Glasgow Centre for Population Health, Glasgow G2 4DL, UK.
Public Health. 2010 Sep;124(9):487-95. doi: 10.1016/j.puhe.2010.02.006. Epub 2010 Mar 11.
The link between deprivation and health is well established. However, recent research has highlighted the existence of a 'Scottish effect', a term used to describe the higher levels of poor health experienced in Scotland over and above that explained by socio-economic circumstances. Evidence of this 'excess' being concentrated in West Central Scotland has led to discussion of a more specific 'Glasgow effect'. However, within the UK, Glasgow is not alone in experiencing relatively high levels of poor health and deprivation; Liverpool and Manchester are two other cities which also stand out in this regard. Previous analyses of this 'effect' were also constrained by limitations of data and geography.
To establish whether there is evidence of a so-called 'Glasgow effect': (1) even when compared with its two most similar and comparable UK cities; and (2) when based on a more robust and spatially sensitive measure of deprivation than was previously available to researchers.
Rates of 'income deprivation' (a measure very highly correlated with the main UK indices of multiple deprivation) were calculated for small areas (average population size: 1600) in Glasgow, Liverpool and Manchester. All-cause and cause-specific standardized mortality ratios were calculated for Glasgow relative to Liverpool and Manchester, standardizing for age, gender and income deprivation decile. In addition, a range of historical census and mortality data were analysed.
The deprivation profiles of Glasgow, Liverpool and Manchester are almost identical. Despite this, premature deaths in Glasgow are more than 30% higher, with all deaths approximately 15% higher. This 'excess' mortality is seen across virtually the entire population: all ages (except the very young), both males and females, in deprived and non-deprived neighbourhoods. For premature mortality, standardized mortality ratios tended to be higher for the more deprived areas (particularly among males), and approximately half of 'excess' deaths under 65 years of age were directly related to alcohol and drugs. Analyses of historical data suggest that it is unlikely that the deprivation profile of Glasgow has changed significantly relative to Liverpool and Manchester in recent decades; however, the mortality gap appears to have widened since the early 1970s, indicating that the 'effect' may be a relatively recent phenomenon.
While deprivation is a fundamental determinant of health and, therefore, an important driver of mortality, it is only one part of a complex picture. As currently measured, deprivation does not explain the higher levels of mortality experienced by Glasgow in relation to two very similar UK cities. Thus, additional explanations are required.
贫困与健康之间存在关联，这一点已得到充分证实。然而，最近的研究强调了“苏格兰效应”的存在，这一术语用于描述苏格兰的健康水平明显低于社会经济状况所解释的水平。西中部苏格兰的“过度”证据表明，存在更为具体的“格拉斯哥效应”。然而，在英国，格拉斯哥并不是唯一一个经历相对较高水平的贫困和剥夺的城市；利物浦和曼彻斯特也是在这方面表现突出的两个城市。之前对这种“效应”的分析也受到数据和地理范围的限制。
确定是否存在所谓的“格拉斯哥效应”的证据：（1）即使与英国两个最相似和最可比的城市相比；（2）当基于比研究人员以前可用的更稳健和空间敏感的贫困衡量标准时。
计算了格拉斯哥、利物浦和曼彻斯特的小地区（平均人口规模：1600）的“收入贫困”（与英国主要的多种贫困指数高度相关的衡量标准）的比率。根据年龄、性别和收入贫困十分位数对格拉斯哥相对于利物浦和曼彻斯特的全因和特定原因标准化死亡率进行了计算。此外，还分析了一系列历史人口普查和死亡率数据。
格拉斯哥、利物浦和曼彻斯特的贫困状况几乎相同。尽管如此，格拉斯哥的早逝率仍高出 30%以上，所有死亡人数高出约 15%。这种“超额”死亡率几乎存在于整个人口：所有年龄段（除了非常年幼的），男性和女性，贫困和非贫困社区。对于早逝，标准化死亡率在较贫困地区（尤其是男性）较高，而 65 岁以下“超额”死亡人数的一半左右直接与酒精和毒品有关。对历史数据的分析表明，在最近几十年里，格拉斯哥的贫困状况相对于利物浦和曼彻斯特不太可能发生重大变化；然而，自 20 世纪 70 年代初以来，死亡率差距似乎有所扩大，这表明这种“效应”可能是一个相对较新的现象。
虽然贫困是健康的基本决定因素，因此也是死亡率的重要驱动因素，但它只是复杂情况的一部分。就目前的衡量标准而言，贫困并不能解释格拉斯哥相对于两个非常相似的英国城市所经历的更高水平的死亡率。因此，需要额外的解释。
