Deprivation (im)mobility and cause-specific premature mortality in Scotland.

A common approach for measuring geographical inequalities in health has been to calculate deprivation scores for small areas and then to aggregate these into quintiles. Mortality rates may then be compared for the highest and lowest deprivation quintiles at two points in time and the change in the difference between the rates determines the extent to which inequalities have widened or narrowed. This 'period-specific' approach to measuring inequalities is problematic both because deprivation calculated at different points in time is not directly comparable, and because the boundaries of the areas used for such analyses often change during the study period. Using 10,058 small areas for Scotland whose boundaries do not change between 1981 and 2001 we examine the deprivation (im)mobility of areas, identifying those that are persistently well-off, stable or deprived and those that improved or worsened during the period. We focus particularly on the 638 persistently most deprived areas. We demonstrate, first and importantly, that premature mortality rates increased significantly over this twenty year period in these areas. Second, we examine which causes of death are mainly responsible for this increase; the risk of death from chronic liver disease, mental disorders due to alcohol, suicide and 'other' causes increased considerably. The geographical approach we describe here is novel and provides new insights into the relationship between deprivation and premature mortality. We suggest that these persistently most deprived Scottish areas deserve special attention and may be particularly appropriate sites for public health interventions related to these causes of premature death.