Recent adverse mortality trends in Scotland: comparison with other high-income countries.
ObjectiveGains in life expectancy have faltered in several high-income countries in recent years. We aim to compare life expectancy trends in Scotland to those seen internationally, and to assess the timing of any recent changes in mortality trends for Scotland. SettingAustria, Croatia, Czech Republic, Denmark, England & Wales, Estonia, France, Germany, Hungary, Iceland, Israel, Japan, Korea, Latvia, Lithuania, Netherlands, Northern Ireland, Poland, Scotland, Slovakia, Spain, Sweden, Switzerland, USA. MethodsWe used life expectancy data from the Human Mortality Database (HMD) to calculate the mean annual life expectancy change for 24 high-income countries over five-year periods from 1992 to 2016, and the change for Scotland for five-year periods from 1857 to 2016. One- and two-break segmented regression models were applied to mortality data from National Records of Scotland (NRS) to identify turning points in age-standardised mortality trends between 1990 and 2018. ResultsIn 2012-2016 life expectancies in Scotland increased by 2.5 weeks/year for females and 4.5 weeks/year for males, the smallest gains of any period since the early 1970s. The improvements in life expectancy in 2012-2016 were smallest among females (<2.0 weeks/year) in Northern Ireland, Iceland, England & Wales and the USA and among males (<5.0 weeks/year) in Iceland, USA, England & Wales and Scotland. Japan, Korea, and countries of Eastern Europe have seen substantial gains in the same period. The best estimate of when mortality rates changed to a slower rate of improvement in Scotland was the year to 2012 Q4 for males and the year to 2014 Q2 for females. ConclusionLife 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. Strengths and limitations of this studyO_LIThe use of five-year time periods for comparison of life expectancy changes reduces the influence of year-to-year variation on observations. C_LIO_LIExamining long-term trends addresses concerns that recent life expectancy stalling may be over-emphasised due to notably large gains in the immediately preceding period. C_LIO_LIThe international comparison was limited to the 24 high-income countries for which data were readily available for the relevant period. C_LIO_LIAnalysis of trend data will always be sensitive to the period selected, however segmented regression of the full period of mortality rates available offers an objective method of identifying the timing of a change in trend. C_LI