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Background This systematic scoping review was commissioned by NHS Health Scotland as one of a number of projects to investigate reasons behind ‘excess’ mortality in Scotland compared to other parts of the UK. It aimed to identify explanations for (1) the high mortality in Scotland, or parts of Scotland relative to comparable populations (2) excess mortality between otherwise comparable populations. Methods Ten electronic databases were searched in November 2014, plus searches of relevant websites and a structured internet search. Potentially relevant records were screened by one reviewer with a random 10% double screened. Data was extracted into the categories: Countries compared; Study design; Outcomes reported; Hypotheses proposed (if any). Results 27,723 articles were screened and 837 included (1) Half of the 305 included studies mentioned deprivation or deprivation-related artefacts as an explanation for excess mortality in Glasgow or Scotland. The next largest category (29%) related to health behaviours. Other significant explanations related to political attack, effects of policies, health services supply and demand, deindustrialisation, different culture of substance misuse, possible mechanisms, migration, lower social capital, poor housing, life course effects, artefacts of measurement and the external physical environment. (2) In the international literature (n = 532), the largest category related to health behaviours (37%), with deprivation featuring in 32%. Other significant explanations related to health services supply and demand, income inequalities, artefacts of measurement, political attack or effects, social capital, different culture of substance misuse, and genetic differences. Conclusions There is a great deal of relevant literature offering explanations for “excess” mortality. Further research that includes validity assessment of these studies would be necessary to understand the reasons more fully and to ascertain which are the most robust. Key messages: Further research might focus on the links between “downstream” (e.g. health behaviours), “midstream” and “upstream” levels of explanations for excess mortality both in Scotland and internationally It would be of interest to explore similarities and differences between upstream influences, health behaviours and linked outcomes in Scotland and in eastern European countries © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Systematic scoping review of proposed explanations for “excess” mortality in Scotland