Chapter 3 - Deaths

Numbers

In 2013, 54,700 deaths were registered in Scotland . This was 237 (0.4 per cent) fewer than in 2012. It represented 10.3 deaths per 1,000 population in 2013.

Figure 2.1 shows that from 1951 up to the early 1990s the annual number of deaths remained relatively stable at about 60,000-65,000 a year. The total then declined slowly to 53,661 in 2011 which was the lowest total recorded since the introduction of civil registration in 1855. The overall 'crude' death rate (10.1 per 1,000 population) was also at its lowest recorded level in 2011. If the age distribution of the population is taken into account (using age-standardised death rates), then the fall in the death rate was even greater.

Causes of death

In 2013 just over half of all deaths were due to the so-called 'three big killers'. There were 15,858 deaths from cancer (29 per cent of all deaths), 7,239 deaths from ischaemic (coronary) heart disease (13 per cent of all deaths) and 4,446 deaths from strokes (8 per cent of all deaths).

Since 1980, the total number of deaths from these causes has reduced, as shown in Table 3.1, falling from 65 per cent of all deaths during 1980-82 and 1990-92, to 58 per cent during 2000-02 and to 50 per cent in 2013. The proportion of deaths caused by coronary heart disease has fallen from 29 per cent in 1980-82 to 13 per cent in 2013, and by strokes from 14 per cent to 8 per cent. However, the number of deaths from cancer rose by 14 per cent (from an average of 13,903 per year in 1980-1982 to 15,858 in 2013); as a proportion of all deaths, it increased from 22 per cent to 29 per cent (mainly due to the 15 per cent fall in the total number of deaths from all causes, from 64,050 per year in 1980-82 to 54,700 in 2013).

Crude death rates, by sex, for some of the most common causes of death are shown in Tables 3.2a and 3.2b. Rates for 2002-2010 have been recalculated using the rebased population estimates which were published in December 2013.

Cancer

Of the 15,858 deaths from cancer in 2013, cancer of the trachea, bronchus and lung was the most common type, with 4,120 deaths (2,127 males and 1,993 females), accounting for over a quarter (26 per cent) of all cancer deaths.

The next most frequent type of cancer death was prostate for males (876 deaths) and breast for females (1,013 deaths). Bowel cancer caused 1,603 deaths (883 males and 720 females) and cancers of the lymphoid, haematopoietic and related tissue caused 1,062 deaths (597 males and 465 females).

Table 3.2a shows that, over the last 30 years or so, male death rates from lung cancer have fallen by 31 per cent (from 119 per 100,000 population in 1980-82 to 82 in 2013). By contrast, the rates for females, though still lower than those for males, have increased by 78 per cent (from 41 per 100,000 population in 1980-82 to 73 in 2013).

Although overall death rates from cancer have risen since the start of the 1980s, from 291 (per 100,000 population) in 1980-82 to 314 for males and from 247 (per 100,000) in 1980- 82 to 283 for females, they have actually fallen for those aged under 75. Table 3.2b shows that for males aged under 75 the rate fell from 214 (per 100,000 population) in 1980-82 to 171 in 2013, and for females aged under 75 it fell from 170 (per 100,000 population) in 1980-82 to 151 in 2013. The average age of death from cancer has risen (Figure 3.1), and the age-standardised death rate (available on the NRS website) for cancer (which takes account of the change in the age-distribution of the population) has fallen considerably over this period.

Heart disease and stroke

Table 3.2a shows that, in contrast to the rises for cancer, death rates for coronary heart disease (ischaemic heart disease) and stroke (cerebrovascular disease) have significantly declined. Between 1980-82 and 2013, rates for males fell by 61 per cent for coronary heart disease and 50 per cent for stroke, compared with reductions of 63 and 54 per cent respectively for females. Table 3.2b shows that the improvement was proportionately greater for people aged under 75, with the coronary heart disease and stroke death rates both falling by 72 per cent for males aged under 75. For females aged under 75 the improvement was greater at 81 per cent for coronary heart disease and 75 per cent for strokes.

Some other major causes of deaths

Other major causes of deaths registered in 2013 included:

• respiratory system diseases (e.g. pneumonia or chronic obstructive pulmonary disease) 7,025 deaths, or 13 per cent of all deaths;
• mental and behavioural disorders (e.g. dementia) 3,912 deaths, or 7 per cent;
• diseases of the circulatory system other than coronary heart disease and stroke (e.g. other forms of heart disease) 3,883 deaths, or 7 per cent;
• diseases of the digestive system (e.g. chronic liver disease) 2,868 deaths, or 5 per cent;
• diseases of the nervous system and the sense organs (e.g. Alzheimer's disease) 2,440 deaths, or 4 per cent;
• accidents (e.g. falls, transport accidents) 1,664 deaths, or 3 per cent;
• diseases of the genitourinary system (e.g. renal failure) 1,081 deaths, or 2 per cent;
• endocrine, nutritional and metabolic diseases (e.g. diabetes) 938 deaths, or 2 per cent; and
• certain infectious and parasitic diseases (e.g. septicaemia) 754 deaths, or 1 per cent.

National Records of Scotland (NRS) publishes a wide range of other statistics on causes of death. They are available from the relevant parts of our website (which include some background information on the basis of the statistics):

• drug-related deaths
• alcohol-related deaths
• deaths involving healthcare associated infections (Clostridium difficile and MRSA)
• suicides
• accidental deaths
• hypothermia
• winter mortality

Mortality by age

The average age at death has increased fairly steadily for many years. Figure 3.1 shows that the average ages at death for cancer, heart disease and stroke have generally increased in line with the average for all deaths.

Figure 3.1: Average age at death, selected causes, Scotland, 1978-2013

About 63 per cent of deaths in 2013 were of people aged 75 and over, and a further 19 per cent were between the ages of 65 and 74. The relative stability in the total number of deaths over recent years masks significant reductions in age-specific mortality. Figure 3.2 shows, for both males and females, selected age-specific mortality rates over the last quarter of a century relative to the 1981 rates. The three age groups shown (45-64, 65-74 and 75 and over) accounted for 96 per cent of all deaths in 2013.

At all these ages, there have been greater improvements in male than in female mortality. In the 45-64 age group, the death rates for males and females dropped by 55 per cent and 49 per cent respectively. In the 65-74 age group, males showed an improvement of 56 per cent compared to 46 per cent for females. The greatest differential is in the 75 plus age group, where male mortality has fallen by 34 per cent compared to only 17 per cent for females. These changes have narrowed the difference between female and (traditionally higher) male mortality.

Figure 3.2: Age specific mortality rates as a proportion of 1981 rate, 1981-2013

Geographical variations in mortality

Using 2012 data, the latest available, Figure 3.3 compares the death rates for the constituent countries of the UK for selected causes after adjusting for differences in age structure, by applying the European Standard Population age structure. The Scottish rates for cancer, ischaemic heart disease, and cerebrovascular disease (stroke) are well above the rates for the other countries of the United Kingdom, for both males and females. The methodology for calculating age-standardised rates has been revised both for Scotland and the other UK countries. More detail on this revision is available on the age standardised death rates section of the NRS website.

Figure 3.3: Age-adjusted¹ mortality rates, by selected cause and sex, 2012

Appendix 1, Table 3 shows the death rate for each of the European Union (EU) member states, and for some other countries in Europe. These are so-called 'crude' death rates. They are calculated by expressing the number of deaths per thousand population. As a result, they do not take account of differences in the sex and age structures of the countries' populations. All else being equal, a country with an unusually high proportion of its population in the younger age groups could have an unusually low 'crude' death rate. So, though the figure for Scotland is higher than those for most of the countries that are shown, this could to some extent be due to the structure of the Scottish population. A better way to compare Scotland's mortality with other countries' is to use the estimates of life expectancy for each country (please refer to Chapter 4) or to consider age-standardised death rates (available on the NRS website).

Stillbirths, perinatal deaths and infant deaths

There were 234 stillbirths registered in Scotland in 2013. Stillbirths (where a child born after the 24^th week of pregnancy does not breathe or show any other sign of life) are registered separately from live births and from deaths, and so are not included in either of those figures.

Perinatal deaths consist of stillbirths plus deaths in the first week of life (the latter are registered as live births and as deaths). There were 93 deaths of children who were aged under one week old, so there was a total of 327 perinatal deaths.

Infant deaths are deaths in the first year of life, all of which are registered as live births and as deaths. In total, 186 infant deaths were registered in Scotland in 2013 (including those who died in the first week of life).

Appendix 1, Table 1 shows that in 2013 the stillbirth rate (4.2 per 1,000 live and still births) and the infant death rate (3.3 per 1,000 live births) were both at their lowest levels ever recorded. Both rates have fallen greatly since the Second World War. The stillbirth rate has fallen slowly in the past 30 years but the infant death rate has continued a steeper decline over the same period.

Appendix 1, Table 3 shows that the stillbirth rate for Scotland in 2013 (4.2) was lower than that for the UK as a whole (4.8) but higher than those of 20 of the 28 European Union (EU) countries. The infant death rate for Scotland in 2013 (3.3) was below the UK rate (4.1) but higher than those of 9 of the 28 EU countries.

More information about death statistics

More detailed information about Scotland's deaths can be found in the Vital Events - Deaths section or in the deaths section of the Vital Events Reference Tables of the NRS website.