How do trends in mortality inequalities by deprivation and education in Scotland and England & Wales compare? A repeat cross-sectional study

OBJECTIVE: To compare the trends in mortality inequalities by educational attainment with trends using area deprivation. SETTING: Scotland and England & Wales (E&W). PARTICIPANTS: All people resident in Scotland and E&W between 1981 and 2011 aged 35–79 years. PRIMARY OUTCOME MEASURES: Absolute inequalities (measured using the Slope Index of Inequality (SII)) and relative inequalities (measured using the Relative Index of Inequality (RII)) in all-cause mortality. RESULTS: Relative inequalities in mortality by area deprivation have consistently increased for men and women in Scotland and E&W between 1981–1983 and 2010–2012. Absolute inequalities increased for men and women in Scotland, and for women in E&W, between 1981–1983 and 2000–2002 before subsequently falling. For men in E&W, absolute inequalities were more stable until 2000–2002 before a subsequent decline. Both absolute and relative inequalities were consistently higher in men and in Scotland. These trends contrast markedly with the reported declines in mortality inequalities by educational attainment and apparent improvement of Scotland’s inequalities with those in E&W. CONCLUSIONS: Trends in health inequalities differ when assessed using different measures of socioeconomic status, reflecting either genuinely variable trends in relation to different aspects of social stratification or varying error or bias. There are particular issues with the educational attainment data in Great Britain prior to 2001 that make these education-based estimates less certain.