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Time to address the double inequality of differences in dietary intake between Scotland and England.

ABSTRACT: Geographical disparities in health outcomes have been evident across the UK for decades. Recent analysis on the dietary differences between Scotland and England that might go some way to explain these health differences is limited. This study aimed to assess whether, and to what degree, aspects of diet and nutrition differ between Scottish and English populations, specifically between those with similar household incomes. A period of 12 years of UK food purchase data (2001-2012) were pooled and used to estimate household-level consumption data for Scotland and England. Population mean food consumption and nutrient intakes were estimated, adjusting for known confounders (year, age of household reference person, age they left full-time education and income). Comparison was also made within equivalised income quintiles. Analysis showed that the foods and nutrients that should be increased in the diet (highlighted in the Scottish Dietary Goals) were lower in Scotland than in England (e.g. fruit and vegetables 267 g/d; 99 % CI 259, 274 v. 298 g/d; 99 % CI 296, 301), P<0·001). Similarly, foods and drinks linked with poor health outcomes were higher in Scotland. These regional inequalities in diet were even more pronounced in the lower-income groups (e.g. red and processed meat consumption in the lowest-income quintile was 65 g/d; 99 % CI 61, 69 in Scotland v. 58 g/day; 99 % CI 57, 60 in England, P<0·001, but similar in the highest-income quintile (58 g/d; 99 % CI 54, 61 v. 59 g/d; 99 % CI 58, 60, respectively). A poorer diet in Scotland compared with England, particularly among disadvantaged groups, may contribute to differences in excess mortality between countries.

SUBMITTER: Barton KL

PROVIDER: S-EPMC6088540 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Time to address the double inequality of differences in dietary intake between Scotland and England.

Barton Karen L KL Chambers Stephanie S Anderson Annie S AS Wrieden Wendy L WL

The British journal of nutrition 20180701 2

Geographical disparities in health outcomes have been evident across the UK for decades. Recent analysis on the dietary differences between Scotland and England that might go some way to explain these health differences is limited. This study aimed to assess whether, and to what degree, aspects of diet and nutrition differ between Scottish and English populations, specifically between those with similar household incomes. A period of 12 years of UK food purchase data (2001-2012) were pooled and ...[more]

PMID: 29947325

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Project description:BackgroundObesity is a health problem in its own right and a risk factor for other conditions such as cardiovascular disease. The prevalence of overweight and obesity increased in Scotland between 1995 and 2008 with socio-economic inequalities persisting in adults over time and increasing in children. This paper explores changes in the underlying distribution of body mass index (BMI) which is less well understood.MethodsUsing data from the Scottish Health Survey (SHeS) between 1995 and 2014 for adults aged 18-64 years, we calculated population distributions for BMI for the population overall, and for age, sex and deprivation strata. We used SHeS data for children aged 2-15 years between 1998 and 2014, in addition to data from the Child Health Systems Programme (CHSP) collected from primary one (P1) children in participating local authorities, to describe the overall trends and to compare trends in inequalities by deprivation strata.ResultsAmongst adults, the BMI distribution shifted upwards, with a large proportion of the population gaining a small amount of weight between 1995 and 2008 before subsequently stabilising across the distribution. In men the prevalence of obesity showed a linear deprivation gradient in 1995 but over time obesity declined in the least deprived quintile while the remaining four quintiles converged (and stabilised). In contrast, a persistent and generally linear gradient is evident among women for most of the 1995-2014 period. For those aged 2-15 years, obesity increased between 1998 and 2014 for the most deprived 40% of children contrasted with stable trends for the least deprived. The surveillance data for P1 children in Scotland showed a persistent inequality between 2005/06 and 2014/15 though it was less clear if this is widening.ConclusionsThe BMI distribution for adults increased between 1995 and 2008 with a large proportion of the population gaining a small amount of weight before stabilising across the distribution. Inequalities in obesity persist for adults (with different underlying patterns evident for men and women), and may be widening for children. Actions to reduce the obesogenic environment, including structural changes not dependent on individual agency, are urgently needed if the long-term health, social and inequality consequences of obesity are to be reduced.

Project description:There is a strong negative correlation between increasing life expectancy and decreasing lifespan variation, a measure of inequality. Previous research suggests that countries achieving a high level of life expectancy later in time generally do so with lower lifespan variation than forerunner countries. This may be because they are able to capitalise on lessons already learnt. However, a few countries achieve a high level of life expectancy later in time with higher inequality. Scotland appears to be such a country and presents an interesting case study because it previously experienced lower inequality when reaching the same level of life expectancy as its closest comparator England and Wales. We calculated life expectancy and lifespan variation for Scotland and England and Wales for the years 1950 to 2012, comparing Scotland to England and Wales when it reached the same level of life expectancy later on in time, and assessed the difference in the level of lifespan variation. The lifespan variation difference between the two countries was then decomposed into age-specific components. Analysis was carried out for males and females separately. Since the 1950s Scotland has achieved the same level of life expectancy at least ten years later in time than England and Wales. Initially it did so with lower lifespan variation. Following the 1980s Scotland has been achieving the same level of life expectancy later in time than England and Wales and with higher inequality, particularly for males. Decomposition revealed that higher inequality is partly explained by lower older age mortality rates but primarily by higher premature adult age mortality rates when life expectancy is the same. Existing studies suggest that premature adult mortality rates are strongly associated with the social determinants of health and may be amenable to social and economic policies. So addressing these policy areas may have benefits for both inequality and population health in Scotland.

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Time to address the double inequality of differences in dietary intake between Scotland and England.

Publications

Time to address the double inequality of differences in dietary intake between Scotland and England.

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