Geographical inequalities in burden of disease at local authority level in Scotland: A subnational analysis for the Scottish Burden of Disease Study 2016

Sammanfattning: Background: Scotland possesses the worst mortality outcomes and slowest improvement in life expectancy of Western Europe. Within Scotland, stark inequalities exist in both morbidity and mortality. There remains paucity in assessment of subnational variation in disease burden. Aim: This thesis explored geographical inequalities in burden of disease (BoD) across 32 Scottish authorities. Secondary analysis assessed association between geographical deprivation and disease burden. Methods: Local data was extracted from the Scottish Burden of Disease 2016 study and encompassed disability-adjusted life years (DALY), years of life lost (YLL), and years lived with disability (YLD) for 68 causes of disease across 32 Scottish local authorities. Geographical trends were assessed for age-standardised all cause rates and for national 10 leading causes, in addition to age- and sex-specific rates. The association between all cause DALY and deprivation was analysed using the Scottish Index of Multiple Deprivation (SIMD). Findings: Glasgow City possessed highest burden for all cause age-standardised rates. Western authorities had largest burden in 8 leading causes whilst Eilean Siar led in 2. Across authorities, working ages showed similar burden in lower back and neck pain, depression, and anxiety disorders. There was a significant association between all cause DALY and SIMD, increased disease burden was associated with increased deprivation. Generally, Western authorities showed greatest levels of deprivation and BoD; Western regions East Dunbartonshire and East Renfrewshire were exceptions, possessing lowest BoD and deprivation of 32 local authorities. Conclusion: Findings show subnational variation in BoD, with nationwide trends of psychosocial morbidity. These estimates at local level will inform policy makers and key stakeholders of effective resource allocation and priority setting across Scottish authorities. Policies that redistribute income to most deprived of the population hold greatest promise in addressing key determinants of health and accordingly geographical inequalities in BoD.