Abstract
There is a strong negative correlation between increasing life expectancy and decreasing lifespan variation, a measure of inequality. Previous research suggests that countries achieving a high level of life expectancy later in time generally do so with lower lifespan variation than forerunner countries. This may be because they are able to capitalise on lessons already learnt. However, a few countries achieve a high level of life expectancy later in time with higher inequality. Scotland appears to be such a country and presents an interesting case study because it previously experienced lower inequality when reaching the same level of life expectancy as its closest comparator England and Wales. We calculated life expectancy and lifespan variation for Scotland and England and Wales for the years 1950 to 2012, comparing Scotland to England and Wales when it reached the same level of life expectancy later on in time, and assessed the difference in the level of lifespan variation. The lifespan variation difference between the two countries was then decomposed into age-specific components. Analysis was carried out for males and females separately. Since the 1950s Scotland has achieved the same level of life expectancy at least ten years later in time than England and Wales. Initially it did so with lower lifespan variation. Following the 1980s Scotland has been achieving the same level of life expectancy later in time than England and Wales and with higher inequality, particularly for males. Decomposition revealed that higher inequality is partly explained by lower older age mortality rates but primarily by higher premature adult age mortality rates when life expectancy is the same. Existing studies suggest that premature adult mortality rates are strongly associated with the social determinants of health and may be amenable to social and economic policies. So addressing these policy areas may have benefits for both inequality and population health in Scotland.
Highlights
There is a strong association between life expectancy and lifespan variation
Life expectancy reflects the average length of life in the population and lifespan variation reflects the variability surrounding the length of life
Lifespan variation is regarded as a measure of inequality and so there is an association between improving average population health and reducing inequality (Shkolnikov, Andreev, Zhang, Oeppen & Vaupel, 2011; van Raalte et al, 2011)
Summary
There is a strong association between life expectancy and lifespan variation. Life expectancy reflects the average length of life in the population and lifespan variation reflects the variability surrounding the length of life (van Raalte et al, 2011). Lifespan variation is regarded as a measure of inequality and so there is an association between improving average population health and reducing inequality (Shkolnikov, Andreev, Zhang, Oeppen & Vaupel, 2011; van Raalte et al, 2011). Reducing the mortality rate at any age will increase life expectancy but improvements in lifespan variation are only achieved if reductions in premature mortality rates are greater than reductions in older age mortality rates This is because reducing premature mortality rates compresses the age distribution of death while reducing older age mortality rates expands the distribution (Oeppen, 2008; Smits & Monden, 2009; Vaupel et al, 2011). Countries reaching the same level of life expectancy at different times can do so with underlying differences in age specific mortality rates, resulting in different levels of lifespan variation (Auger et al, 2014; Nau & Firebaugh, 2012; Shkolnikov et al, 2011)
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