So we 're going to hear from Chris Harkins from Glasgow Centre for Population Health
and Alison Gornall from Big Noise Govan Hill about the evaluation of Systema Scotland's
approach to orchestral tuition with children and before that we'll hear from Claire Bynner
from What Works Scotland which is a collaboration between the universities of Glasgow and Edinburgh
and she 's going to talk about place based approaches.
And to introduce all of this and to remind us of the stark challenge we're trying to address,
and what the current picture is around that, is Denise Brown from the MRCCSO social and
public health sciences unit at University of Glasgow.
So Denise, if you 'd like to start us off please, thanks.
[Applause] So good afternoon. I 'm going to be looking
at changes to age and core specific mortality rates in Scotland over the last 30 years and
the contribution to area based on equalities mortality and this is joint marked with colleagues
from the University of Glasgow. So, overall there 's been a large reduction
in the number of deaths in Scotland over the last 30 years, a reduction of around 10,000
deaths equating to about 16% but inequalities in all-caused mortality widened over this
time and this is in part due to slower reductions in mortality rates for those in the most deprived areas.
So the aim of this work is to examine the contribution of age and specific causes of
death to area based inequalities of mortality in Scotland over the last 30 years.
We look at all cause mortality in a number of individual cause specific mortalities.
Ischaemic heart disease, stroke, all cancers, chronic or respiratory diseases, alcohol,
drugs, suicides and accidents. And suicides and accidents also have some causes of death
associated with drug and alcohol poisonings, so these definitions exclude alcohol and drug
poisonings as they're already accounted for in the alcohol related harm and drug related
harm cause. Rates are age standardised and that stuck out for different age structures
in populations we're comparing, with rates expressed per 100,000 population.
So for each census time point, we have three years of death data. We didn't have death
data for 1990 in Scotland because some postcode sectors in Scotland changed and we couldn't find assign
death codes to those new postcode areas. We see that the population between '81 and
2001 increased slightly with the number of deaths going down decade on decade. We look
area based measures of deprivation at the postcode sector level and these had a average
population in 2011 of around 5000 people. We look at Carstairs deprivation scores which is a
measure of deprivation based on four census variables: lack of car ownership, male unemployment,
over crowding and low social class. And these were first created following the 1981 census
and have been created following each census since. So they cover the time span of the study.
Carstair scores are divided into population related quintiles each containing 20% of the
population and we rank the quintiles as Quintile 1 which are the most deprived areas to Quintile
5 the least deprived. So this is just a graph looking at the change
in mortality across all four countries in the UK over the last 30 years. So we've got
four lines in blue representing males in Scotland, Wales, Northern Ireland and England, and then
we've got the four red lines representing the same for females, and we can see that
for both males and females the long dash line is Scotland. So across the UK rates in Scotland
are higher for both males and females, although reduction rates have been higher for males
so the difference between male and female rates have been narrowing over time.
So if we consider first the effect of age, this table looks at mortality rates just for
the most recent census period 2011, and we focus more on the change in rates over time
between censuses and overall change between 1981 and 2011. Ages are broken down into
five year age bands. So we can see, if we focus on the change between '81 and 2011, that there
there's been consistent reductions across all age categories over time. Largest reductions have
been in the youngest age groups, under 15s. Fairly large reductions in the over 45s and
lower rates of reduction for those aged 15 to 44. This is in part because of periods
increasing rates between 91 and 2001 for this age groups.
Looking now at selected causes of death, again we show the rate in 2011 and focus more
on the change, and these causes of deaths are ranked in terms of those that had the
highest rate of reduction between '81 and 2011. So large rates of reduction were for
ischaemic heart disease, stroke, accidents and respiratory diseases, all of those
decreased by at least 50% over this time and cancers decreasing by around 40%. For suicides
and alcohol and drug related harms we saw an increase over the last 30 years and again
this is in part due to the large increases between '91 and 2001. For suicides and alcohol
related harms there's actually been a decrease following that period between 2001 and 2011
but still we see the overall increase over time.
For females it 's a similar picture, reductions across all age groups with the largest reductions
being in the youngest aged categories and the lowest reductions in the 15 to 29 age
categories, so a reduction of just 12% over time there. And again looking at the selective
causes of death, with deaths ranked in terms of largest reductions, ischaemic heart disease,
stroke and accidents all decreased by over 50%. With decreases for cancer, respiratory
and suicides, but for females they also saw an increase in rates for drug related harms
and alcohol related harms. And we also see that given the large reductions
in rates for ischaemic heart disease and then the large increases for alcohol related harms,
the alcohol related harm and ischaemic heart disease rates for 2001, err 2011 are now of
a comparable level. So 13 per 100,000 for alcohol related harms and 12 for ischaemic
heart disease. So if you think now about deprivation, these...
this plot shows rates across Scotland and how they've changed between 1981 and 2011,
so there 's been a consistent decrease in rates for the whole of Scotland and this plot
is for males under 65, so we 're focussing the rest of presentation on males. Breaking
down into the different 20% of the population we can see the usual deprivation gradient
where rates are higher and most deprived quintiles and it 's reduce as we move towards the less
deprived quintiles. The pattern over time 's the same for the
whole of Scotland and most of the quintiles, except for in the most deprived where there
was a slight increase between 1991 and 2001 followed by quite a large reduction between
2001 and 2011. However, despite this large reduction in the most deprived quintiles between
2001 and 2011, rates in 2011 are still higher than they were 30 years ago in the least deprived
areas. So this plot shows the most deprived areas
and least deprived areas side by side and again you see this is for males aged 20 to
64, so we 're now looking at male adults and again we see this pattern where rates across
all years in the most deprived quintile are higher than 30 years previously. And this
shows all cause mortality over time. If you look at the absolute change in rates
in the most deprived quintile between 1981 and 2011 we can see that rates reduce by 343
per 100,000 population, compared to an absolute reduction in the least deprived quintiles
of 315, so these are fairly comparable in terms of the absolute reduction in rates over
time in the most extreme deprivation quintiles. If you look instead at the relative difference,
so how much in terms of percentage wise rates have changed over this time, there was 35%
reduction in the most deprived quintile between '81 and 2011, but a 58% reduction in the least
deprived quintile. So relative differences are higher.
So if we take the bars for all cause mortality, we can split those into bars showing the contribution
of all the different causes. So we've got ischaemic heart disease along the bottom,
all cancers, respiratory, stroke, accidents and then in green we've the alcohol, drug
and suicide causes and then the blue bars at the top just show that all, that the main
other causes not accounted for by these individual causes. Some deaths have been grouped together
just for ease of presentation so that you can see what 's happening in the bars.
So for ischaemic heart disease, cancer, respiratory disease and stroke and accidents rates, the
bars have decreased as we move across time within the most deprived quintile but also
within the least deprived quintile In terms of alcohol, drugs and suicides the
bar has increased slightly, we 're up quite a bit in the most deprived quintile as time
passes. So again, comparing within quintiles,
ischaemic heart disease reduced by 68% in the most deprived quintile which is quite
a substantial reduction but it decreased by more, 83%, in the least deprived quintile.
Similarly cancers 38% compared to 45% and similar patterns with stroke and respiratory
diseases. The only cause here that didn't differ was
accidents. Accidents decreased by 60% in both the most and least deprived quintiles.
The terms of those causes that increased over the time, the rates increased over time, we
can see that rates increase faster, or at a higher rate in the most deprived quintile.
So, suicide increased by 19% between ' '81 and 2011 compared to 4% in the least deprived
quintiles, and we also see large increases for alcohol and drug related harms.
So the last plot looked at the contribution of specific causes for one particular age
group, so we sort for males aged 20 to 64. This mounting plot looks at the whole age
range in the five age bands, so from 0 to 5, up to 85 plus. It shows the relative index
of inequality and this is a measure of the steepness of the gradients across the deprivation
quintiles. Positive values, as we can see here, indicate that the rates are higher in
the most deprived areas and the higher the value the more inequality at that age group.
So we can see, this is again for all cause mortality, we can see that all cause, the
mountain plot increases to around age 30 to 40 but it peaks and then it starts to decline
towards the older age groups, but even at 85 plus age groups we still see positive values.
So though inequality is less in the older age groups, they still exist.
Again we can break this down into the individual causes of death, to see what contributes at
what age and for the under 5s, so the green bars are the all other causes that aren't
accounted for elsewhere, so for under 5s there are some inequalities and these relate to
other causes including perinatal mortality. Around the age of 15 plus we can see the dark
blue and the sort of light blue colour, that 's drugs and suicides, they start to come
into play, and they 're important up until about the age of 40 where ischaemic heart
disease in purple and all cancers in the yellow at the bottom, seem to be more important in
terms of inequalities at older ages. So that was for males in 2011, and this is
for males in, so that was sorry males in 2001 and this is for males in 2011. So we can see
similar patterns with same causes of death being important at different ages. I think
the main thing between the two plots is that for 2011 peak now seems to have shifted to
around 40 to 45 years of age, so there 's been a shift in peak, but the contributions
at the different ages seem to be similar. So we see that all cause mortality rates in
Scotland declined over the last three decades and the gap between males and females mortality
rates has narrowed slightly. For males it was those in the 30 to 44 year age group who
experienced the lowest rates of decline in all cause mortality and the youngest group
had the highest decline. And we saw that deaths due to ischaemic heart disease, stroke,
accidents, all cancers and chronic lower respiratory diseases reduced over 30 years while
suicide, alcohol and drug related harms had increased.
Findings were similar for females. It was those aged 15 to 29 who experienced the lowest
rates of decline and the youngest group the largest. Many of the causes of death reduced
over this time but we saw that alcohol and drug related harm had increased. And we saw
that alcohol was now at a similar rate to ischaemic heart disease for females.
There was an increase in rates between 1991 and 2001 and then quite a substantial increase
between 2001 and 2011 but despite this decrease, rates were still higher than they were in
the least deprived quintile 30 years previously. When we looked at the absolute changes in
the most deprived and least deprived quintiles, we saw that those were similar between '81
and 2011 but the all cause mortality rates had reduced by more than a half in the least
deprived areas but by only a third in the most deprived.
For the causes of death that had reduced over time, the greater reductions were for those
in the least deprived quintiles while for causes increasing, the greater increases were
in the most deprived quintiles. We didn't look at all those plots for females
but when we do we see that the findings are similar, but that the rates tend to be lower
than for males and inequalities less. Looked at contributions of specific causes
to inequalities and how those changed across the age groups. In 2001 we saw inequalities
for males who peaked at around age 30 to 40 but by 2011 the peak had shifted and started
from around age 40. So to conclude overall, we saw mortality is declining
but inequalities mortality continues to increase. Rates have reduced least in the most deprived
areas and for the causes of death, increased suicide, alcohol and drug related harms, these
were increasing fast, at a faster rate in the most deprived areas. And for these causes
of death rates are rising more quickly in young adult populations and we saw that quite
often it was the young adult populations that had the largest inequalities. So perhaps targeting
these causes of death in those age groups may help to reduce widening inequalities.
Thank you. [Applause]