Drug-related deaths in Scotland 1979–2013: evidence of a vulnerable cohort of young men living in deprived areas

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Abstract

Background

Even after accounting for deprivation, mortality rates are higher in Scotland relative to the rest of Western Europe. Higher mortality from alcohol- and drug-related deaths (DRDs), violence and suicide (particularly in young adults) contribute to this ‘excess’ mortality. Age-period and cohort effects help explain the trends in alcohol-related deaths and suicide, respectively. This study investigated whether age, period or cohort effects might explain recent trends in DRDs in Scotland and relate to exposure to the changing political context from the 1980s.

Methods

We analysed data on DRDs from 1979 to 2013 by sex and deprivation using shaded contour plots and intrinsic estimator regression modelling to identify and quantify relative age, period and cohort effects.

Results

The peak age for DRDs fell around 1990, especially for males as rates increased for those aged 18 to 45 years. There was evidence of a cohort effect, especially among males living in the most deprived areas; those born between 1960 and 1980 had an increased risk of DRD, highest for those born 1970 to 1975. The cohort effect started around a decade earlier in the most deprived areas compared to the rest of the population.

Conclusion

Age-standardised rates for DRDs among young adults rose during the 1990s in Scotland due to an increased risk of DRD for the cohort born between 1960 and 1980, especially for males living in the most deprived areas. This cohort effect is consistent with the hypothesis that exposure to the changing social, economic and political contexts of the 1980s created a delayed negative health impact.

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The online version of this article (10.1186/s12889-018-5267-2) contains supplementary material, which is available to authorized users.

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Most cited references 30

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Mortality and Morbidity in the 21st Century

Angus Deaton, Anne Case (2017)

We build on and extend the findings in Case and Deaton (2015) on increases in mortality and morbidity among white non-Hispanic Americans in midlife since the turn of the century. Increases in all-cause mortality continued unabated to 2015, with additional increases in drug overdoses, suicides, and alcohol-related liver mortality, particularly among those with a high-school degree or less. The decline in mortality from heart disease has slowed and, most recently, stopped, and this combined with the three other causes is responsible for the increase in all-cause mortality. Not only are educational differences in mortality among whites increasing, but from 1998 to 2015 mortality rose for those without, and fell for those with, a college degree. This is true for non-Hispanic white men and women in all five year age groups from 35-39 through 55-59. Mortality rates among blacks and Hispanics continued to fall; in 1999, the mortality rate of white non-Hispanics aged 50-54 with only a high-school degree was 30 percent lower than the mortality rate of blacks in the same age group but irrespective of education; by 2015, it was 30 percent higher. There are similar crossovers in all age groups from 25-29 to 60-64. Mortality rates in comparable rich countries have continued their pre-millennial fall at the rates that used to characterize the US. In contrast to the US, mortality rates in Europe are falling for those with low levels of educational attainment, and have fallen further over this period than mortality rates for those with higher levels of education. Many commentators have suggested that poor mortality outcomes can be attributed to contemporaneous levels of resources, particularly to slowly growing, stagnant, and even declining incomes; we evaluate this possibility, but find that it cannot provide a comprehensive explanation. In particular, the income profiles for blacks and Hispanics, whose mortality rates have fallen, are no better than those for whites. Nor is there any evidence in the European data that mortality trends match income trends, in spite of sharply different patterns of median income across countries after the Great Recession. We propose a preliminary but plausible story in which cumulative disadvantage from one birth cohort to the next, in the labor market, in marriage and child outcomes, and in health, is triggered by progressively worsening labor market opportunities at the time of entry for whites with low levels of education. This account, which fits much of the data, has the profoundly negative implication that policies, even ones that successfully improve earnings and jobs, or redistribute income, will take many years to reverse the mortality and morbidity increase, and that those in midlife now are likely to do much worse in old age than those currently older than 65. This is in contrast to an account in which resources affect health contemporaneously, so that those in midlife now can expect to do better in old age as they receive Social Security and Medicare. None of this implies that there are no policy levers to be pulled; preventing the over-prescription of opioids is an obvious target that would clearly be helpful.

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Deprivation: explaining differences in mortality between Scotland and England and Wales.

Sheldon R. Morris, V Carstairs (1989)

To detect reasons for the difference in mortality between Scotland and England and Wales a measure of deprivation was studied, comprising overcrowding, unemployment of men, low social class, and not having a car. Data for Scotland for 1980-2 showed this measure to be strongly associated with mortality, with gradients being particularly steep in young adults. Deprivation was much severe in Scotland than in England and Wales. These findings suggest that much excess mortality may be ascribed to more adverse conditions. Standardising the mortality ratios to take account of the relative affluence and deprivation of the two populations led to the differentials observed being radically adjusted, while standardising for social class had little effect. Deprivation measures based on areas overcome many of the limitations associated with social class analysis and also show much greater discrimination between populations. Measures of deprivation apparently provide a powerful basis for explanation of health differences. Such measures should therefore form part of the 1991 census output to facilitate their use on a consistent basis.

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The Intrinsic Estimator for Age‐Period‐Cohort Analysis: What It Is and How to Use It

Yang Yang, Sam Schulhofer‐Wohl, Wenjiang J. Fu … (2008)

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Author and article information

Contributors

Jane Parkinson:

ORCID: http://orcid.org/0000-0002-5697-1645

07500 854571 , jane.parkinson@nhs.net

Jon Minton: jonathan.minton@glasgow.ac.uk

James Lewsey: jim.lewsey@glasgow.ac.uk

Janet Bouttell: janet.bouttell@glasgow.ac.uk

Gerry McCartney: gmccartney@nhs.net

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 27 March 2018

Publication date PMC-release: 27 March 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 357

Affiliations

[1 ]ISNI 0000 0000 9506 6213, GRID grid.422655.2, Public Health Observatory, , NHS Health Scotland, Meridian Court, ; 5 Cadogan Street, Glasgow, G2 6QE UK

[2 ]ISNI 0000 0001 2193 314X, GRID grid.8756.c, Urban Studies, School of Social and Political Sciences, , University of Glasgow, ; 25 Bute Gardens, Glasgow, G12 8RT UK

[3 ]ISNI 0000 0001 2193 314X, GRID grid.8756.c, Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, , University of Glasgow, ; 1 Lilybank Gardens, Glasgow, G12 8RZ UK

Author information

Jane Parkinson http://orcid.org/0000-0002-5697-1645

Article

Publisher ID: 5267

DOI: 10.1186/s12889-018-5267-2

PMC ID: 5870372

PubMed ID: 29580222

SO-VID: 2fe36a3f-0eeb-4b2b-bbf7-0626cd8850dc

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 6 July 2017

Date accepted : 7 March 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000269, Economic and Social Research Council;

Award ID: ES/K006460/1

Custom metadata

ScienceOpen disciplines: Public health

Keywords: drug-related deaths,excess mortality,scottish effect,age-period-cohort effects,scotland,shaded contour plots,intrinsic estimator

Data availability:

ScienceOpen disciplines: Public health

Keywords: drug-related deaths, excess mortality, scottish effect, age-period-cohort effects, scotland, shaded contour plots, intrinsic estimator

Drug-related deaths in Scotland 1979–2013: evidence of a vulnerable cohort of young men living in deprived areas

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IEEE: COVID-19 related research

Most cited references 30

Mortality and Morbidity in the 21st Century

Deprivation: explaining differences in mortality between Scotland and England and Wales.

The Intrinsic Estimator for Age‐Period‐Cohort Analysis: What It Is and How to Use It

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