Recent adverse mortality trends in Scotland: comparison with other high-income countries

Abstract

Objective: Gains in life expectancy have faltered in several high-income countries in recent years. Scotland has consistently had a lower life expectancy than many other high-income countries over the past 70 years. We aim to compare life expectancy trends in Scotland to those seen internationally and to assess the timing and importance of any recent changes in mortality trends for Scotland.

Setting: Austria, Croatia, Czech Republic, Denmark, England and Wales, Estonia, France, Germany, Hungary, Iceland, Israel, Japan, Korea, Latvia, Lithuania, Netherlands, Northern Ireland, Poland, Scotland, Slovakia, Spain, Sweden, Switzerland and USA.

Methods: We used life expectancy data from the Human Mortality Database (HMD) to calculate the mean annual life expectancy change for 24 high-income countries over 5-year periods from 1992 to 2016. Linear regression was used to assess the association between life expectancy in 2011 and mean life expectancy change over the subsequent 5 years. One-break and two-break segmented regression models were used to test the timing of mortality rate changes in Scotland between 1990 and 2018.

Results: Mean improvements in life expectancy in 2012-2016 were smallest among women (<2 weeks/year) in Northern Ireland, Iceland, England and Wales, and the USA and among men (<5 weeks/year) in Iceland, USA, England and Wales, and Scotland. Japan, Korea and countries of Eastern Europe had substantial gains in life expectancy over the same period. The best estimate of when mortality rates changed to a slower rate of improvement in Scotland was the year to 2012 quarter 4 for men and the year to 2014 quarter 2 for women.

Conclusions: Life expectancy improvement has stalled across many, but not all, high-income countries. The recent change in the mortality trend in Scotland occurred within the period 2012-2014. Further research is required to understand these trends, but governments must also take timely action on plausible contributors.

Keywords: epidemiology; public health; statistics & research methods.

Figure 1

Mean annual change in female life expectancy at birth (weeks), for 5-year periods 1991–2016, by country. Countries are ordered on the size of mean life expectancy change in the most recent period (2012–2016).

Figure 2

Mean annual change in male life expectancy at birth (weeks), for 5-year periods 1991–2016, by country. Countries are ordered on the size of mean life expectancy change in the most recent period (2012–2016).

Figure 3

Life expectancy in 2011 (years) and mean change in life expectancy 2012–2016 (weeks), for 24 high-income countries, by sex.

Figure 4

Age-standardised rolling four-quarterly mortality rates for men and women in Scotland, with segmented regression models fitted, 1990–2018.