From February 2017, information about the work of the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow is available and updated on the University of Glasgow website.

Population Health in Scotland

A series of studies - principally based on routinely collected and/or survey data - is strengthening our understanding of the health of the Scottish population and the inequalities in health that exist between different social groups and regions.

Inequalities in health in Scotland
 
We are completing a study of inequalities in health in Scotland between 1981 and 2011. This work will provide an overview of the state of and changes in inequalities in mortality, morbidity and other health outcomes by area deprivation and individual socioeconomic status. This study will complement previous work which looked at the changing patterns of causes of death by age, individual occupational, socio-economic status and the level of deprivation of an individual's area of residence. A report Inequalities in mortality in Scotland, 1981-2001 (released 16 February 2007) along with an executive summary and additional material can be downloaded from http://www.inequalitiesinhealth.com/.
 
The mountain plot displaying the contribution of each cause of death to inequalities for each age group was one of the main findings from the Inequalities in mortality in Scotland, 1981-2001 report. We developed the mountain plot as a jigsaw in 2013 with the aim of communicating these key findings and engaging people in discussions around inequalities in mortality. The jigsaw had a very successful outing as part of the MRC Centenary Celebrations Public Health interactive games at Glasgow Science Centre.
 
Work examining the social patterning of deaths due to assault in Scotland showed marked inequalities between 1980 and 2005; the rate in men under 65 years in the most deprived fifth of areas was 32 times that of men in the least deprived fifth. Assault accounted for over 6% of inequalities in mortality in men aged 15-44.Glasgow has high levels of deprivation and is known for its poor health and health-related behaviours. Using data from the Scottish Health Surveys (SHeS) we investigated differences between dietary habits in Glasgow and elsewhere in Scotland and found that associations between unhealthy eating and deprivation accounted for much of the tendency of people in Glasgow to have poor diets. Similarly, high levels of smoking in Greater Glasgow were attributable to its poorer socioeconomic composition and the social patterning of smoking.
 
Further, using data from the Twenty-07 study, we showed that health deteriorated more rapidly among people in more deprived areas. We also found the healthy survivor effect to be important when considering inequalities at older ages; the inclusion of deaths led to the reversal of an apparent convergence of health trajectories with increasing age. Further, socioeconomic status was an important determinant of the patterns of development of smoking and drinking behaviour and psychiatric distress in adolescence. Smoking was differentially patterned by area deprivation and rurality among 15 year olds in Scotland.
 
Lung function
 
Lung function has been shown to be a long-term predictor of mortality from a range of causes in addition to respiratory disease. Previous studies have demonstrated its positive correlation with social status. Although lung function is known to decline over age, little is known about changes in social patterns over the life course or over time. We investigated differences in social patterns over age and time. We found cross-sectional evidence from 24,500 respondents from the annual Scottish Health Surveys (SHeS) that socioeconomic disparities in lung function increase with age, especially for men.  Our findings indicate that early-life factors may predict inequity during younger adulthood, with environmental factors becoming more important at older ages, suggesting different opportunities for interventions at different stages of the lifecourse. We are also evaluating the predictive ability of lung function in relation to other predictors of mortality separately for men and women.
 
Exploring the relationship between obesity and smoking
 
In line with other Western countries, the overall prevalence of cigarette smoking in Scotland has fallen in recent decades. Evidence suggests that current smokers have lower body mass index (BMI) than people who have never smoked and those who have quit have higher BMI than never-smokers. However, the relationship between smoking and BMI may be more complex. The belief that smoking can aid weight control is cited by some people, especially adolescent girls, as a reason for starting, or not stopping, smoking; scientific evidence which refutes this association could be powerful in health promotion. We investigated the impact of smoking and smoking cessation on overweight and obesity in 40,000+ participants in SHeS and found that whilst current smoking is associated with reduced risk of being overweight or obese in some older adults, there was no evidence of this association among young people.
 
In a separate study, we are also investigating whether the association between BMI and smoking depends on social status and whether any such variations have been consistent over time. 
 
Amenable deaths and hospitalisations
 
Mortality amenable to health care comprises those deaths that should not occur in the presence of timely and effective health care. It is a measure of how much health care can contribute to the health of populations. A current PhD project will describe trends in amenable mortality over time in Scotland, and willassess the socioeconomic inequalities in these.
 
We have also used linked Finnish data to examine socioeconomic disparities in mortality amenable to health care intervention. We noted a slower rate of improvement in mortality due to such causes of death in the lowest income groups and found inequalities in mortality attributable to primary care to be larger than those attributable to specialised care. In New South Wales, Australia, we are investigating the validity of potentially preventable hospitalisations as a means of assessing the effectiveness of primary care services. This has led to a CSO-funded project on avoidable hospitalisations in Scotland.
 
Body Mass Index and mental health in adolescents
 
In recent years, increasing levels of obesity have become a major public health concern, particularly among children and adolescents, for whom prevalence of depression has also increased. It is important to understand the connection between obesity and psychological wellbeing in pre-adulthood since this is potentially a crucial stage in the development of both; few previous studies have accounted for the possibility of gender-specific associations in adolescents. Using data from the Scottish Health Surveys we established that being overweight was associated with mental health in female but not male adolescents. Addressing depressed mood in girls prior to or during adolescence may be instrumental in preventing onset of obesity.
 
Excess deaths in Scotland attributable to drug use 
 
The higher mortality rates seen in Scotland compared to England cannot be explained by higher levels of deprivation in Scotland – a disparity that has come to be known as ‘the Scottish effect’. We have shown how the higher prevalence of problem drug use in Scotland – and the higher mortality rates associated with this group – may explain one third of the excess mortality over that seen in England between the ages of 15 and 54.
 
Homicide rates in Scotland
 
Analysis of homicide rates in Scotland showed an increase of 83% between 1982 and 2002. Over the same period homicides involving knives and other sharp objects increased by 164%. Rates were particularly high in Glasgow; by 2002 the homicide rate in Glasgow was nearly 3 times that for Scotland as a whole. The extent to which the increase in homicide rates is attributable to knives - particularly in Glasgow - suggests that homicides involving knives is becoming a public health problem.
 
Scottish Health Survey
 
As a partner in the annual Scottish Health Surveys (SHeS) we have contributed numerous chapters to the published survey reports, on topics including smoking, obesity, diet, and long-term conditions. .
 
The main findings from our chapters in the most recent Scottish Health Survey (2012) are:
 
Smoking
  • One in four adults was a current cigarette smoker and those aged 25 to 44 were most likely to smoke.
  • Smoking prevalence among 16 to 64 year olds has declined from 35% in 1995 to 27%.
  • Smokers smoked an average of 13.5 cigarettes per day in 2012 (higher for men), which has decreased over time.
  • One in six non-smoking adults were exposed to second-hand smoke in their own or someone else’s home and 16% reported exposure in a public place.
  • One in five children lived in a household where someone smokes within the home.
  • Around three-quarters of smokers said that they would like to quit. 
Adult obesity
  • 27% of adults were obese, and 68% of men and 60% of women were overweight. 
  • Since 1995, the proportion of adults aged 16-64 who were overweight or obese increased from 52% to 62% in 2012; the prevalence of obesity increased from 17% to 26%, although the levels have remained fairly constant since 2008.
  • The mean adult BMI was 27.3 kg/m2. 
Child obesity
  • 65% of boys and 70% of girls had a healthy weight; those aged 12-15 were least likely to have healthy weight.
  • The proportion of children at risk of obesity rose from 14% to 17% between 1998 and 2008 but has remained stable since then.
  • The proportion at risk of overweight including obese increased from 30% in 1998. to 33% in 2008 but since then has fluctuated with no clear pattern (31% in 2012).
  • 2.3% of girls and 1.4% of boys were at risk of underweight. 
Long-term conditions 
  • Almost half of adults reported having a long-term condition (a physical or mental health condition or illness lasting/likely to last for twelve months or more).
  • A third had a long-term condition that limited their daily activities.
  • Women and older adults were more likely to report having a long-term condition.
  • Since 1998 the proportion of adults with doctor-diagnosed asthma has increased from 11% to 17%.
  • Declining from 18% in 1998, 13% of children had been diagnosed with asthma, with boys more likely than girls.
  • 4% of adults had been diagnosed with chronic obstructive pulmonary disease.
  • One in six adults had a cardiovascular condition.
  • 5.5% of all adults in Scotland had diabetes.
Our findings from other Scottish Health Survey reports can be found here.
 
Cardiovascular disease and occupational social class
 
Previous research has shown that Cardiovascular Disease (CVD) is associated with both individual social class and the deprivation of the area of residence. We examined whether individual or area characteristics showed a stronger relationship with CVD, after adjusting for individual smoking status.
 
Coronary Heart disease and parental height
 
We explored the effects of parental height in relation to their offspring’s coronary heart disease risk. Using data from the west of Scotland Midspan Family Study we examined almost 1,500 married couples in two Scottish towns who had their height measured in the 1970s were combined with health risk data from their adult children (the ‘offspring’, n=2,300) obtained in 1996 when aged 30-59 years; the offspring were monitored for subsequent hospital admissions or deaths from heart disease. Stronger associations with mother’s height could be explained by stronger associations between health-related behaviours of mothers and their children, or by fetal development in utero being affected by the mother’s own early life circumstances.
 
Suicide in Scotland and England & Wales
 
This project compared suicide rates in England & Wales and Scotland. Following an initial period in which Scotland had a lower suicide rate, the two countries converged by 1968 and then diverged slightly as rates increased more rapidly in Scotland than in England & Wales. Since 1992 rates have fallen in England & Wales but not Scotland leading to further divergence, driven largely by a rise in suicide in young men and deaths by hanging in Scotland. Subsequent ecological analysis suggested that more than half of Scotland’s excess suicide risk could be explained by various area-level measures including alcohol and drug use, prescriptions for psychotropic drugs, socioeconomic deprivation, and social fragmentation. This suggests that efforts to reduce the difference in suicide rates between UK nations should focus on preventing and treating mental ill health, and drug and alcohol problems.
 
Comparing health across Europe using routine survey data
 
We led a European collaboration using health survey data on almost 127,000 people from 33 metropolitan areas, including Greater Glasgow, to compare general health, psychological distress, longstanding illness, acute sickness, and obesity. We found health tends to be worse in the north and west of the UK and central belt and south eastern Germany, and more favourable in Sweden and north west Belgium, even after accounting for differences in socio-economic composition.

Publications

2016

Gray L, Leyland AH. Chapter 2: General health and multiple conditions. In: Campbell-Jack D, Hinchliffe S, Rutherford L, editors The Scottish Health Survey 2015: Volume 1 - Main Report. Edinburgh: The Scottish Government Health Directorate, 2016.

open access  

Gray L, Leyland AH. Chapter 4: Alcohol Consumption. In: Campbell-Jack D, Hinchliffe S, Rutherford L, editors The Scottish Health Survey 2015: Volume 1 - Main Report. Edinburgh: The Scottish Government Health Directorate, 2016.

open access  

Gray L, Leyland AH. Chapter 5: Smoking. In: Campbell-Jack D, Hinchliffe S, Rutherford L, editors The Scottish Health Survey 2015: Volume 1 - Main Report. Edinburgh: The Scottish Government Health Directorate, 2016.

open access  

2015

Gray L, Leyland AH. Chapter 2: Alcohol consumption. In: Campbell-Jack D, Hinchliffe S, Bromley C, editors The Scottish Health Survey 2014 volume 1: main report. Edinburgh: The Scottish Government Health Directorate, 2015.

open access  

Gray L, Leyland AH. Chapter 3: Smoking. In: Campbell-Jack D, Hinchliffe S, Bromley C, editors The Scottish Health Survey 2014 volume 1: main report. Edinburgh: The Scottish Government Health Directorate, 2015.

open access  

Gray L, Leyland AH. Chapter 9: Inequalities in health risks. In: Campbell-Jack D, Hinchliffe S, Bromley C, editors The Scottish Health Survey 2014 volume 1: main report. Edinburgh: The Scottish Government Health Directorate, 2015.

open access  

2014

Gray L, Leyland AH. Chapter 4: Smoking. In: Rutherford L, Hinchliffe S, Sharp C, editors The Scottish Health Survey 2013 volume 1: main report. Edinburgh: The Scottish Government Health Directorate, 2014.

open access  

Gray L, Leyland AH. Chapter 5: Alcohol consumption. In: Rutherford L, Hinchliffe S, Sharp C, editors The Scottish Health Survey 2013 volume 1: main report. Edinburgh: The Scottish Government Health Directorate, 2014.

open access  

Gray L, Leyland AH. Chapter 8: General health, mental wellbeing and caring. In: Rutherford L, Hinchliffe S, Sharp C, editors The Scottish Health Survey 2013 volume 1: main report. Edinburgh: The Scottish Government Health Directorate, 2014.

open access  

2013

Gray L, Leyland AH, Benzeval M, Watt GCM. Explaining the social patterning of lung function in adulthood at different ages: the roles of childhood precursors, health behaviours and environmental factors. Journal of Epidemiology & Community Health 2013;67:905-91

open access  

Gray L, White IR, McCartney G, Katikireddi SV, Rutherford L, Gorman E, Leyland AH. Use of record-linkage to handle non-response and improve alcohol consumption estimates in health survey data: a study protocol. BMJ Open 2013;3:e002647

open access  

Mackay DF, Gray L, Pell JP. Impact of smoking and smoking cessation on overweight and obesity: Scotland-wide, cross-sectional study on 40,036 participants. BMC Public Health 2013;348

pubmed  open access  

Mok PLH, Leyland AH, Kapur N, Windfuhr K, Appleby L, Platt S, Webb RT. Why does Scotland have a higher suicide rate than England? An area-level investigation of health and social factors. Journal of Epidemiology & Community Health 2013;67:63-70

pubmed  open access  

2012

Gray L, Leyland AH. Chapter 3: Diet. In: Rutherford L, Sharp C, Bromley C, editors The Scottish Health Survey 2011 volume 2: children. Edinburgh: The Scottish Government Health Directorate, 2012:62-85.

Gray L, Leyland AH. Chapter 5: obesity. In: Rutherford L, Sharp C, Bromley C, editors The Scottish Health Survey 2011 volume 2: children. Edinburgh: The Scottish Government Health Directorate, 2012:101-115.

Gray L, Leyland AH. Chapter 7: obesity. In: Rutherford L, Sharp C, Bromley C, editors The Scottish Health Survey 2011 volume 1: adults. Edinburgh: The Scottish Government Health Directorate, 2012:185-205.

Gray L, Smith GD, McConnachie A, Watt GCM, Hart CL, Upton MN, Macfarlane PW, Batty GD. Parental height in relation to offspring coronary heart disease: examining transgenerational influences on health using the west of Scotland Midspan Family Study. International Journal of Epidemiology 2012;41:1776-85

open access  

Mok PL, Kapur N, Windfhur K, Leyland AH, Appleby L, Platt S, Webb RT. Trends in national suicide rates for Scotland and England and Wales, 1960-2008. British Journal of Psychiatry 2012;200:245-251

pubmed  open access  

Mok PLH, Kapur N, Windfuhr K, Appleby L, Leyland AH, Platt S, Webb RT. Authors’ reply [letter]. British Journal of Psychiatry 2012;201

2011

Gray L, Leyland AH. Chapter 5: fruit and vegetable consumption. In: Bromley C, Bradshaw P, Given L, editors The Scottish Health Survey 2010 volume 1: main report. Edinburgh: The Scottish Government Health Directorate, 2011.

open access  

Gray L, Leyland AH. Chapter 7: adult and child obesity. In: Bromley C, Given L, editors The Scottish Health Survey 2010 volume 1: main report. Edinburgh: The Scottish Government Health Directorate, 2011.

open access  

Gray L, Leyland AH. Chapter 8: respiratory health and lung function. In: Bromley C, Given L, editors The Scottish Health Survey 2010 volume 1: main report. Edinburgh: 2011.

open access  

2010

Dundas R, Leyland AH. The social patterning of deaths due to assault in Scotland, 1980-2005: a population based study. AQMeN Applied Quantitative Methods Newsletter 2010;3

Gray L, Batty GD, Craig P, Stewart C, Whyte B, Findlayson B, Leyland AH. Cohort profile: the Scottish Health Surveys Cohort - linkage of study participants to routinely collected records for mortality, hospital discharge, cancer and offspring birth characteristics in three nationwide studies. International Journal of Epidemiology 2010;39:345-50

pubmed  open access  

Gray L, Hart C L, Smith DG, Batty GD. What is the predictive value of established risk factors for total and cardiovascular disease mortality when measured before middle-age? pooled analyses of two prospective cohort studies from Scotland. European Journal of Cardiovascular Prevention & Rehabilitation 2010;17:106-112

pubmed  open access  

Gray L, Leyland AH. Chapter 5: diet. In: Bromley C, Given L, Ormston R, editors The Scottish Health Survey 2009 volume 1: main report. Edinburgh: The Scottish Government Health Directorate, 2010.

open access  

Gray L, Leyland AH. Chapter 7: adult obesity. In: Bromley C, Given L, Ormston R, editors The Scottish Health Survey 2009 volume 1: main report. Edinburgh: The Scottish Government Health Directorate, 2010.

open access  

Leyland AH, Dundas R. The social patterning of deaths due to assault in Scotland, 1980-2005: population based study. Journal of Epidemiology & Community Health 2010;64:432-9

pubmed  open access  

2009

Gray L, Leyland AH. Chapter 4: smoking. In: Bromley C, Bradshaw P, Given L, editors The Scottish Health Survey 2008 volume 1: main report. Edinburgh: The Scottish Government Health Directorate, 2009:101-136.

open access  

Gray L, Leyland AH. Chapter 5: fruit and vegetable consumption. In: Bromley C, Bradshaw P, Given L, editors The Scottish Health Survey 2008 volume 1: main report. Edinburgh: The Scottish Government Health Directorate, 2009:137-156.

Gray L, Leyland AH. Chapter 7: obesity. In: Bromley C, Bradshaw P, Given L, editors The Scottish Health Survey 2008 volume 1: main report. Edinburgh: The Scottish Government Health Directorate, 2009:191-228.

2008

Bloor M, Gannon M, Hay G, Jackson G, Leyland AH, McKeganey N. Contribution of problem drug users' deaths to excess mortality in Scotland: secondary analysis of cohort study. BMJ 2008;337:a478

open access  

Gray L, Leyland AH. Overweight status and psychological wellbeing in adolescent boys and girls: a multilevel analysis. European Journal of Public Health 2008;18:616-621

pubmed  open access  

2007

Leyland AH, Dundas R, McLoone P, Boddy FA. Inequalities in mortality in Scotland 1981-2001. MRC/CSO Social and Public Health Sciences Unit Occasional paper no. 16, Glasgow, 2007

open access  

Leyland AH, Dundas R, McLoone P, Boddy FA. Cause-specific inequalities in mortality in Scotland: two decades of change - a population-based study. BMC Public Health 2007;7:172

pubmed  open access  

2006

Leyland AH. Homicides involving knives and other sharp objects in Scotland, 1981-2003. Journal of Public Health 2006;28:145-147

pubmed  

2005

Gray L, Leyland AH. General and psychosocial health. In: Bromley S, Shelton N, editors The Scottish Health Survey 2003 volume 3: children. Edinburgh: The Scottish Executive Department of Health, 2005:129-168.

open access  

Gray L, Leyland AH. General health, psychosocial health and use of services. In: Bromley C, Sproston K, Shelton N, editors The Scottish Health Survey 2003 volume 2: adults. Edinburgh: Scottish Executive, 2005:191-254.

open access  

Leyland AH. Socioeconomic gradients in the prevalence of cardiovascular disease in Scotland: the roles of composition and context. Journal of Epidemiology & Community Health 2005;59:799-803

pubmed  

2004

Leyland AH. Increasing inequalities in premature mortality in Great Britain. Journal of Epidemiology & Community Health 2004;58:296-302

pubmed  open access  

2003

McLoone P. Increasing mortality among adults in Scotland 1981 to 1999. European Journal of Public Health 2003;13:230-234

2002

Westert G, Lagoe R, Keskimäki I, Leyland AH, Murphy M. An international study of hospital readmissions and related utilization in Europe and the USA. Health Policy 2002;61:269-278

pubmed  

Glossary

  • Attenuate To make smaller, particularly in relation to an effect
  • BMI Body Mass Index
  • Carstairs scores A summary measure applied to populations of areas, especially postcode sectors, based on variables taken from decennial population Censuses. This indicator of relative disadvantage uses measures of overcrowding, male unemployment, households with no car and low social class.
  • Occupational social class The Registrar General's classification of social status based upon an individual's occupation.
  • Postcode sector The set of unit postcodes that are the same apart from the last two characters e.g. G12 8. The mean population is about 5000.
  • Scottish Health Survey The Scottish Health Survey provides a detailed picture of the health of the Scottish population living in private households. The survey is used to monitor health in Scotland.
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