Abstract
BackgroundEven after accounting for deprivation, mortality rates are higher in Scotland relative to the rest of Western Europe. Higher mortality from alcohol- and drug-related deaths (DRDs), violence and suicide (particularly in young adults) contribute to this ‘excess’ mortality. Age-period and cohort effects help explain the trends in alcohol-related deaths and suicide, respectively. This study investigated whether age, period or cohort effects might explain recent trends in DRDs in Scotland and relate to exposure to the changing political context from the 1980s.MethodsWe analysed data on DRDs from 1979 to 2013 by sex and deprivation using shaded contour plots and intrinsic estimator regression modelling to identify and quantify relative age, period and cohort effects.ResultsThe peak age for DRDs fell around 1990, especially for males as rates increased for those aged 18 to 45 years. There was evidence of a cohort effect, especially among males living in the most deprived areas; those born between 1960 and 1980 had an increased risk of DRD, highest for those born 1970 to 1975. The cohort effect started around a decade earlier in the most deprived areas compared to the rest of the population.ConclusionAge-standardised rates for DRDs among young adults rose during the 1990s in Scotland due to an increased risk of DRD for the cohort born between 1960 and 1980, especially for males living in the most deprived areas. This cohort effect is consistent with the hypothesis that exposure to the changing social, economic and political contexts of the 1980s created a delayed negative health impact.
Highlights
Even after accounting for deprivation, mortality rates are higher in Scotland relative to the rest of Western Europe
In this paper we explore whether there are age, period or cohort (APC) effects in drug-related death (DRD) in Scotland corresponding to the changing political context from the 1980s, which might help explain these recent trends in DRDs in Scotland
The findings presented here echo those of recent APC research on suicide in Scotland where a cohort effect was identified for people born between 1960 and 1980 [20]
Summary
Even after accounting for deprivation, mortality rates are higher in Scotland relative to the rest of Western Europe. Higher mortality from alcohol- and drug-related deaths (DRDs), violence and suicide ( in young adults) and higher mortality from heart disease, stroke and cancer throughout adulthood contribute to this ‘excess’ mortality (i.e. higher mortality over and above that explained by differences in socioeconomic deprivation), the. Part of the Scottish population, the working class living in the deindustrialising regions, may have been badly affected by these dramatic changes of the 1980s [6, 10, 11, 14,15,16,17] If this impact of political change was partially responsible for the mortality phenomena in Scotland, the worst affected cohort of individuals would be those most directly exposed (i.e. working class, young adults first experiencing working life during 1979–1990). There is, ambiguity around this exposure cohort; the timing of the exposure is rather indistinct with deindustrialisation occurring earlier [18] and the change in political approach persisted after [11, 12]
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