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Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 1992 Oct;46(5):498–505. doi: 10.1136/jech.46.5.498

Mortality in Glasgow and Edinburgh: a paradigm of inequality in health.

G C Watt 1, R Ecob 1
PMCID: PMC1059640  PMID: 1479319

Abstract

STUDY OBJECTIVE--The aim was to describe, predict, and interpret mortality in Glasgow and Edinburgh. DESIGN--The study was an analysis of all cause and cause specific mortality data for quinquennia based on census years between 1931 and 1981, linking age and sex specific mortality rates by year of birth, for people dying between the ages of 25 and 74 years. SETTING--Glasgow and Edinburgh, Scotland. MAIN RESULTS--Age and sex specific mortality rates declined steadily in Edinburgh and Glasgow during the period 1931-1981, with rates always being lower in Edinburgh than in Glasgow. Since 1961 log mortality rates have tended to rise linearly with age in both cities. In 1979-83, the population of Glasgow reached a given all cause mortality rate 3.9 years earlier in men and 3.6 years earlier in women than did the population of Edinburgh. These differences have increased, and are predicted to increase further, especially in men. CONCLUSIONS--The current 40% cross sectional difference in mortality rates between the cities is largely determined by levels of mortality in early adulthood which provide a baseline for the subsequent rise in log mortality. Disease specific epidemiology provides a limited view of inequalities in health, and a partial basis for health promotion. Campaigns to alter disease risk profiles in adults should be complemented by measures operating earlier in life to reduce susceptibility to risk. Maternal and child health require greater priority in public health policy, particularly in areas of socioeconomic disadvantage.

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Selected References

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  1. Barker D. J., Bull A. R., Osmond C., Simmonds S. J. Fetal and placental size and risk of hypertension in adult life. BMJ. 1990 Aug 4;301(6746):259–262. doi: 10.1136/bmj.301.6746.259. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Barker D. J., Godfrey K. M., Fall C., Osmond C., Winter P. D., Shaheen S. O. Relation of birth weight and childhood respiratory infection to adult lung function and death from chronic obstructive airways disease. BMJ. 1991 Sep 21;303(6804):671–675. doi: 10.1136/bmj.303.6804.671. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Barker D. J., Osmond C. Childhood respiratory infection and adult chronic bronchitis in England and Wales. Br Med J (Clin Res Ed) 1986 Nov 15;293(6557):1271–1275. doi: 10.1136/bmj.293.6557.1271. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Barker D. J. The fetal and infant origins of adult disease. BMJ. 1990 Nov 17;301(6761):1111–1111. doi: 10.1136/bmj.301.6761.1111. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Barker D. J., Winter P. D., Osmond C., Margetts B., Simmonds S. J. Weight in infancy and death from ischaemic heart disease. Lancet. 1989 Sep 9;2(8663):577–580. doi: 10.1016/s0140-6736(89)90710-1. [DOI] [PubMed] [Google Scholar]
  6. Ben-Shlomo Y., Smith G. D. Deprivation in infancy or in adult life: which is more important for mortality risk? Lancet. 1991 Mar 2;337(8740):530–534. doi: 10.1016/0140-6736(91)91307-g. [DOI] [PubMed] [Google Scholar]
  7. Boyle P., Robertson C. Statistical modelling of lung cancer and laryngeal cancer incidence in Scotland, 1960-1979. Am J Epidemiol. 1987 Apr;125(4):731–744. doi: 10.1093/oxfordjournals.aje.a114585. [DOI] [PubMed] [Google Scholar]
  8. Cassel J. The contribution of the social environment to host resistance: the Fourth Wade Hampton Frost Lecture. Am J Epidemiol. 1976 Aug;104(2):107–123. doi: 10.1093/oxfordjournals.aje.a112281. [DOI] [PubMed] [Google Scholar]
  9. Clayton D., Schifflers E. Models for temporal variation in cancer rates. I: Age-period and age-cohort models. Stat Med. 1987 Jun;6(4):449–467. doi: 10.1002/sim.4780060405. [DOI] [PubMed] [Google Scholar]
  10. Crombie I. K., Kenicer M. B., Smith W. C., Tunstall-Pedoe H. D. Unemployment, socioenvironmental factors, and coronary heart disease in Scotland. Br Heart J. 1989 Feb;61(2):172–177. doi: 10.1136/hrt.61.2.172. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Cummins R. O., Shaper A. G., Walker M., Wale C. J. Smoking and drinking by middle-aged British men: effects of social class and town of residence. Br Med J (Clin Res Ed) 1981 Dec 5;283(6305):1497–1502. doi: 10.1136/bmj.283.6305.1497. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Ebi-Kryston K. L., Hawthorne V. M., Rose G., Shipley M. J., Gillis C. R., Hole D. J., Carmen W., Eshleman S., Higgins M. W. Breathlessness, chronic bronchitis and reduced pulmonary function as predictors of cardiovascular disease mortality among men in England, Scotland and the United States. Int J Epidemiol. 1989 Mar;18(1):84–88. doi: 10.1093/ije/18.1.84. [DOI] [PubMed] [Google Scholar]
  13. Fox A. J., Goldblatt P. O., Adelstein A. M. Selection and mortality differentials. J Epidemiol Community Health. 1982 Jun;36(2):69–79. doi: 10.1136/jech.36.2.69. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Gillis C. R., Hole D. J., Hawthorne V. M. Cigarette smoking and male lung cancer in an area of very high incidence. II. Report of a general population cohort study in the West of Scotland. J Epidemiol Community Health. 1988 Mar;42(1):44–48. doi: 10.1136/jech.42.1.44. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Haan M., Kaplan G. A., Camacho T. Poverty and health. Prospective evidence from the Alameda County Study. Am J Epidemiol. 1987 Jun;125(6):989–998. doi: 10.1093/oxfordjournals.aje.a114637. [DOI] [PubMed] [Google Scholar]
  16. JONES H. B. A special consideration of the aging process, disease, and life expectancy. Adv Biol Med Phys. 1956;4:281–337. doi: 10.1016/b978-1-4832-3110-5.50012-1. [DOI] [PubMed] [Google Scholar]
  17. Joseph K. S. The Matthew effect in health development. BMJ. 1989 Jun 3;298(6686):1497–1498. doi: 10.1136/bmj.298.6686.1497. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Kuller L. H., Ockene J. K., Townsend M., Browner W., Meilahn E., Wentworth D. N. The epidemiology of pulmonary function and COPD mortality in the multiple risk factor intervention trial. Am Rev Respir Dis. 1989 Sep;140(3 Pt 2):S76–S81. doi: 10.1164/ajrccm/140.3_Pt_2.S76. [DOI] [PubMed] [Google Scholar]
  19. Marmot M. G., McDowall M. E. Mortality decline and widening social inequalities. Lancet. 1986 Aug 2;2(8501):274–276. doi: 10.1016/s0140-6736(86)92085-4. [DOI] [PubMed] [Google Scholar]
  20. Marmot M. G., Shipley M. J., Rose G. Inequalities in death--specific explanations of a general pattern? Lancet. 1984 May 5;1(8384):1003–1006. doi: 10.1016/s0140-6736(84)92337-7. [DOI] [PubMed] [Google Scholar]
  21. Morris J. N. Inequalities in health: ten years and little further on. Lancet. 1990 Aug 25;336(8713):491–493. doi: 10.1016/0140-6736(90)92026-e. [DOI] [PubMed] [Google Scholar]
  22. Pocock S. J., Shaper A. G., Cook D. G., Phillips A. N., Walker M. Social class differences in ischaemic heart disease in British men. Lancet. 1987 Jul 25;2(8552):197–201. doi: 10.1016/s0140-6736(87)90774-4. [DOI] [PubMed] [Google Scholar]
  23. Reading V. M., Weale R. A. A new analysis of United Nations mortality statistics. Mech Ageing Dev. 1991 Jan;57(1):25–48. doi: 10.1016/0047-6374(91)90022-r. [DOI] [PubMed] [Google Scholar]
  24. Shaper A. G., Pocock S. J., Walker M., Cohen N. M., Wale C. J., Thomson A. G. British Regional Heart Study: cardiovascular risk factors in middle-aged men in 24 towns. Br Med J (Clin Res Ed) 1981 Jul 18;283(6285):179–186. doi: 10.1136/bmj.283.6285.179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Smith G. D., Bartley M., Blane D. The Black report on socioeconomic inequalities in health 10 years on. BMJ. 1990 Aug 18;301(6748):373–377. doi: 10.1136/bmj.301.6748.373. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Smith G. D., Shipley M. J., Rose G. Magnitude and causes of socioeconomic differentials in mortality: further evidence from the Whitehall Study. J Epidemiol Community Health. 1990 Dec;44(4):265–270. doi: 10.1136/jech.44.4.265. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Smith W. C., Shewry M. C., Tunstall-Pedoe H., Crombie I. K., Tavendale R. Cardiovascular disease in Edinburgh and north Glasgow--a tale of two cities. J Clin Epidemiol. 1990;43(7):637–643. doi: 10.1016/0895-4356(90)90033-l. [DOI] [PubMed] [Google Scholar]
  28. Thelle D. S., Shaper A. G., Whitehead T. P., Bullock D. G., Ashby D., Patel I. Blood lipids in middle-aged British men. Br Heart J. 1983 Mar;49(3):205–213. doi: 10.1136/hrt.49.3.205. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Tunstall-Pedoe H. Coronary heart disease. BMJ. 1991 Sep 21;303(6804):701–704. doi: 10.1136/bmj.303.6804.701. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Tunstall-Pedoe H., Smith W. C., Crombie I. K., Tavendale R. Coronary risk factor and lifestyle variation across Scotland: results from the Scottish Heart Health Study. Scott Med J. 1989 Dec;34(6):556–560. doi: 10.1177/003693308903400604. [DOI] [PubMed] [Google Scholar]
  31. Ueshima H., Cooper R., Stamler J., Yu C., Tatara K., Asakura S. Age specific mortality trends in the U.S.A. from 1960 to 1980: divergent age-sex-color patterns. J Chronic Dis. 1984;37(6):425–439. doi: 10.1016/0021-9681(84)90026-2. [DOI] [PubMed] [Google Scholar]
  32. Walker M., Shaper A. G., Phillips A. N., Cook D. G. Short stature, lung function and risk of a heart attack. Int J Epidemiol. 1989 Sep;18(3):602–606. doi: 10.1093/ije/18.3.602. [DOI] [PubMed] [Google Scholar]
  33. West R. R. Geographical variation mortality from ischaemic heart disease in England and Wales. Br J Prev Soc Med. 1977 Dec;31(4):245–250. doi: 10.1136/jech.31.4.245. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. West R. R. High death rates: more deaths or earlier deaths? J R Coll Physicians Lond. 1987 Jan;21(1):73–76. [PMC free article] [PubMed] [Google Scholar]

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