ScotPHO Health for All

Statistical Publication Notice

27 October 2009

The Scotland and European Health for All (HfA) Database 2009.

INTRODUCTION

KEY POINTS

• 600 health and health-related indicators, with Scottish data available for 490
• time trends based on annual data, from 1970 to 2007 where available
• data for Scotland and the 53 Member States currently in the WHO European Region, including the UK, plus averages such as the European Union.

INTERPRETATION

DETAILED FINDINGS

The Scotland and European HfA Database 2009 comprises:

• 600 health and health-related indicators, with Scottish data available for 490 (82%)
• time trends based on annual data, from 1970 to 2007 where available
• data for Scotland and the 53 Member States currently in the WHO European Region, including the UK, plus averages such as the European Union (27 Member States).

The briefing notes accompanying the database examine trends for the 490 indicators for Scotland, both over time and compared with the following selected European "countries": Denmark, France, Germany, Ireland, Portugal, UK, and the average of the 27 European Union countries (EU).

Some indicators for Scotland show important changes over time and/or differences from these selected countries. They can be grouped into eight broad categories, which are shown below with examples:

1. Scotland is improving over time, and has a favourable position relative to the selected countries:

• perinatal deaths (stillbirths plus deaths at 0-6 days) per 1000 total births (for birthweights of 1000g or more)
• standardised death rates for transport accidents and the subset motor vehicle traffic accidents
• rates of persons injured due to work-related accidents.

2. Scotland has mainly steady rates over time, but a favourable position relative to the selected countries:

• incidence rates for certain infectious diseases, eg measles and rubella
• rates of road traffic accidents involving alcohol
• rates of deaths due to work-related accidents (low in Scotland and the UK as a whole).

3. Scotland has improved over time, but still compares unfavourably with the selected countries:

• standardised death rates for all causes
• standardised death rates for diseases of the circulatory system such as ischaemic heart disease and cerebrovascular diseases (eg strokes)
• life expectancy at birth, age 1, 15, 45 and 65 years
• % of regular daily smokers in the population, age 15+ years (this tends to be a little higher in Scotland than the UK as a whole and Ireland, but the results should be treated with caution as there are differences in survey methodology etc)
• % of all live births to mothers aged under 20 years (this tends to be high compared to most of the selected countries, including the UK as a whole).

4.  Scotland has worsened over time, but compares favourably with the selected countries:

• rate of abortions per 1000 live births (for all ages of mother, and under 20 years).

5.  Scotland has worsened over time, but is broadly in line with the selected countries:

• HIV incidence per 100,000 population
• cancer incidence (rate of new cases) per 100,000 population (although the increasing Scottish rate seems to have flattened out after 1996)
• cancer prevalence, in % (based on the number of people living with cancer, who were diagnosed within the last 20 years).

6.  Scotland has worsened over time, and is currently worse than the selected countries:

• standardised death rates for diseases of the digestive system, in particular chronic liver disease and cirrhosis. (The pattern for liver cirrhosis is well-known, raising concern about levels of problematic drinking and alcohol-related harm in Scotland. There is, however, some suggestion that the rates have started to level out since about 2003.)

7.  Scotland tends to be worse than the selected countries, and exhibits a gender difference related to different historical lifestyle behaviour:

• standardised death rates for malignant neoplasms (all cancers) (for 65+ years)
• standardised death rates for trachea/bronchus/lung cancer (for all ages and 65+ years)
• trachea, bronchus and lung cancer incidence per 100,000 (for all ages).

For all three indicators, while the rates for males have fallen over time in Scotland, the rates for females tended to increase steadily until the early/mid 1990s and have not yet started to fall substantially. This is undoubtedly related to two aspects of historic smoking patterns: the earlier uptake of smoking in the UK (and Scotland) than in most other European countries; and the later peak in smoking prevalence among women than men in Scotland and the UK.

8.  Scotland demonstrates poor health, but comparisons with some of the selected countries (eg the UK as a whole) are limited due to insufficient or non-comparable data:

• diabetes prevalence, in % (the increase over time is likely to be due to the ageing population, improved data capture and the rising diabetes incidence in the western world, but there are few comparable data from the other selected countries)
• standardised death rates for homicide and intentional injury. (The rates for males of all ages and 0-64 years are noticeably high, and ? after disregarding the impact of the Lockerbie disaster in 1988 and 1989 ? have increased over time although tending to level out in more recent years. There is an apparent divergence from the selected countries, including the UK as a whole. However, the UK rates shown are underestimates, and comparisons with the Scottish rates are not valid (see briefing notes for more detail)).

This summary has tended to focus on the more robust indicators for comparison, eg mortality and some morbidity and lifestyle indicators.  However the database includes many other indicators, including those for hospital discharges, the environment, health care resources, and health care utilisation and expenditure. The briefing notes accompanying the database summarise the trends for all the indicators for Scotland, and offer further interpretation of some key results.

CONCLUSIONS

The Scotland and European HfA database provides a quick and easy-to-use tool to examine (via graphs and tables) patterns in a range of health indicators, both over time and comparing Scotland to other countries within the WHO European Region.

We hope that the database will be a useful resource for monitoring long-term trends in a wide range of health and health-related indicators, and comparing Scotland's position within Europe.

MAIN CONTACTS:

Alison Burlison
Senior Information Analyst
0131 275 6216
alison.burlison@nhs.net

Dr Colin Fischbacher
Consultant in Public Health Medicine
0131 275 7063 
colin.fischbacher@nhs.net

GLOSSARY:

Standardised death rates (SDRs), expressed per 100,000 population: SDRs are used to compare death rates both between populations which have different age structures, and within a population over time. The SDRs are all directly age-standardised to the European standard population (but in the case of rates for persons, not also standardised for sex). Further details are given in the database under Help - Technical notes .

Note that deaths of non-residents of Scotland which occurred in Scotland are included in the standardised death rates, and therefore the Lockerbie bombing in December 1988 (where a total of 270 people were killed) will considerably inflate the data for 1988 and 1989 for homicide and intentional injury.

PRE-RELEASE ACCESS:

HISTORY OF THIS PUBLICATION:

Last Published: June 2007
Next Due: 2011
Data first available: Database first published in 2006.
Data in all versions/updates include time trends, back to 1970 for some indicators.

Main contact: Dr Alison Burlison

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