Visual Summary
In 2023, around one in four deaths was considered avoidable.
Avoidable deaths are deaths considered preventable or treatable.
Main Points
- Around one in four deaths were considered preventable or treatable in Scotland in 2023. This proportion of avoidable deaths is similar to 2022.
- There was regional variation within Scotland; the highest rates of avoidable mortality were in Glasgow City and the lowest rates in East Dunbartonshire and East Renfrewshire.
- There were higher rates of avoidable mortality in more deprived areas; the avoidable mortality rate for the most deprived quintile was 4 times as high as the least deprived quintile.
- Avoidable mortality rates among males were 1.6 times as high as among females; the avoidable mortality rates for males were higher compared with females across all SIMD deprivation quintiles.
- The leading cause of avoidable mortality remained cancer, despite the rate steadily decreasing over time, followed by diseases of the circulatory system.
- Avoidable mortality due to alcohol and drug related causes has generally increased over the last decade, with 2023 having the third highest rate since the series began in 2001.
- Scotland continues to have a higher avoidable mortality rate than both England and Wales.
Avoidable, preventable and treatable mortality in Scotland
Avoidable mortality
Avoidable mortality is defined as deaths that are either preventable or treatable for those aged under 75 years, in line with the international avoidable mortality definition.
Avoidable mortality is defined using the International Classification of Diseases, 10th Revision (ICD-10).
The ICD-10 is the standard diagnostic tool for epidemiology, health management and clinical purposes. It is used to classify diseases and other health problems.
In 2020, the new avoidable mortality definition created by an OECD working group was implemented. The definition was introduced for years 2001 onwards, replacing the two avoidable mortality definitions previously used. Further information on the new definition and its impact on the reporting of avoidable mortality statistics can be found via the ONS Review of the avoidable mortality definition.
Avoidable mortality is defined as deaths that are either preventable or treatable.
A (cause of) death is classified as preventable when it can be mainly avoided through effective public health and primary prevention interventions.
A (cause of) death is classified as treatable when it can be mainly avoided through timely and effective healthcare interventions.
In 2023
- 26% of all deaths were considered avoidable (16,548 deaths).
- the age-standardised mortality rate was 319.5 (confidence intervals 314.9 to 324.2) deaths per 100,000 people.
The age-standardised mortality rates in 2023 were similar to the rates in the previous year.
Age-standardised mortality rates (ASMRs) are used to allow comparisons between populations that may contain different proportions of people of different ages.
They are a better measure of mortality than numbers of deaths. They account for the population size and age structure and provide more reliable comparisons between groups or over time.
They are calculated using the 2013 European Standard Population (ESP2013) after taking account of changes in the distribution by age of the Scottish population.
More information on the calculation of age-standardised mortality rates is available on our website.
Age-standardised mortality from avoidable causes increased throughout the coronavirus (COVID-19) pandemic from 2019 to 2021, and following this, decreased from 2021 to 2022. The rate is similar from 2022 to 2023. In 2023, the avoidable mortality rate is still higher than in 2019 before the pandemic.
Figure 1: Avoidable mortality rates in 2023 are similar to 2022 and are still higher than pre-coronavirus levels.
Avoidable age-standardised mortality (ASMR) rates in Scotland: 2001 to 2023
The avoidable mortality rate for both males and females in 2023 was similar to the previous year. The rate for both males and females is still higher than before the pandemic in 2019. Males continue to have a higher rate of avoidable mortality (1.6 times as high in 2023) than females.
Preventable and treatable mortality
There are two types of avoidable mortality: preventable mortality and treatable mortality, which refer to deaths that could be attributed to conditions considered preventable or treatable.
Of the 16,548 avoidable deaths in Scotland in 2023, 11,131 (67.3%) could be attributed to conditions considered preventable and 5,417 (32.7%) could be attributed to conditions considered treatable.
Preventable deaths increased between 2020 and 2022 as preventable deaths include those due to COVID-19. Males have higher preventable and treatable mortality rates than females.
Avoidable mortality by Scottish areas
Council areas
The council area with the highest avoidable mortality rate was Glasgow City (469 deaths per 100,000 population) over the period 2021 to 2023.
The lowest rates were found in East Dunbartonshire (205 deaths per 100,000) and East Renfrewshire (198 deaths per 100,000).
Figure 2: Glasgow City was the council area with the highest avoidable mortality rate in the period 2020-2023. East Dunbartonshire and East Renfrewshire had the lowest rates.
Avoidable mortality rates by council area, all persons: 2020 to 2023 average.
Health Boards
The highest avoidable mortality rates in health boards were recorded in Greater Glasgow and Clyde (382 deaths per 100,000), Ayrshire and Arran (373 deaths per 100,000), and in Lanarkshire (370 deaths per 100,000) over the period 2021 to 2023.
Shetland (229 deaths per 100,000) and Borders (254 deaths per 100,000) saw the lowest avoidable mortality rates.
Figure 3: Health boards in the west of Scotland experienced the highest rates of avoidable mortality in the period 2020 to 2023.
Avoidable mortality rates by Health Board, all persons: 2020 to 2023 average.
Avoidable mortality by deprivation
The Scottish Index of Multiple Deprivation (SIMD) is a measure of how deprived an area is.
SIMD quintiles rank areas of Scotland from 1 (most deprived) to 5 (least deprived).
In 2023, people living in the most deprived quintile in Scotland were four times as likely to die an avoidable death compared to those in the least deprived quintile.
In all SIMD quintiles, the ASMR was higher for males than females, suggesting that regardless of deprivation, males are more at risk of avoidable mortality.
In 2023, the male avoidable ASMR in the most deprived areas of Scotland (quintile 1) was 742.0 deaths per 100,000 males (confidence intervals 717.6 to 766.3). This was 4.0 times higher than the 184.3 deaths per 100,000 males (confidence intervals 173.2 to 195.3) seen in the least deprived areas (quintile 5).
The female ASMRs showed a similar difference between most and least deprived areas, with 455.9 deaths per 100,000 females (confidence intervals 437.4 to 474.4) in the most deprived areas (quintile 1), which was 3.9 times higher than the 118.0 deaths per 100,000 females (confidence intervals 109.4 to 126.5) in the least deprived areas (quintile 5).
Figure 4: Males appear to be more at risk of avoidable mortality regardless of deprivation.
Avoidable mortality rates by sex and SIMD quintile: 2023.
Avoidable mortality rates have decreased over the last two decades in all SIMD quintiles, with the exception of the coronavirus pandemic which saw increased rates in 2020 and 2021.
In 2023, the rate of avoidable mortality in the most deprived quintile was 4.0 times as high as the least deprived. This gap has increased from 2.9 times as high in 2001. In 2021, the absolute gap in avoidable mortality between the most and least deprived areas widened to the highest level since 2001.
Figure 5: Avoidable mortality rates in the most deprived areas are four times as high as the least deprived areas.
Avoidable mortality rates by deprivation, all persons, 2001 to 2023.
Avoidable mortality by cause
In 2023, the leading cause of avoidable deaths was cancer, followed by diseases of the circulatory system.
Cancer has been the leading cause of avoidable deaths since 2008, however the rates for cancer have continued to decline. In 2023, the ASMR for cancer was 90 deaths per 100,000 people (confidence intervals 87.6 to 92.4).
In 2023, the ASMR for diseases of the circulatory system was 84.4 deaths per 100,000 people (confidence intervals 82.0 to 86.8). It is higher than the values pre-pandemic in 2019.
Nearly one in six avoidable deaths were alcohol or drug-related. Contrary to the trend of avoidable mortality caused by cancer steadily decreasing over time since 2001, avoidable mortality due to alcohol- and drug-related causes has been increasing since 2013, except in 2022 where the rate decreased by 9%.
The ICD classification “Provisional assignment of new diseases” contains deaths caused by COVID-19.
COVID-19 was a significant contributor to avoidable mortality in 2020 and in 2021, with an avoidable mortality rate of 28 deaths per 100,000 people in 2020 and 34 deaths per 100,000 in 2021. In 2023 the ASMR for Covid-19 was 6 deaths per 100,000 people (confidence intervals 5.4 to 6.6).
Figure 6: In 2023 the leading cause of avoidable deaths was cancer, followed by diseases of the circulatory system.
Avoidable mortality rates by cause, all persons, 2001 to 2023.
Please note, for causes which are only classed as preventable the avoidable and preventable rates are the same. These lines will overlap on the charts above.
For males the leading cause of avoidable and treatable deaths were circulatory system diseases, whilst the leading cause of preventable deaths were cancers.
In comparison, for females the leading cause of all avoidable, preventable and treatable deaths were cancer.
For a full summary of all causes of death in Scotland (not only included in the avoidable mortality definition) please see NRS Vital Events Reference Tables 2023 (Section 6: Deaths - Causes).
Avoidable mortality and cause by SIMD
The leading cause of avoidable mortality was cancer in all quintiles except the most deprived. The leading cause in the most deprived quintile was diseases of the circulatory system, although the rate was not statistically different from the rate for cancer.
Since 2001, the mortality rates for cancer and diseases of the circulatory system have been decreasing in the most and the least deprived quintiles. Over the same period, the gap between the most and the least deprived quintiles have been widening. In 2001, the mortality rate for diseases of the circulatory system was 2.8 times as high in the most deprived quintile compared to the least deprived quintile. In 2023, it was 4 times as high.
Figure 7: In 2023 the leading cause of avoidable deaths in the most deprived quintile was diseases of the circulatory system. In all other quintiles it was cancers.
Avoidable mortality rates by cause and deprivation, all persons, 2001 to 2023.
Avoidable Mortality in Great Britain
Scotland continues to have higher avoidable mortality than both England and Wales.
Figure 9 compares the avoidable mortality rates between Scotland, England, and Wales. Scotland (320 deaths per 100,000 people) has a higher avoidable mortality rate than both England (238 deaths per 100,000 people) and Wales (277 deaths per 100,000 people). This continues the historic trend of Scotland having higher avoidable mortality rates, although the gap between Scotland and England and Wales has narrowed slightly in 2020. The gap between Scotland and Wales has been narrowing since 2020.
Figure 8: Scotland has a higher avoidable mortality rate than both England and Wales. This has been the same since 2001.
Avoidable mortality rates in Great Britain, all persons, 2001 to 2023.
Source: England and Wales data from the Office for National Statistics
In 2023, the leading cause of avoidable mortality in both England and Wales was cancers, the same as in Scotland, followed by diseases of the circulatory system.
In 2023, mortality rates for Scotland were higher than the mortality rates in England and Wales for all of the avoidable causes of death. This has been the case since 2001 for the majority of causes.
Figure 9: In 2023, the leading cause of avoidable mortality in both England and Wales was cancer, the same than in Scotland, followed by diseases of the circulatory system.
Avoidable mortality rates by cause in Great Britain, 2001 to 2023.
Source: England and Wales data from the Office for National Statistics
Glossary
Age-standardised mortality rates
Age-standardised mortality rates per 100,000 population, standardised to the 2013 European Standard Population. Age-standardised rates allow comparison between populations with different age structures over time.
Avoidable mortality
Deaths which are considered either preventable or treatable for those aged under 75 years, in line with the international definition by the OECD/Eurostat.
For the list of causes of death that are classified as avoidable, please see the “Definition sheet” in our accompanying dataset.
Confidence Intervals
A confidence interval is a measure of the statistical precision of an estimate and shows the range of uncertainty around the estimated figure.
They are based on the lower and upper 95% confidence limits for the age-standardised mortality rates.
As a general rule, if the confidence interval around one figure overlaps with the interval around another, we cannot say with certainty that the difference between figures is statistically significant.
Preventable mortality
Causes of death that can be mainly avoided through effective public health and primary prevention interventions.
Scottish Index of Multiple Deprivation (SIMD)
The Scottish Index of Multiple Deprivation is a measure of how deprived an area is.
If an area is identified as ‘deprived’, this can relate to people having a low income but it can also mean fewer resources or opportunities.
A score is given to all of Scotland’s data zones based on multiple indicators of deprivation. The data zones are then ranked 1 to 6,976 based on their score. Subsequently, the rankings are split into 5 equally sized groups forming SIMD quintiles.
Statistical significance
Refers to statistically significant changes or differences. Statistical significance has been determined using the 95% confidence intervals, where instances of non-overlapping confidence intervals between figures indicate the difference is unlikely to have arisen from random fluctuation.
Treatable mortality
Causes of death that can be mainly avoided through timely and effective healthcare interventions, including secondary prevention and treatment.
Methodology
NRS has updated its definition of avoidable mortality to use the new OECD international definition of avoidable mortality to ensure our statistics are comparable internationally and with other parts of the UK.
The new definition has been applied to the full time series back to 2001.
Deaths are classified as preventable or treatable according to their cause of death and the age at death.
More information on the quality and methodology can be found on the ONS website.
Revisions and corrections
Please note that the following errors were identified in previous publications of this data which impacted figures for 2001 to 2021:
- Deaths due to venous thromboembolism were incorrectly counted as preventable deaths rather than treatable. This resulted in an overcount of the number of preventable deaths (around 1% to 2%) and an undercount of treatable deaths (around 3% to 5%) each year. This did not change the overall trend of preventable or treatable deaths.
- Some deaths due to drug disorders and poisonings (ICD-10 codes Y10-Y14) were not counted in the alcohol- and drug-related deaths grouping. This resulted in an undercount of on average 108 deaths each year. This had limited impact on the number of avoidable deaths and overall trend, with increases in avoidable deaths of at most 1.7% each year.
- Deaths from pneumonia due to streptococcus pneumonia or haemophilus influenza were incorrectly counted as infectious diseases. This resulted in an overcount of infectious diseases and undercount of diseases of the respiratory system by on average 10 deaths each year. This had no impact on the number of avoidable, preventable or treatable deaths.
These errors have been corrected in the time series data available below and additional checks have implemented to minimise the risk of similar errors in the future.
Population estimates for 2011 to 2021 were rebased following the 2022 Census. Mortality rates for 2011 to 2021 have been updated to incorporate the rebased population estimates and may therefore differ from those previously published.
Strengths and Limitations
Strengths
- Information is supplied when a death is registered, giving complete coverage of the population and ensures highly accurate estimates that are representative of the population.
- Coding for cause of death is carried out according to the World Health Organization (WHO) ICD-10 framework.
- The use of age-standardised mortality rates means our statistics are comparable between local health boards, councils and at national level.
- The use of the OECD definition also makes the statistics in this report comparable internationally.
Limitations
- Data are insufficiently robust to provide local authority estimates for smaller areas for single years (hence why they are aggregated over a 3-year period). This limits the timeliness of the data.
- In a small number of cause of death categories, the number of deaths was too small to report a reliable rate. For this reason, the categories were combined in and thus limits the precision accuracy of our cause of death reporting.
- When the number of deaths was too small to report a reliable rate, (10 or less deaths), only the number of deaths were reported.
Information about our statistics
These statistics are designated as Accredited Official Statistics. More information about Official Statistics can be found on the Statistics governance and consultation page.
We also provide information about upcoming publications on our website.
If you would like receive updates on our statistics, you can register your interest on the Scottish Government ScotStat website.
