Mortality in Glasgow and Edinburgh: a paradigm of inequality in health.

STUDY OBJECTIVE: The aim was to describe, predict, and interpret mortality in Glasgow and Edinburgh. DESIGN: The study was an analysis of all cause and cause specific mortality data for quinquennia based on census years between 1931 and 1981, linking age and sex specific mortality rates by year of birth, for people dying between the ages of 25 and 74 years. SETTING: Glasgow and Edinburgh, Scotland. MAIN RESULTS: Age and sex specific mortality rates declined steadily in Edinburgh and Glasgow during the period 1931-1981, with rates always being lower in Edinburgh than in Glasgow. Since 1961 log mortality rates have tended to rise linearly with age in both cities. In 1979-83, the population of Glasgow reached a given all cause mortality rate 3.9 years earlier in men and 3.6 years earlier in women than did the population of Edinburgh. These differences have increased, and are predicted to increase further, especially in men. CONCLUSIONS: The current 40% cross sectional difference in mortality rates between the cities is largely determined by levels of mortality in early adulthood which provide a baseline for the subsequent rise in log mortality. Disease specific epidemiology provides a limited view of inequalities in health, and a partial basis for health promotion. Campaigns to alter disease risk profiles in adults should be complemented by measures operating earlier in life to reduce susceptibility to risk. Maternal and child health require greater priority in public health policy, particularly in areas of socioeconomic disadvantage.