The social patterning of deaths due to assault in Scotland, 1980-2005: population-based study

OBJECTIVES: The objectives of this study were to explore the extent of the social gradient for deaths due to assault and its impact on overall inequalities in mortality and to investigate the contribution to assault mortality of knives and other sharp weapons. DESIGN: An analysis of death records and contemporaneous population estimates was conducted. SETTING: The authors investigated the social patterning of homicide in Scotland. PARTICIPANTS: This study included deaths between 1980 and 2005 due to assault. MAIN MEASUREMENTS: Death rates were standardised to the European standard population. Time trends were analysed and inequalities were assessed, using rate ratios and the slope index of inequality, along axes defined by individual occupational socioeconomic status and area deprivation. RESULTS: An increase in mortality due to assault was most pronounced at ages 15-44 and was steeper among assaults involving knives. The death rate among men in routine occupations aged 20-59 was nearly 12 times that of those in higher managerial and professional occupations. Men under 65 living in the most deprived quintile of areas had a death rate due to assault 31.9 times (95% CI 13.1 to 77.9) that of those living in the least deprived quintile; for women, this ratio was 35.0 (4.8 to 256.2). Despite comprising just 3.2% of all male deaths between 15 and 44 years, assault accounted for 6.4% of the inequalities in mortality. CONCLUSIONS: Inequalities in mortality due to assault in Scotland exceed those in other countries and are greater than for other causes of death in Scotland. Reducing mortality and inequalities depends on addressing the problems of deprivation as well as targeting known contributors, such as alcohol use, the carrying of knives and gang culture.