Intended for healthcare professionals


Scotland introduces record of ethnicity on death certificates

BMJ 2012; 344 doi: (Published 17 January 2012) Cite this as: BMJ 2012;344:e475
  1. Bryan Christie
  1. 1Edinburgh

Scotland has become the first UK country—and one of the first in the world—to record ethnic origin on death certificates. The data will be used to learn more about important health differences between different groups.

The change to death certification was introduced by the registrar general for Scotland this month and will mean that anyone registering a death will be asked whether they are willing to provide the information. It is entirely voluntary. Those involved will be told that the information will be used by the NHS for research purposes only and that no individual will be identified through use of the information. It follows a consultation exercise last year that found strong support for the change.

Until now information on death certificates has been restricted to the deceased’s country of birth, which traditionally has been used as a proxy for ethnic origin. However, the value of this has diminished over time as subsequent generations of immigrants have been born in the United Kingdom.

“People working in this field have been recommending for 25 years that we need to move towards ethnicity, but it has never happened until now,” said Raj Bhopal, professor of public health at the University of Edinburgh and a leading advocate of the change in Scotland. He said that offspring of immigrants are often not picked up in the system at present despite them having similar health patterns to older generations.

Susceptibility to a number of conditions, including cardiovascular disease, diabetes, and cancer, differs significantly among ethnic groups, and reliable data are needed to aid study of these differences and to learn from them. The proposal to collect data on death certificates grew out of a 2009 report, Health in our Multi-Ethnic Scotland: Future Research Priorities (

Laurence Gruer, director of public health science at NHS Health Scotland and chairman of the group that took forward the report’s recommendations, said, “To our knowledge few other countries record ethnic origin on death certificates and none for the explicit purpose of carrying out health research. As the number of deaths accumulate we will be able to build up a much clearer picture of the main causes of death and differences between ethnic groups in Scotland. This will be of immense value in studying the underlying reasons for different death rates with the aim of improving preventive efforts and health service responses for all ethnic groups.”

Although the system is voluntary, Dr Gruer said that experience has shown that most people respond positively to sharing such information with the NHS. “We will be monitoring the proportion of informants who agree to provide the information. If high rates are achieved, we hope other parts of the UK will start to do the same.”


Cite this as: BMJ 2012;344:e475

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