Does ethnic diversity explain intra-UK variation in mortality? A longitudinal cohort study

Area of Science:

• Public Health
• Epidemiology
• Sociology

Background:

• Higher mortality rates in Scotland compared to England and Wales, and in Glasgow versus other UK cities, have been observed.
• A hypothesis suggests greater ethnic diversity in England and Wales may explain these differences.

Purpose of the Study:

• To assess the extent to which excess mortality in Scotland and Glasgow is reduced by adjusting for ethnicity and country of birth.
• To explore the role of ethnicity and country of birth in observed mortality differences.

Main Methods:

• Utilized the Scottish Longitudinal Study and the Office for National Statistics Longitudinal Study of England and Wales (2001-2010).
• Analyzed all-cause mortality risk in participants aged 35-74 years, adjusting for age, gender, socioeconomic position (SEP), ethnicity, and country of birth.
• Compared mortality rates between Scotland and England/Wales, and between Glasgow and Manchester.

Main Results:

• Glasgow had 33% higher mortality than Manchester, reducing to 20% after adjusting for SEP, and 20% after adjusting for ethnicity and country of birth.
• Scotland had 18% higher mortality than England and Wales, reducing to 10% after adjusting for SEP, and 7% after adjusting for ethnicity and country of birth.
• Non-Whites born outside the UK had lower mortality; in Scotland, non-Whites born in the UK had higher mortality than Whites born in the UK.

Conclusions:

• Findings support the role of ethnic diversity and international migration in explaining excess Scottish mortality.
• A significant excess mortality remains in Glasgow, indicating that socioeconomic factors like poverty and inequality are still critical.
• Policy implications addressing poverty, vulnerability, and inequality remain relevant for reducing mortality disparities.