Dundee and Edinburgh. Life expectancy was calculated for deciles of income deprivation, based on the national ranking of datazones, using the Scottish Index of Multiple Deprivation. Life expectancy in Glasgow overall, and by deprivation decile, was compared to that in Aberdeen, Dundee and Edinburgh combined, and the life expectancy difference decomposed by age using Arriaga’s discrete method.

Results

Life expectancy for the whole Glasgow population was lower than the population of Aberdeen, Dundee and Edinburgh combined. When life expectancy was compared by national income deprivation decile, Glasgow’s life expectancy was not systematically lower, and deprivation accounted for over 90 % of the difference. This was reduced to 70 % of the difference when carrying out sensitivity analysis using city-specific income deprivation deciles. In both analyses life expectancy was not systematically lower in Glasgow when stratified by deprivation. Decomposing the differences in life expectancy also showed that the age distribution of mortality was not systematically different in Glasgow after accounting for deprivation.

Conclusions

Life expectancy is not systematically lower across the Glasgow population compared to Aberdeen, Dundee and Edinburgh combined, once deprivation is accounted for. This provides further evidence that tackling deprivation in Glasgow would probably reduce the health inequalities that exist between Scottish cities. The change in the amount of unexplained difference when carrying out sensitivity analysis demonstrates the difficulties in comparing socioeconomic deprivation between populations, even within the same country and when applying an established ecological measure. Although the majority of health inequality between Glasgow and other Scottish cities is explained by deprivation, the difference in the amount of unexplained inequality depending on the relative context of deprivation used demonstrates the challenges associated with attributing mortality inequalities to an independent ‘place effect’.
Zusatzmaterial
Additional file 1: Comparability of Glasgow and Aberdeen, Dundee and Edinburgh combined when ranking datazones by ‘city specific’ deprivation. Table showing the distribution of datazones, mean income rank of decile, number of income deprived, population estimates and deaths for each ‘city specific’ deprivation decile. Datazones in Glasgow, Aberdeen, Dundee and Edinburgh only are re-ranked. (DOCX 26 kb)
12889_2015_2358_MOESM1_ESM.docx
Additional file 2: Life expectancy at birth with 95 % confidence intervals by sex, ‘city specific’ deprivation decile and comparison population. Plot of life expectancy with 95 % confidence intervals for each ‘city specific’ deprivation decile. (TIFF 1549 kb)
12889_2015_2358_MOESM2_ESM.tiff
Additional file 3: Years contributed by each age group to the difference in life expectancy between Glasgow and ADE before and after accounting for ‘city specific’ deprivation. Age decomposition graph before and after accounting for ‘city specific’ deprivation. (TIFF 1549 kb)
12889_2015_2358_MOESM3_ESM.tiff
Additional file 4: Results of ‘city specific’ deprivation analysis. Life expectancy results using ‘city specific’ deprivation. (DOCX 13 kb)
12889_2015_2358_MOESM4_ESM.docx
Additional file 5: Life expectancy at birth with 95 % confidence intervals comparing national and city specific deciles, males. Plot of life expectancy with 95 % confidence intervals comparing results using national and ‘city specific’ deprivation deciles, males. Decile 10 in Glasgow was merged with decile 9 when using ‘city specific’ deprivation because of the small population size. (TIFF 1549 kb)
12889_2015_2358_MOESM5_ESM.tiff
Additional file 6: Life expectancy at birth with 95 % confidence intervals comparing national and city specific deciles, females. Plot of life expectancy with 95 % confidence intervals comparing results using national and ‘city specific’ deprivation deciles, females. Decile 10 in Glasgow was merged with decile 9 when using ‘city specific’ deprivation because of the small population size. (TIFF 1549 kb)
12889_2015_2358_MOESM6_ESM.tiff
Literatur
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