title: Are there gender differences in the geography of alcohol-related mortality in Scotland? An ecological study.
abstract: BACKGROUND
  There is growing concern about alcohol-related harm, particularly within Scotland which has some of the highest rates of alcohol-related death in western Europe. There are large gender differences in alcohol-related mortality rates in Scotland and in other countries, but the reasons for these differences are not clearly understood. In this paper, we aimed to address calls in the literature for further research on gender differences in the causes, contexts and consequences of alcohol-related harm. Our primary research question was whether the kind of social environment which tends to produce higher or lower rates of alcohol-related mortality is the same for both men and women across Scotland.
  
  
  METHODS
  Cross-sectional, ecological design. A comparison was made between spatial variation in men's and women's age-standardised alcohol-related mortality rates in Scotland using maps, Moran's Index, linear regression and spatial analyses of residuals. Directly standardised mortality rates were derived from individual level records of death registration, 2000-2005 (n = 8685).
  
  
  RESULTS
  As expected, men's alcohol-related mortality rate substantially exceeded women's and there was substantial spatial variation in these rates for both men and women within Scotland. However, there was little spatial variation in the relationship between men's and women's alcohol-mortality rates (r2 = 0.73); areas with relatively high rates of alcohol-related mortality for men tended also to have relatively high rates for women. In a small number of areas (8 out of 144) the relationship between men's and women's alcohol-related mortality rates was significantly different.
  
  
  CONCLUSIONS
  In as far as geographic location captures exposure to social and economic environment, our results suggest that the relationship between social and economic environment and alcohol-related harm is very similar for men and women. The existence of a small number of areas in which men's and women's alcohol-related mortality had an different relationship suggests that some places may have unusual drinking cultures. These might prove useful for further investigations into the factors which influence drinking behaviour in men and women.
authors.affiliation: MRC Social and Public Health Sciences Unit, Glasgow, UK. C.Emslie@sphsu.mrc.ac.uk
authors.forename: Carol
authors.initials: C
authors.lastname: Emslie
authors.forename: Richard
authors.initials: R
authors.lastname: Mitchell
mesh_terms: D000328:Adult; D000367:Age Factors; D000428:Alcohol Drinking / Q000453:epidemiology / Q000401:mortality*; D000437:Alcoholism / Q000453:epidemiology / Q000401:mortality*; D002423:Cause of Death; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003466:Cultural Characteristics; D004463:Ecology; D005260:Female; D005843:Geography; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011336:Probability; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D012720:Severity of Illness Index; D012737:Sex Factors; D012959:Socioeconomic Factors; D055815:Young Adult