Scottish Burden of Disease study: Exploring the future burden of disease across Scotland's NHS sub-national planning areas
The impact of demographic change, 2025 to 2040

About this release

This Scottish Burden of Disease (SBoD) research report aims to explore how projected changes in population size and age structure between 2025 and 2040 could affect future health loss across Scotland, its two NHS sub-national planning areas, and territorial NHS boards. It presents scenario-based estimates of the future burden of disease by applying 2019 age- and sex-specific SBoD rates to projected populations. The report explores how demographic changes alone could alter the scale, age distribution, and leading causes of disease burden.

Main points

Overall summary

• Scotland's annual burden of disease is estimated to increase by 16% between 2025 and 2040 due to projected demographic change alone. Corresponding increases are estimated at 14% in Scotland West, ranging from +10% to +17% across NHS boards, and 18% in Scotland East, ranging from +15% to +22% across NHS boards.
• All territorial NHS boards are estimated to experience increased disease burdens, despite having different population trajectories. Seven of Scotland's 14 territorial NHS boards (4 in Scotland West; 3 in Scotland East) are projected to experience population decline between 2025 and 2040, but disease burden is still estimated to rise because of population ageing.
• Many of the highest relative increases in disease burden are estimated in NHS boards containing relatively less deprived populations. This should not be interpreted as indicating lower need in more deprived areas. Rather, it reflects longstanding inequalities in premature mortality, whereby people living in more deprived areas are less likely to survive to the oldest ages where disease burden increases most steeply. In addition, these estimates describe how disease burden may change under projected demographic trends, but do not indicate the extent to which those changes are preventable or avoidable through public health action, healthcare interventions, or wider social and economic policies. Equity must therefore be central to any response.
• These findings highlight the potential for substantial additional pressure on Scotland's health and social care services over the next 15 years. However, they do not represent inevitable outcomes. Sustained action to improve the building blocks of health, reduce exposure to health-harming risks, strengthen primary, secondary and tertiary prevention, and transform services can change these trends and support longer lives in better health.

Population sub-groups and major disease group findings

• Estimated increases in disease burden are driven predominantly by those aged 65 years and over. The greatest contribution varies locally between those aged 65 to 84 years and those aged 85 years and over. In NHS Greater Glasgow and Clyde and NHS Lothian, increases among people aged under 65 years also make a meaningful contribution to the overall change.
• The leading three causes of disease burden estimated for 2040 remain the same across Scotland, both sub-national NHS planning areas, and all territorial NHS boards: cancers, cardiovascular diseases, and neurological disorders. Mental health disorders and musculoskeletal disorders remain prominent contributors across most NHS boards, while substance use disorders feature among the leading five causes in Scotland West.
• The largest absolute increases in disease burden between 2025 and 2040 are consistently attributable to cardiovascular diseases, cancers and neurological disorders. Chronic respiratory diseases and common infections also contribute materially to estimated increases in several local areas.
• The fastest relative percentage increases are estimated for cause groups with a high burden at older ages. Common infections, neurological disorders, cardiovascular diseases, unintentional injuries, and diabetes and kidney diseases are consistently among the causes with the largest relative growth across Scotland, Scotland West, and Scotland East.

Background

The SBoD study monitors how diseases, injuries and risk factors prevent the Scottish population from living longer lives in better health. Burden of disease assessment help us to understand which diseases and injuries pose the greatest threat to population health and wellbeing, which can be used to shape decisions on how to use limited resources for maximum population health benefit.