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PubMed1999

Record-linkage for pharmacovigilance in Scotland.

Record-linkage is the linkage of patient-specific information that is stored separately. Recent advances in computerization have meant that record-linkage techniques in medical research are increasingly being used and refined. In particular, they have made a significant contribution to pharmacovigilance, which involves linking drug exposure to outcomes data. In this article, the contribution of record-linkage in Scotland to medical research is described. The two organizations that utilize record-linkage techniques are the Medicines Monitoring Unit (MEMO) of the University of Dundee and the Information and Statistics Division (ISD) of the NHS in Scotland. Pharmacovigilance is MEMO's main concern (using data from the Tayside region of Scotland), while ISD link health care datasets for Scotland for general health care research. The experience of the two groups is now being combined to carry out drug safety studies in the entire population of Scotland.

Drug Monitoring↗
PubMed1998

Geographical inequality in the provision of carotid endarterectomy in Scotland. Scottish Vascular Audit Group.

BACKGROUND: Carotid endarterectomy (CEA) is a proven method of stroke prevention in patients with symptomatic and asymptomatic high-grade internal carotid artery stenosis. This study examined whether site of residence affects access to CEA in Scotland. METHODS: Scottish Morbidity Record hospital discharge data were collected by the Information and Statistics Division of the National Health Service in Scotland and analysed for the interval 1 January 1989 to 31 December 1995. The number of CEAs performed in the hospitals of each of the 15 regional Health Boards, and CEA rate per 100000 population resident in each Health Board region, were determined. RESULTS: In 1989, 65 CEAs were performed in the hospitals of five Health Boards and in 1995, 431 CEAs were performed in nine Health Boards. In 1989, the CEA rate per 100000 resident population varied between 0 (four regions) and 4 (one region), with one region significantly different from Scotland as a whole (P<0.001). In 1995, the CEA rate varied between 0 (two regions) and 19 (one region), with two regions significantly different from Scotland as a whole (P< 0.01). CONCLUSION: Despite a sixfold increase in the number of CEAs being performed, and a rise in the number of centres performing CEA, there is increasing geographical inequality in the provision of CEA in Scotland.

Adult↗
PubMed1994

Infection caused by Escherichia coli O157:H7 in Alberta, Canada, and in Scotland: a five-year review, 1987-1991.

Infections and life-threatening complications due to verotoxin-producing Escherichia coli (VTEC) have been increasingly recognized as a public health problem in recent years. Through enhanced surveillance in Alberta, Canada, and in Scotland, 1,993 cases of VTEC infection and 115 cases of hemolytic-uremic syndrome (HUS) were detected in 1987-1991 in a combined population of more than 7.5 million; there were 24 deaths. The mean annual rates of VTEC infection were 12.1/100,000 and 2.0/100,000 for Alberta and Scotland, respectively. One case of HUS occurred for every 14 (Scotland) to 19 (Alberta) cases of VTEC infection. Rates of VTEC infection were highest among children < 5 years of age, while rates of resultant hospitalization were highest among the elderly. Male-to-female ratios for patients with VTEC infection varied with the age group. The incidence of this infection was highest in the summer: 64.0%-81.7% of cases occurred between May and September. Hamburger was the most common source reported. Unexplained geographic variation in prevalence was evident in both Alberta and Scotland. Most cases were sporadic, although several community and point-source outbreaks were identified in Scotland. HUS exhibited similar epidemiological patterns. Infections with VTEC impose a substantial preventable clinical and public health burden. Routine monitoring of these infections is considered worthwhile in order to elucidate their epidemiology and modes of transmission and ultimately to control them more effectively.

Adolescent↗
PubMed2004

Peritoneal dialysis-associated peritonitis in Scotland (1999-2002).

BACKGROUND: Peritonitis is a major complication of peritoneal dialysis (PD). We have performed a national study of all patients on PD in Scotland over a 3.5 year period examining the causes of technique failure, rates of peritonitis, causative organisms, clinical outcomes and differences between automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD). METHODS: All 10 adult renal units in Scotland participated in the study and the data include all 1205 patients who were on PD in Scotland from January 1999 to June 2002. The data were collected prospectively by the PD nurses and reported to the Scottish Renal Registry every 6 months. RESULTS: Refractory or recurrent peritonitis was the cause of technique failure in 167 patients (42.6% of all cases of technique failure). There were 928 cases of peritonitis in 1487 patient-years, which equates to an overall peritonitis rate of one episode every 19.2 months. The peritonitis rates for APD and CAPD were similar at one episode every 20.3 months and one episode every 18.6 months, respectively. These results include 88 cases of peritonitis due to relapse or re-infection. There was a statistically significant difference (P = 0.012) in peritonitis rates between units using nasal mupiricin (one episode every 21.9 months) and those that did not (one episode every 18.3 months). Coagulase-negative Staphylococcus was the most common cause of peritonitis (29%), although this rate is lower than in historic studies. The overall initial cure rate was 75%. The initial cure rate for APD was 77.2% and for CAPD was 73.7%. No causative organism was isolated in 17% of cases. CONCLUSION: PD-associated peritonitis is the leading cause of technique failure in Scotland. We validate previous studies showing a decrease in the proportion of peritonitis episodes that are caused by coagulase-negative staphylococci. APD peritonitis rates are not significantly better than CAPD peritonitis rates in Scotland, and the initial cure rates for APD and CAPD are similar.

Coagulase↗
PubMed1993

Law and forensic medicine in Scotland.

Scotland was an independent nation state until 1707 when it became the most northerly part of the United Kingdom. Today Scotland, constitutionally, is less than a state or a province in a federal union, but retains vestiges of its ancient sovereignty by having its own legal system and separate administration. English law and Scots law are two quite separate systems--a unique constitutional phenomenon within a unitary state. Scots law is a "mixed" legal system embodying aspects of both the Romano-Germanic and Anglo-American families of legal systems. A central feature is the public prosecution of crimes under the control of the Lord Advocate and the Crown Office in Edinburgh. The hierarchy of criminal courts comprises the High Court of Justiciary, the Sheriff court, and the District court. For serious offences, criminal trial is by "solemn procedure" before a judge sitting with a jury of 15 persons whose verdict of "guility", "not guilty", or "not proven" may be reached by majority. The prosecution must prove its case beyond reasonable doubt on corroborated evidence. The essential requirement for corroboration means that two pathologists must perform and sign the report on any autopsy related to criminal proceedings. The writ of habeus corpus is not operative in Scotland, but there are strict rules to prevent an accused person from languishing in prison without trial. Under solemn procedure the trial must begin within 110 days or the accused is freed with immunity from further prosecution for the crime charged. Procurators fiscal are the public prosecutors whose responsibilities include the investigation of crime and all sudden, suspicious, or unexplained deaths. There are no coroners in Scotland. Investigations are performed in private and it is uncommon for a public inquiry ("a Fatal Accident Inquiry") to be held. A Fatal Accident Inquiry is an inquisitorial proceeding heard before a sheriff sitting without a jury. In Scotland, unlike in England, the more serious crimes are not covered by legislation. Scots law divides homicide into three classes: murder, culpable homicide (ie. murder under mitigating circumstances), and non-criminal homicide. The homicide rate is relatively low with approximately 60 murders and 40 culpable homicides each year for a population of 5.12 million. The commonest methods are stabbing/cutting (40%) and hitting/kicking (20%). Only 3% are by firearms. Organised forensic medicine began with the professorships in medical jurisprudence at Edinburgh in 1806 and at Glasgow in 1839. Today forensic pathology services are funded by the central government but are based in the universities of Edinburgh, Glasgow, Dundee, and Aberdeen.(ABSTRACT TRUNCATED AT 400 WORDS)

Criminal Law↗
PubMed1989

Origin, training, and subsequent practice location of Scotland's General and Community dentists.

In view of the continuing concern, in the United Kingdom (UK) and many other countries, over the maldistribution of dental manpower and the far-reaching plans now being contemplated to correct existing imbalances, it was felt to be necessary to document the current situation in Scotland. This study set out to identify the origins, place of training, and subsequent practice locations of Scotland's General and Community dentists. A questionnaire was sent to a list of all General Dental Practitioners (GDPs) and Clinical Community Dental Officers (CCDOs) in Scotland. The final response rate was 72%. 85% of respondents had received the majority of their secondary school education in Scotland, and a total of 92.5% of respondents had received their undergraduate dental training at one of the three Scottish dental schools. Factors elicited as being associated with practice location choice included school of dental training, location of a dentist's original home and relatives, and, to some extent, market forces in terms of "demand for dentists" in some areas in Scotland.

Community Dentistry↗
PubMed1993

Asbestos and lung cancer in Glasgow and the west of Scotland.

OBJECTIVE: To quantify the relation between lung cancer and exposure to asbestos in men in west Scotland and to estimate the proportion of lung cancer which may be attributed to exposure to asbestos. DESIGN: An ecological correlation study of the incidence of lung cancer in men and past asbestos exposure. The unit of analysis was the postcode sector. Correction was made for past cigarette smoking, air pollution, and deprivation. SETTING: The region covered by the west of Scotland cancer registry, containing 2.72 million people and including Glasgow and the lower reaches of the River Clyde, where shipbuilding was once a major industry. SUBJECTS: All men diagnosed with lung cancer between 1975 and 1984 whose residence at the time of registration was within the west of Scotland. MAIN OUTCOME MEASURE: The population attributable risk for asbestos related lung cancer. RESULTS: An estimated 5.7% (95% confidence interval 2.3 to 9.1%) of all lung cancers in men registered in the west of Scotland during the period 1975-84 were asbestos related, amounting to 1081 cases. CONCLUSIONS: A considerable proportion of cases of lung cancer in men in Glasgow and the west of Scotland from 1975 to 1984 were asbestos related. Most of these may not have been considered for compensation by the Department of Social Security. Given the very small annual number of recorded cases of asbestosis this condition is probably not a prerequisite for the development of asbestos related lung cancer. A heightened awareness of the increasing incidence of asbestos related neoplasms and their more thorough investigation are recommended.

Asbestos↗
PubMed1994

Screening for cervical intraepithelial neoplasia in north east Scotland shows fall in incidence and mortality from invasive cancer with concomitant rise in preinvasive disease.

OBJECTIVE: To assess the effect of screening for cervical intraepithelial neoplasia on the incidence of and mortality from invasive squamous cell carcinoma of cervix in north east Scotland and to discover why cases of invasive cancer still occur. DESIGN: (a) Analysis of data on cases of cervical intraepithelial neoplasia obtained from the cytology data bank; (b) analysis of data on 612 women presenting with invasive squamous cancer during 1968-91, obtained from cancer registry and hospital records; (c) analysis of death rates obtained from the registrar general's (Scotland) annual reports, the Information Services Division of the Home and Health Department (Scotland), and local records for 1974-91; (d) case-control studies on 282 cases of invasive cancer and 108 deaths which occurred in 1982-91. Cases were matched with two controls both for age and for having a negative smear test result at the time of presentation of the case. SETTING: North east Scotland (Grampian region, Orkney, and Shetland). SUBJECTS: Women (n = 306,608) who had had cervical smear tests between 1960 and 1991. RESULTS: There had been a substantial increase in cases of cervical intraepithelial neoplasia grade III since 1982. The incidence of invasive cancer has fallen since the start of screening in 1960, the fall occurring mainly in the well screened age group 40-69 years. There was a rise in women aged under 40 and over 70. Women with invasive disease seen between 1982 and 1991 mostly presented at stage I. Of these, half were unscreened, one third were poorly screened, 11% were found in retrospect to have had abnormal cells, 3% had recurrence of disease after treatment for cervical intraepithelial neoplasia grade III, and 3% were lost to follow up. Death rates had fallen, most noticeably in women aged 45-64, who had had the opportunity to be screened and rescreened. There was a disturbing rise in deaths among women under 45. Most deaths (65%) occurred in unscreened women. Case-control studies showed that the longer the time and absence of a smear test before presentation the higher was the risk of invasive cancer and of death. CONCLUSIONS: Screening has been effective in reducing the incidence of and mortality from cervical cancer in north east Scotland. Most cases and deaths occurred in unscreened women or in those who had had few smears at long intervals. An increase in cases of cervical intraepithelial neoplasia grade III in women screened for the first time occurred during 1982-91.

Adult↗
PubMed1987

Coronary heart disease and water hardness in Scotland--is there a relationship?

Scotland has a mortality rate from coronary disease which is one of the highest in the world. There is also a considerable variation in this mortality rate within Scotland. Data on water hardness throughout Scotland have been collected from Regional Water Authorities to see whether variations in coronary mortality rates can be explained by variations in water hardness. Analysis demonstrates a much weaker negative association than has been demonstrated in studies in other countries. The geographical variation in coronary mortality rates in Scotland cannot be explained by variations in water hardness, and weak association between these in Scotland is discussed.

Adult↗
PubMed1999

Homosexual men's HIV related sexual risk behaviour in Scotland.

OBJECTIVE: To date, the epidemic of HIV infection in Scotland has been primarily associated with injecting drug use. However, the epidemiology of HIV in Scotland changed in the late 1980s, with homosexual men becoming the largest group at risk of HIV infection and AIDS. Our aim was to describe homosexual men's sexual risk behaviours for HIV infection in a sample of men in Scotland's two largest cities. DESIGN/SETTING: Trained sessional research staff administered a short self completed questionnaire, to homosexual men present in all of Glasgow's and Edinburgh's "gay bars," during a 1 month period. SUBJECTS: A total of 2276 homosexual men participated, with a response rate of 78.5%. Of these, 1245 were contacted in Glasgow and 1031 in Edinburgh. MAIN OUTCOME MEASURES: Sociodemographic data, recent (past year) sexual behaviour, information on last occasion of anal intercourse with and without condoms, and sexual health service use. RESULTS: Anal intercourse is a common behaviour; 75% of men have had anal intercourse in the past year. A third of our sample report anal intercourse with one partner in the past year, but 42% have had anal intercourse with multiple partners. Over two thirds of the total population have not had any unprotected anal intercourse (UAI) in the past year and a quarter of the sample have had UAI with one partner only. 8% report UAI with two or more partners. More men in Edinburgh (17% v 10%) reported unprotected sex with casual partners only, but more men in Glasgow (29% v 20%) reported UAI with both casual and regular partners (chi 2 = 12.183 p < 0.02). Multiple logistical regression found that odds of UAI are 30% lower for men with degree level education and 40% lower for men who claim to know their own HIV status, whereas they are 40% higher for those who have been tested for HIV and 48% higher for infrequent visitors to the "gay scene". Men who have had an STI in the past year are 2.4 times more likely to report UAI than those who have not. Men with a regular partner were significantly more likely to report UAI, as were those who had known their partner for longer, and who claimed to know their partner's antibody status. CONCLUSION: On the basis of current sexual risk taking, the epidemic of HIV among homosexual men in Scotland will continue in future years. The data reported here will prove useful both for surveillance of sexual risk taking, and the effectiveness of Scotland-wide and UK-wide HIV prevention efforts among homosexual men.

Adolescent↗
PubMed2002

Crime and Punishment (Scotland) Act 1997: a survey of sentencers' views concerning the Scottish 'hybrid order'.

The Crime and Punishment (Scotland) Act 1997 introduced the hospital direction (HD), often termed the 'hybrid order' because it allows courts to simultaneously send a mentally disordered offender to hospital and impose a prison sentence, to be completed after hospital discharge. It is the first measure that explicitly allows the imposition of a prison sentence for an offender meeting criteria for detention under the Mental Health (Scotland) Act 1984. A previous survey showed that psychiatrists in Scotland favoured the principle of a hybrid order (Darjee et al., 2000). In this study all Scottish Sheriffs (n = 110) and High Court Judges (n = 26) were surveyed for their views on the HD. Of the 56 respondents 19 felt unable to participate largely due to lack of experience in sentencing mentally disordered offenders. Respondents felt the HD was a useful measure, but, in contrast to Scottish Office guidance, indicated that psychiatrists should recommend it directly if they considered that it was an appropriate disposal. Respondents viewed the HD as primarily an incapacitating measure and most respondents hoped that it would encourage psychiatrists to admit 'psychopaths'; although Scottish psychiatrists do not favour the hospitalisation of offenders with primary personality disorders. It is concluded that in its current form and with current guidance the HD is difficult to use, as there are no criteria to differentiate it from a hospital order (HO) and psychiatrists cannot recommend it. Further, recent legislation that makes public safety the primary concern when deciding on the discharge of restricted patients in Scotland, erodes the utility of the HD as an incapacitating measure. However following the Reports of the Millan and MacLean Committees in Scotland, the role of the HD may be strengthened and clarified.

Antisocial Personality Disorder↗
PubMed1990

Suicide in England and Wales and in Scotland. An examination of divergent trends.

The suicide rates in England and Wales and Scotland converged during the late 1960s, and from 1970 were higher in Scotland. The convergence occurred because of differences in the falls in rates of those aged over 45 years and not because of differences in frequency and decline of coal gas suicide. Male suicide increased more rapidly in Scotland during the 1970s. In England and Wales overall female suicide rates fell during 1958-76 whereas in Scotland there was no clear trend. Suicide by car exhaust increased similarly in both countries, but that by hanging and drug poisoning increased more rapidly in Scotland.

Adolescent↗
PubMed2006

Hepatitis C virus infection in Scotland: epidemiological review and public health challenges.

INTRODUCTION: In 2004, Scotland's Health Minister stated that the hepatitis C virus (HCV) "is one of the most serious and significant public health risks of our generation". METHODS: To appreciate the prevention and care challenges posed by HCV in Scotland, we reviewed all country-specific data on i) the prevalence of infection among different populations, ii) the numbers infected with HCV, and iii) the current and future HCV disease burden. RESULTS: An estimated 1% of Scotland's population has HCV; 85-90% of those infected were injecting drug users (IDUs). Reductions in HCV prevalence among young IDUs during the early 1990s suggest that the incidence of HCV had decreased; since then, the absence of further reductions highlight that existing prevention measures are insufficient. Two-thirds of the estimated 37,500 chronically HCV-infected individuals in Scotland remain undiagnosed and two-thirds of this group are former IDUs. An estimated 9,000 former IDUs were living with either moderate or severe HCV disease in 2004; if the current uptake of antiviral therapy continues, this number was estimated to double by 2016. Approximately 1,200 HCV-infected IDUs had developed liver failure by 2004; this figure was predicted to increase to 3,200 by 2020. CONCLUSIONS: Scotland faces three principal public health challenges: i) the prevention of HCV among current IDUs, ii) the diagnosis of HCV-infected persons, particularly those most in need of therapy to prevent severe HCV disease, and iii) the current and future provision of adequate resources to ensure that the movement of patients through the diagnostic and clinical care pathway is optimal.

Adolescent↗
PubMed2003

Socioeconomic status and orofacial clefts in Scotland, 1989 to 1998.

OBJECTIVE: The purpose of this study was to investigate the association between socioeconomic status and orofacial clefts (OFC) in Scotland. DESIGN: Study of prevalence at birth over a 10-year period using an area-based measure of material deprivation. SETTING: Population-based study throughout Scotland. PARTICIPANTS: Eight hundred thirty-four live births with OFC born between January 1, 1989, and December 31, 1998, ascertained from the nationwide register of the Cleft Service in Scotland, compared with the total 603,825 live births in Scotland in this period. RESULTS: There was a strong positive relationship whereby the prevalence of OFC at birth increased with increasing deprivation. This trend was statistically significant for cleft lip and/or palate (CL[P]: p =.016) but not for cleft palate (CP; p =.078). For each type of cleft, the relative risk among those resident in the most deprived areas, compared with those resident in the least deprived areas, was 2.33. CONCLUSIONS: The association between OFC and socioeconomic status is consistent with a report for an earlier period in a smaller part of Scotland. Unlike the earlier study, this pattern appears to be stronger for CL(P) than for CP. These observations do not appear to be an artifact of recording. It is possible that they reflect the association between deprivation and risk factors for OFC, most likely tobacco smoking during pregnancy. Because the relationship between OFC and socioeconomic status appears to have been virtually unstudied in other populations, it would be valuable to investigate this relationship elsewhere and determine whether known risk factors account for the relationship.

Cleft Lip↗
PubMed2001

What do we know about the voluntary healthcare sector in Scotland?

OBJECTIVE: To document sources of information available to the National Health Service in Scotland (NHSiS) which relate to the health voluntary sector. DESIGN: Interrogation of the databases of the Charities Register in Scotland (CRIS) and Health Education Board for Scotland (HEBS) for information on health voluntary organisations and a retrospective review of information held on health voluntary organisations recently funded by health boards. SETTING: National Health Service in Scotland and the Scottish Council for Voluntary Organisations RESULTS: Nine hundred and fifty six health voluntary organisations in Scotland were registered with the CRIS database. Five hundred and forty five (57%) of these had annual incomes of less than 100,000 Pounds and two thirds of them (630) operated at a local level. Information on 3,106 health and support organisations was present on the HEBS database. In 1997-98 Scottish Health Boards grant funded 278 voluntary organisations. Eighty seven (31%) of these had information held on the CRIS database and another 87 (31%) with the HEBS database. Funding was much more likely to be given to organisations dealing with adult physical health and alcohol problems. Organisations dealing with specific diseases were less likely to be funded. Of the 87 funded organisations registered with CRIS, health boards typically contributed less than 10% of annual funding. CONCLUSIONS: Health planning decisions are made difficult by a deficiency of useful information on the existence, activities and financial positions of voluntary organisations. Construction of accurate and comprehensive national databases to inform these decisions would be expensive. However, the development of appropriate local databases by health boards and the voluntary sector would facilitate the development of a constructive partnership.

Databases, Factual↗
PubMed1999

Childhood injury mortality in Scotland, 1981-95.

OBJECTIVE: To examine the trends in childhood injury mortality in Scotland between 1981 and 1995. DESIGN: Analysis of mortality data from the Registrar General for Scotland. SETTING: Scotland, UK. SUBJECTS: Children aged 0-14 years. MAIN RESULTS: A total of 1,728 children died in Scotland as a result of an injury between 1981-1995. While a significant decrease in the rates of unintentional injury mortality was observed for both sexes, all ages and most causes over the study period, the proportion of total child deaths due to injury decreased only slightly. Road traffic accidents were the major cause of injury mortality in this age group, representing over 40% of all injury deaths both at the beginning and the end of the study period. Males and young children of both sexes had consistently higher injury mortality rates. Similar reductions in injury mortality rates were observed for males and females. CONCLUSIONS: Childhood injury mortality rates have declined in Scotland, affecting all injury causes. The analysis of injury mortality rates in the population is helpful in highlighting potential environmental hazards that result in injury and in monitoring progress towards the achievement of national and local targets.

Accidents, Traffic↗
PubMed2000

Anti-psychotic drug prescribing trends in primary care in Scotland 1994-97.

OBJECTIVE: To describe trends in the use of anti-psychotic drugs prescribed in Primary Care in Scotland. DESIGN: Information on prescription numbers and costs were obtained from the Pharmacy Prescribing Division. SETTING: Scotland 1994-1997. Results Prescriptions for anti-psychotic drugs in Primary Care in Scotland increased by 28% in the period April 1994-December 97. In the same period, quarterly costs increased from 523,971 Pounds to 1,339,215 Pounds, an increase of 155%. Ninety per cent of the increase is accounted for by use of the five drugs risperidone, sertindole, olanzapine, clozapine and quetiapine. Health Board areas vary markedly in their uptake of the new drugs. CONCLUSION: The use of new anti-psychotic drugs in Scotland represents a substantial additional investment in mental health care. This has happened with little discussion or debate. Scotland needs to make explicit decisions on the place of newer anti-psychotics in treatment, and on the balance between investing in these drugs and investing in other aspects of mental health services.

Antipsychotic Agents↗
PubMed1998

Trends in incidence of and mortality from invasive cancer of the uterine cervix in Scotland (1975-1994).

OBJECTIVE: I. To identify major trends in the incidence of and mortality from invasive cancer of the cervix uteri in Scotland during the twenty year period 1975-1994; II. to consider the extent to which these trends may have been shaped by the introduction of systematic cervical screening. DESIGN: Analysis of annual age standardised and age specific rates for incidence and mortality, based on data collected by the Scottish Cancer Registry and the General Register Office for Scotland. SETTING: Scotland. SUBJECTS: Women registered with the Scottish Cancer Registry as having developed invasive cancer of the cervix during the period of interest. RESULTS: Annual all ages incidence rates of invasive cervical cancer show little overall change over the period 1975-1989, but exhibit a pronounced decline from 1990 onwards. All-ages mortality rates show clear evidence of decline during the period 1975-1994, the rate for 1994 being some 30% lower than that for 1975. Annual age-specific incidence rates show different patterns by age group, with clear evidence of decreasing trends in the age range 50-64 years but different patterns in younger and older age groups. Most age groups show steep declines in incidence from 1990 onwards. Age specific mortality rates for 1975-1994 exhibit the most pronounced decreasing trends in the age range 50-64 years. The trends identified are broadly similar to those experienced in England and Wales over an approximately comparable period. CONCLUSIONS: The overall (all ages) incidence of invasive cervical cancer in Scotland changed little during the period 1975-1989, but declined sharply from 1990 onwards. The most pronounced decline in incidence across the period 1975-1994 appears to have taken place in the age range 50-64 years. This decline has been accompanied by a commensurate fall in mortality in the same age range. These reductions in incidence and mortality may be attributable in part to increased coverage of cervical screening programmes during the period of interest. Evidence from other studies suggest that, without the increased coverage of cervical screening achieved during this period incidence rates in Scotland might have been seen to increase.

Adult↗