Diversity in causes of mortality in the measurement of population health in Scotland

McMonagle, Ciaran (2023) Diversity in causes of mortality in the measurement of population health in Scotland. PhD thesis, University of Glasgow.

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Measuring diversity in causes of mortality offers an insight into variation in health outcomes within a population. Increased diversity in causes of mortality indicates that deaths have occurred from more varied causes. This may increase diagnostic uncertainty and means health care, promotion, and prevention resources must be spread wider and these sectors must adopt a more comprehensive approach. Diversity in mortality causes has not been measured in Scotland, despite poor health outcomes relative to European comparators. Further, limited previous examination exists of differences in mortality cause diversity in sub‐national population groups, divided by socioeconomic or geographic factors. Health inequalities in Scotland are large and understanding tendencies in mortality cause diversity may be valuable to addressing differential health patterns. Mortality cause diversity has been shown to be associated with increasing life expectancy and falling lifespan variation over time across nations. This relationship has not been examined between different subpopulations within a nation. Finally, the effect of the COVID‐19 pandemic on diversity in causes of mortality has not been examined and this analysis may be a valuable tool to assess the ongoing impact caused by this unprecedented upheaval in population health.

In this thesis I calculate diversity in underlying and contributory causes of mortality as well as lifespan diversity using observed data and distributions extracted from multiple‐decrement life tables. I propose novel methods for assessing the contribution of causes of mortality to diversity and a novel method for the measurement of lifespan diversity. I find that diversity in underlying and contributory causes of mortality increased in Scotland from 2001 to the mid 2010s when trends diverge. Trends in variation are shown to be similar across subpopulations, meaning despite socioeconomic or geographic differences reductions in the proportion of individuals who die of the most common causes and a redistribution to a wider variety of causes has occurred at similar rates. Confirming previous research, diversity in causes of mortality is found to increase as the population of Scotland lived longer and to more equal ages. However, higher diversity in causes of mortality is not necessarily found among subpopulations who live to older and more equal ages. I suggest falling mortality rates associated with the most common causes, especially at premature ages, have driven increasing diversity in causes of mortality and life expectancy and falling lifespan diversity. Diversity in causes of mortality, with COVID‐19 deaths are excluded from analysis, is shown to have remained consistent with trends in previous years during the COVID‐19 pandemic. Monitoring diversity in mortality causes has the potential to expand knowledge around patterns of mortality and to provide valuable insight into pressures on public health and healthcare systems.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Subjects: H Social Sciences > HA Statistics
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
Supervisor's Name: Mancy, Dr. Rebecca, Brown, Dr. Denise and Reeve, Professor Richard
Date of Award: 2023
Depositing User: Theses Team
Unique ID: glathesis:2023-84005
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 20 Dec 2023 16:07
Last Modified: 20 Dec 2023 16:11
Thesis DOI: 10.5525/gla.thesis.84005
URI: https://theses.gla.ac.uk/id/eprint/84005
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