How have changes in death by cause and age group contributed to the recent stalling of life expectancy gains in Scotland? Comparative decomposition analysis of mortality data, 2000-2002 to 2015-2017.

OBJECTIVE: Annual gains in life expectancy in Scotland were slower in recent years than in the previous two decades. This analysis investigates how deaths in different age groups and from different causes have contributed to annual average change in life expectancy across two time periods: 2000-2002 to 2012-2014 and 2012-2014 to 2015-2017. SETTING: Scotland. METHODS: Life expectancy at birth was calculated from death and population counts, disaggregated by 5 year age group and by underlying cause of death. Arriaga's method of life expectancy decomposition was applied to produce estimates of the contribution of different age groups and underlying causes to changes in life expectancy at birth for the two periods. RESULTS: Annualised gains in life expectancy between 2012-2014 and 2015-2017 were markedly smaller than in the earlier period. Almost all age groups saw worsening mortality trends, which deteriorated for most cause of death groups between 2012-2014 and 2015-2017. In particular, the previously observed substantial life expectancy gains due to reductions in mortality from circulatory causes, which most benefited those aged 55-84 years, more than halved. Mortality rates for those aged 30-54 years and 90+ years worsened, due in large part to increases in drug-related deaths, and dementia and Alzheimer's disease, respectively. CONCLUSION: Future research should seek to explain the changes in mortality trends for all age groups and causes. More investigation is required to establish to what extent shortcomings in the social security system and public services may be contributing to the adverse trends and preventing mitigation of the impact of other contributing factors, such as influenza outbreaks.

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

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.