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Choi MH, Moon MH, Yoon TH. Avoidable Mortality between Metropolitan and Non-Metropolitan Areas in Korea from 1995 to 2019: A Descriptive Study of Implications for the National Healthcare Policy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063475. [PMID: 35329162 PMCID: PMC8955663 DOI: 10.3390/ijerph19063475] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/28/2022] [Accepted: 03/14/2022] [Indexed: 01/27/2023]
Abstract
This study aims to investigate the trends of avoidable mortality and regional inequality from 1995 to 2019 and to provide evidence for policy effectiveness to address regional health disparities in Korea. Mortality and population data were obtained from the Statistics Korea database. Age-standardized all-cause, avoidable, preventable, and treatable mortality was calculated for each year by sex and region. Changes in mortality trends between metropolitan and non-metropolitan areas were compared with absolute and relative differences. Avoidable mortality decreased by 65.7% (350.5 to 120.2/100,000 persons) in Korea, 64.5% in metropolitan areas, and 65.8% in non-metropolitan areas. The reduction in avoidable mortality was greater in males than in females in both areas. The main causes of death that contribute to the reduction of avoidable mortality are cardiovascular diseases, cancer, and injuries. In preventable mortality, the decrease in non-metropolitan areas (−192.4/100,000 persons) was greater than that in metropolitan areas (−142.7/100,000 persons). However, in treatable mortality, there was no significant difference between the two areas. While inequalities in preventable mortality improved, inequalities in treatable mortality worsened, especially in females. Our findings suggest that regional health disparities can be resolved through a balanced regional development strategy with an ultimate goal of reducing health disparities.
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Affiliation(s)
- Min-Hyeok Choi
- Department of Preventive and Occupational & Environmental Medicine, Medical College, Pusan National University, Yangsan 50612, Korea;
- Office of Public Healthcare Service, Pusan National University Yangsan Hospital, Yangsan 50612, Korea;
| | - Min-Hui Moon
- Office of Public Healthcare Service, Pusan National University Yangsan Hospital, Yangsan 50612, Korea;
| | - Tae-Ho Yoon
- Department of Preventive and Occupational & Environmental Medicine, Medical College, Pusan National University, Yangsan 50612, Korea;
- Correspondence: ; Tel.: +82-51-510-8030
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2
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Kim W, Jang S, Lee G, Chang YJ. Disparities in Cancer-Related Avoidable Mortality by the Level of Area Deprivation in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157856. [PMID: 34360148 PMCID: PMC8345709 DOI: 10.3390/ijerph18157856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 12/03/2022]
Abstract
Background: This study investigated trends in cancer-related avoidable (preventable and treatable) mortality and its association with area deprivation in Korea. Methods: Cancer-related avoidable mortality rates per 100,000 population between 2015 and 2019 were measured using the Causes of Death Statistics. Area Deprivation Index (ADI) was measured from the Population and Housing Census and information on other independent variables from the Korea Community Health Survey. The gap in avoidable mortality between the more and less deprived groups was expressed as rate ratios (RR) and absolute differences (ADs) with a 95 percent confidence interval (95% CI). The association between avoidable mortality and ADI was investigated through Poisson regression modelling. Results: The more deprived areas had higher avoidable (RR 1.15, 95% CI 1.13–1.17; AD 6.58, 95% CI 5.59–7.57) and preventable (RR 1.19, 95% CI 1.17–1.21; AD 6.22, 95% CI 5.38–7.06) mortality. The overall cancer-related avoidable mortality decreased but the gap between the more and less deprived groups did not decline significantly during the study period. The association between avoidable and preventable mortality and area deprivation remained significant after adjusting for variables, including area levels of smokers and alcohol drinkers. Conclusions: The gap in avoidable mortality signifies the importance of addressing related disparities in cancer.
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Zygmunt A, Kendall CE, James P, Lima I, Tuna M, Tanuseputro P. Avoidable Mortality Rates Decrease but Inequity Gaps Widen for Marginalized Neighborhoods: A Population-Based Analysis in Ontario, Canada from 1993 to 2014. J Community Health 2021; 45:579-597. [PMID: 31722048 DOI: 10.1007/s10900-019-00778-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Avoidable mortality (AM) is a health indicator used to examine trends in avoidable deaths amenable to public health and medical interventions. AM is more likely amongst marginalized populations. Our objective was to examine trends in AM rates by level of neighborhood marginalization. Decedents under age 75 years in Ontario from 1993 to 2014 (n = 691,453) were assigned to a quintile-level of each Ontario Marginalization (ON-Marg) Index dimension: material deprivation, residential instability, dependency, and ethnic concentration. We calculated ON-Marg Index dimension and quintile specific age- and sex-standardized AM incidence rates. We then calculated annual AM rate ratios between the most (Q5) and least (Q1) marginalized quintiles for each ON-Marg dimension. To describe the inequity gap in AM over time we calculated the absolute difference in the Q5/Q1 rate ratio between 2014 and 1993 for each dimension. AM rates in Ontario were almost halved (48.6%) from 1993 to 2014 (216 vs. 111 per 100,000 population). This decline was greater for treatable AM (75 vs. 36 per 100,000 population) than preventable AM (128 vs. 88 per 100,000 population). The inequity gap in AM Q5/Q1 rate ratios (RR) between 1993 and 2014 widened for all marginalization dimensions: dependency (RR 2.11-2.58), ethnic concentration (RR 0.59-0.48), material deprivation (RR 1.63-2.23), and residential instability (RR 2.01-2.43). To attain further declines in AM, policymakers and governments must address AM due to preventable deaths in neighborhoods highly marginalized by dependency, material deprivation, and residential instability.
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Affiliation(s)
- Austin Zygmunt
- School of Epidemiology and Public Health, University of Ottawa, Room 101 - 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.
| | - Claire E Kendall
- Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Canada.,ICES uOttawa, The Ottawa Hospital, Civic Campus 1053 Carling Avenue, Ottawa, Canada.,CT Lamont Primary Health Care Research Group, Bruyère Research Institute, Ottawa, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Paul James
- ICES uOttawa, The Ottawa Hospital, Civic Campus 1053 Carling Avenue, Ottawa, Canada.,Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Isac Lima
- Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Canada.,ICES uOttawa, The Ottawa Hospital, Civic Campus 1053 Carling Avenue, Ottawa, Canada
| | - Meltem Tuna
- Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Canada.,ICES uOttawa, The Ottawa Hospital, Civic Campus 1053 Carling Avenue, Ottawa, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Canada.,ICES uOttawa, The Ottawa Hospital, Civic Campus 1053 Carling Avenue, Ottawa, Canada.,CT Lamont Primary Health Care Research Group, Bruyère Research Institute, Ottawa, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Canada
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Zygmunt A, Tanuseputro P, James P, Lima I, Tuna M, Kendall CE. Neighbourhood-level marginalization and avoidable mortality in Ontario, Canada: a population-based study. Canadian Journal of Public Health 2019; 111:169-181. [PMID: 31828730 DOI: 10.17269/s41997-019-00270-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 10/09/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the impact of neighbourhood marginalization on avoidable mortality (AM) from preventable and treatable causes of death. METHODS All premature deaths between 1993 and 2014 (N = 691,453) in Ontario, Canada, were assigned to quintiles of neighbourhood marginalization using the four dimensions of the Ontario Marginalization Index: dependency, ethnic concentration, material deprivation, and residential instability. We conducted two multivariate logistic regressions to examine the association between neighbourhood marginalization, first with AM compared with non-AM as the outcome, and second with AM from preventable causes compared with treatable causes as the outcome. All models were adjusted for decedent age, sex, urban/rural location, and level of comorbidity. RESULTS A total of 463,015 deaths were classified as AM and 228,438 deaths were classified as non-AM. Persons living in the most materially deprived (OR, 1.24; 95% CI, 1.22 to 1.27) and residentially unstable neighbourhoods (OR, 1.13; 95% CI, 1.11 to 1.15) had greater odds of AM, particularly from preventable causes. Those living in the most dependent (OR, 0.91; 95% CI, 0.89 to 0.93) and ethnically concentrated neighbourhoods (OR, 0.93; 95% CI, 0.91 to 0.93) had lower odds of AM, although when AM occurred, it was more likely to arise from treatable causes. CONCLUSION Different marginalization dimensions have unique associations with AM. By identifying how different aspects of neighbourhood marginalization influence AM, these results may have important implications for future public health efforts to reduce inequities in avoidable deaths.
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Affiliation(s)
- Austin Zygmunt
- School of Epidemiology and Public Health, University of Ottawa, Room 101, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Canada.,ICES uOttawa, The Ottawa Hospital, Civic Campus 1053 Carling Avenue, Ottawa, Canada.,CT Lamont Primary Health Care Research Group, Bruyère Research Institute, Ottawa, Canada.,Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Canada
| | - Paul James
- ICES uOttawa, The Ottawa Hospital, Civic Campus 1053 Carling Avenue, Ottawa, Canada.,Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Isac Lima
- Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Canada.,ICES uOttawa, The Ottawa Hospital, Civic Campus 1053 Carling Avenue, Ottawa, Canada
| | - Meltem Tuna
- Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Canada.,ICES uOttawa, The Ottawa Hospital, Civic Campus 1053 Carling Avenue, Ottawa, Canada
| | - Claire E Kendall
- Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Canada.,ICES uOttawa, The Ottawa Hospital, Civic Campus 1053 Carling Avenue, Ottawa, Canada.,CT Lamont Primary Health Care Research Group, Bruyère Research Institute, Ottawa, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
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Gianino MM, Lenzi J, Bonaudo M, Fantini MP, Siliquini R, Ricciardi W, Damiani G. Patterns of amenable child mortality over time in 34 member countries of the Organisation for Economic Co-operation and Development (OECD): evidence from a 15-year time trend analysis (2001-2015). BMJ Open 2019; 9:e027909. [PMID: 31122996 PMCID: PMC6538061 DOI: 10.1136/bmjopen-2018-027909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 04/18/2019] [Accepted: 04/24/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To analyse the trends of amenable mortality rates (AMRs) in children over the period 2001-2015. DESIGN Time trend analysis. SETTING Thirty-four member countries of the Organisation for Economic Co-operation and Development (OECD). PARTICIPANTS Midyear estimates of the resident population aged ≤14 years. PRIMARY AND SECONDARY OUTCOME MEASURES Using data from the WHO Mortality Database and Nolte and McKee's list, AMRs were calculated as the annual number of deaths over the population/100 000 inhabitants. The rates were stratified by age groups (<1, 1-4, 5-9 and 10-14 years). All data were summarised by presenting the average rates for the years 2001/2005, 2006/2010 and 2011/2015. RESULTS There was a significant decline in children's AMRs in the <1 year group in all 34 OECD countries from 2001/2005 to 2006/2010 (332.78 to 295.17/100 000; %Δ -11.30%; 95% CI -18.75% to -3.85%) and from 2006/2010 to 2011/2015 (295.17 to 240.22/100 000; %Δ -18.62%; 95% CI -26.53% to -10.70%) and a slow decline in the other age classes. The only cause of death that was significantly reduced was conditions originating in the early neonatal period for the <1 year group. The age-specific distribution of causes of death did not vary significantly over the study period. CONCLUSIONS The low decline in amenable mortality rates for children aged ≥1 year, the large variation in amenable mortality rates across countries and the insufficient success in reducing mortality from all causes suggest that the heath system should increase its efforts to enhance child survival. Promoting models of comanagement between primary care and subspecialty services, encouraging high-quality healthcare and knowledge, financing universal access to healthcare and adopting best practice guidelines might help reduce amenable child mortality.
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Affiliation(s)
- Maria Michela Gianino
- Department of Public Health Sciences and Pediatrics, Università degli Studi di Torino, Torino, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum – University of Bologna, Bologna, Italy
| | - Marco Bonaudo
- Department of Public Health Sciences and Pediatrics, Università degli Studi di Torino, Torino, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum – University of Bologna, Bologna, Italy
| | - Roberta Siliquini
- Department of Public Health Sciences and Pediatrics, Università degli Studi di Torino, Torino, Italy
| | - Walter Ricciardi
- Istituto di Sanità Pubblica, Universita Cattolica del Sacro Cuore Sede di Roma, Roma, Lazio, Italy
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCS, Roma, Italy
| | - Gianfranco Damiani
- Istituto di Sanità Pubblica, Universita Cattolica del Sacro Cuore Sede di Roma, Roma, Lazio, Italy
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCS, Roma, Italy
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Khan AM, Urquia M, Kornas K, Henry D, Cheng SY, Bornbaum C, Rosella LC. Socioeconomic gradients in all-cause, premature and avoidable mortality among immigrants and long-term residents using linked death records in Ontario, Canada. J Epidemiol Community Health 2017; 71:625-632. [PMID: 28289039 PMCID: PMC5485756 DOI: 10.1136/jech-2016-208525] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/09/2017] [Accepted: 01/29/2017] [Indexed: 12/03/2022]
Abstract
Background Immigrants have been shown to possess a health advantage, yet are also more likely to reside in arduous economic conditions. Little is known about if and how the socioeconomic gradient for all-cause, premature and avoidable mortality differs according to immigration status. Methods Using several linked population-based vital and demographic databases from Ontario, we examined a cohort of all deaths in the province between 2002 and 2012. We constructed count models, adjusted for relevant covariates, to attain age-adjusted mortality rates and rate ratios for all-cause, premature and avoidable mortality across income quintile in immigrants and long-term residents, stratified by sex. Results A downward gradient in age-adjusted all-cause mortality was observed with increasing income quintile, in immigrants (males: Q5: 13.32, Q1: 20.18; females: Q5: 9.88, Q1: 12.51) and long-term residents (males: Q5: 33.25, Q1: 57.67; females: Q5: 22.31, Q1: 36.76). Comparing the lowest and highest income quintiles, male and female immigrants had a 56% and 28% lower all-cause mortality rate, respectively. Similar trends were observed for premature and avoidable mortality. Although immigrants had consistently lower mortality rates compared with long-term residents, trends only differed statistically across immigration status for females (p<0.05). Conclusions This study illustrated the presence of income disparities as it pertains to all-cause, premature, and avoidable mortality, irrespective of immigration status. Additionally, the immigrant health advantage was observed and income disparities were less pronounced in immigrants compared with long-term residents. These findings support the need to examine the factors that drive inequalities in mortality within and across immigration status.
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Affiliation(s)
- Anam M Khan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Marcelo Urquia
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Centre for Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kathy Kornas
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - David Henry
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Stephanie Y Cheng
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Catherine Bornbaum
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
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7
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Chen BK, Yang YT, Yang CY. Trends in amenable deaths based on township income quartiles in Taiwan, 1971-2008: did universal health insurance close the gap? J Public Health (Oxf) 2016; 38:e524-e536. [PMID: 28158683 DOI: 10.1093/pubmed/fdv156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brian K Chen
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 915 Greene Street Suite 354, Columbia, SC 29208, USA
| | - Y Tony Yang
- College of Health and Human Services, George Mason University, 4400 University Dr, Fairfax, VA 22030-4444, USA
| | - Chun-Yuh Yang
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan
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8
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Nolasco A, Moncho J, Quesada JA, Melchor I, Pereyra-Zamora P, Tamayo-Fonseca N, Martínez-Beneito MA, Zurriaga O, Ballesta M, Daponte A, Gandarillas A, Domínguez-Berjón MF, Marí-Dell'Olmo M, Gotsens M, Izco N, Moreno MC, Sáez M, Martos C, Sánchez-Villegas P, Borrell C. Trends in socioeconomic inequalities in preventable mortality in urban areas of 33 Spanish cities, 1996-2007 (MEDEA project). Int J Equity Health 2015; 14:33. [PMID: 25879739 PMCID: PMC4392789 DOI: 10.1186/s12939-015-0164-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/17/2015] [Indexed: 11/30/2022] Open
Abstract
Background Preventable mortality is a good indicator of possible problems to be investigated in the primary prevention chain, making it also a useful tool with which to evaluate health policies particularly public health policies. This study describes inequalities in preventable avoidable mortality in relation to socioeconomic status in small urban areas of thirty three Spanish cities, and analyses their evolution over the course of the periods 1996–2001 and 2002–2007. Methods We analysed census tracts and all deaths occurring in the population residing in these cities from 1996 to 2007 were taken into account. The causes included in the study were lung cancer, cirrhosis, AIDS/HIV, motor vehicle traffic accidents injuries, suicide and homicide. The census tracts were classified into three groups, according their socioeconomic level. To analyse inequalities in mortality risks between the highest and lowest socioeconomic levels and over different periods, for each city and separating by sex, Poisson regression were used. Results Preventable avoidable mortality made a significant contribution to general mortality (around 7.5%, higher among men), having decreased over time in men (12.7 in 1996–2001 and 10.9 in 2002–2007), though not so clearly among women (3.3% in 1996–2001 and 2.9% in 2002–2007). It has been observed in men that the risks of death are higher in areas of greater deprivation, and that these excesses have not modified over time. The result in women is different and differences in mortality risks by socioeconomic level could not be established in many cities. Conclusions Preventable mortality decreased between the 1996–2001 and 2002–2007 periods, more markedly in men than in women. There were socioeconomic inequalities in mortality in most cities analysed, associating a higher risk of death with higher levels of deprivation. Inequalities have remained over the two periods analysed. This study makes it possible to identify those areas where excess preventable mortality was associated with more deprived zones. It is in these deprived zones where actions to reduce and monitor health inequalities should be put into place. Primary healthcare may play an important role in this process.
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Affiliation(s)
- Andreu Nolasco
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia. Campus de San Vicente del Raspeig s/n. Apartado 99, Universidad de Alicante, 03080, Alicante, España.
| | - Joaquin Moncho
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia. Campus de San Vicente del Raspeig s/n. Apartado 99, Universidad de Alicante, 03080, Alicante, España.
| | - Jose Antonio Quesada
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia. Campus de San Vicente del Raspeig s/n. Apartado 99, Universidad de Alicante, 03080, Alicante, España.
| | - Inmaculada Melchor
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia. Campus de San Vicente del Raspeig s/n. Apartado 99, Universidad de Alicante, 03080, Alicante, España. .,Registro de Mortalidad de la Comunidad Valenciana, Servicio de Estudios Epidemiológicos y Estadísticas Sanitarias, Subdirección General de Epidemiología y Vigilancia de la Salud. Conselleria de Sanitat, Plaza de España 6, 03010, Alicante, España.
| | - Pamela Pereyra-Zamora
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia. Campus de San Vicente del Raspeig s/n. Apartado 99, Universidad de Alicante, 03080, Alicante, España.
| | - Nayara Tamayo-Fonseca
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia. Campus de San Vicente del Raspeig s/n. Apartado 99, Universidad de Alicante, 03080, Alicante, España.
| | - Miguel Angel Martínez-Beneito
- Área de Desigualdades en Salud. FISABIO-CSISP, Conselleria de Sanitat, Avenida de Cataluña, 21, 46020, Valencia, España. .,Ciber de Epidemiología y Salud Pública CIBERESP, Instituto de Salud Carlos III, Melchor Fernández Almagro, 3-5 28029, Madrid, España.
| | - Oscar Zurriaga
- Área de Desigualdades en Salud. FISABIO-CSISP, Conselleria de Sanitat, Avenida de Cataluña, 21, 46020, Valencia, España. .,Servicio de Estudios Epidemiológicos y Estadísticas Sanitarias, Subdirección General de Epidemiología y Vigilancia de la Salud. Conselleria de Sanitat, Avenida de Cataluña, 21, 46020, Valencia, España. .,Ciber de Epidemiología y Salud Pública CIBERESP, Instituto de Salud Carlos III, Melchor Fernández Almagro, 3-5 28029, Madrid, España.
| | - Mónica Ballesta
- Department of Epidemiology, Regional Health Council, Murcia, Spain.
| | - Antonio Daponte
- Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN). Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Cuesta del Observatorio, 4. Ap. Correos 2070, Granada, 18080, España.
| | - Ana Gandarillas
- Servicio de Epidemiología. Subdirección de Promoción de la Salud y Prevención. Dirección General de Atención Primaria, Consejería de Sanidad Comunidad de Madrid, C/ San Martín de Porres, n° 6, 1ª planta, 28035, Madrid, España.
| | - M Felicitas Domínguez-Berjón
- Servicio de Informes de Salud y Estudios. Subdirección de Promoción de la Salud y Prevención. Dirección General de Atención Primaria, Consejería de Sanidad Comunidad de Madrid, C/ San Martín de Porres, n° 6, 1ª planta, 28035, Madrid, España.
| | - Marc Marí-Dell'Olmo
- Ciber de Epidemiología y Salud Pública CIBERESP, Instituto de Salud Carlos III, Melchor Fernández Almagro, 3-5 28029, Madrid, España. .,Agència de Salut Pública de Barcelona, Plaça Lesseps, 1, 08023, Barcelona, España. .,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
| | - Mercè Gotsens
- Ciber de Epidemiología y Salud Pública CIBERESP, Instituto de Salud Carlos III, Melchor Fernández Almagro, 3-5 28029, Madrid, España. .,Agència de Salut Pública de Barcelona, Plaça Lesseps, 1, 08023, Barcelona, España. .,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
| | - Natividad Izco
- Dirección General de Salud Pública y Consumo, Gobierno de La Rioja, Calle Vara de Rey n° 8, 1ª planta, 26071, Logroño, España.
| | - M Concepción Moreno
- Ciber de Epidemiología y Salud Pública CIBERESP, Instituto de Salud Carlos III, Melchor Fernández Almagro, 3-5 28029, Madrid, España. .,Instituto de Salud Pública y Laboral de Navarra, C/ Leyre, 15, 31003, Pamplona, Navarra, Spain.
| | - Marc Sáez
- Ciber de Epidemiología y Salud Pública CIBERESP, Instituto de Salud Carlos III, Melchor Fernández Almagro, 3-5 28029, Madrid, España. .,Grupo de Investigación en Estadística, Econometría y Salud (GRECS), [Research Group on Statistics, Econometrics and Health (GRECS)], Universidad de Girona. Calle de la Universidad 10, Campus de Montilivi, 17071, Girona, España.
| | - Carmen Martos
- Ciber de Epidemiología y Salud Pública CIBERESP, Instituto de Salud Carlos III, Melchor Fernández Almagro, 3-5 28029, Madrid, España. .,Instituto Aragonés de Ciencias de la Salud, Avda. San Juan Bosco, n°13, 50009, Zaragoza, España.
| | - Pablo Sánchez-Villegas
- Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN). Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Cuesta del Observatorio, 4. Ap. Correos 2070, Granada, 18080, España.
| | - Carme Borrell
- Ciber de Epidemiología y Salud Pública CIBERESP, Instituto de Salud Carlos III, Melchor Fernández Almagro, 3-5 28029, Madrid, España. .,Agència de Salut Pública de Barcelona, Plaça Lesseps, 1, 08023, Barcelona, España.
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Nolasco A, Quesada JA, Moncho J, Melchor I, Pereyra-Zamora P, Tamayo-Fonseca N, Martínez-Beneito MA, Zurriaga O. Trends in socioeconomic inequalities in amenable mortality in urban areas of Spanish cities, 1996-2007. BMC Public Health 2014; 14:299. [PMID: 24690471 PMCID: PMC3983886 DOI: 10.1186/1471-2458-14-299] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/28/2014] [Indexed: 12/02/2022] Open
Abstract
Background While research continues into indicators such as preventable and amenable mortality in order to evaluate quality, access, and equity in the healthcare, it is also necessary to continue identifying the areas of greatest risk owing to these causes of death in urban areas of large cities, where a large part of the population is concentrated, in order to carry out specific actions and reduce inequalities in mortality. This study describes inequalities in amenable mortality in relation to socioeconomic status in small urban areas, and analyses their evolution over the course of the periods 1996–99, 2000–2003 and 2004–2007 in three major cities in the Spanish Mediterranean coast (Alicante, Castellón, and Valencia). Methods All deaths attributed to amenable causes were analysed among non-institutionalised residents in the three cities studied over the course of the study periods. Census tracts for the cities were grouped into 3 socioeconomic status levels, from higher to lower levels of deprivation, using 5 indicators obtained from the 2001 Spanish Population Census. For each city, the relative risks of death were estimated between socioeconomic status levels using Poisson’s Regression models, adjusted for age and study period, and distinguishing between genders. Results Amenable mortality contributes significantly to general mortality (around 10%, higher among men), having decreased over time in the three cities studied for men and women. In the three cities studied, with a high degree of consistency, it has been seen that the risks of mortality are greater in areas of higher deprivation, and that these excesses have not significantly modified over time. Conclusions Although amenable mortality decreases over the time period studied, the socioeconomic inequalities observed are maintained in the three cities. Areas have been identified that display excesses in amenable mortality, potentially attributable to differences in the healthcare system, associated with areas of greater deprivation. Action must be taken in these areas of greater inequality in order to reduce the health inequalities detected. The causes behind socioeconomic inequalities in amenable mortality must be studied in depth.
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Affiliation(s)
- Andreu Nolasco
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias, Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universidad de Alicante Campus de San Vicente del Raspeig s/n, Apartado 99, 03080 Alicante, España.
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Commentary: approaches, strengths, and limitations of avoidable mortality. J Public Health Policy 2014; 35:171-84. [PMID: 24621843 DOI: 10.1057/jphp.2014.8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Publication of recent papers such as the one by Schoenbaum and colleagues entitled 'Mortality Amenable to Health Care in the United States: The Roles of Demographics and Health Systems Performance' has stimulated this commentary. We discuss strengths and limitations of amenable and avoidable mortality in health-care systems' performance and their contribution to health inequalities. To illustrate, we present a case study of avoidable and amenable mortality in Spain over 27 years. We conclude that amenable mortality is not a good indicator of health-care systems' performance, or for determining whether it could give rise to health inequalities. To understand health problems and to assess the impact of interventions affecting health requires good, basic, and routine monitoring of health indicators and of socioeconomic determinants of health.
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Elo IT, Beltrán-Sánchez H, Macinko J. The Contribution of Health Care and Other Interventions to Black-White Disparities in Life Expectancy, 1980-2007. POPULATION RESEARCH AND POLICY REVIEW 2014; 33:97-126. [PMID: 24554793 PMCID: PMC3925638 DOI: 10.1007/s11113-013-9309-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Black-white mortality disparities remain sizable in the United States. In this study, we use the concept of avoidable/amenable mortality to estimate cause-of-death contributions to the difference in life expectancy between whites and blacks by gender in the United States in 1980, 1993, and 2007. We begin with a review of the concept of "avoidable mortality" and results of prior studies using this cause-of-death classification. We then present the results of our empirical analyses. We classified causes of death as amenable to medical care, sensitive to public health policies and health behaviors, ischemic heart disease, suicide, HIV/AIDS, and all other causes combined. We used vital statistics data on deaths and Census Bureau population estimates and standard demographic decomposition techniques. In 2007, causes of death amenable to medical care continued to account for close to 2 years of the racial difference in life expectancy among men (2.08) and women (1.85). Causes amenable to public health interventions made a larger contribution to the racial difference in life expectancy among men (1.17 years) than women (0.08 years). The contribution of HIV/AIDS substantially widened the racial difference among both men (1.08 years) and women (0.42 years) in 1993, but its contribution declined over time. Despite progress observed over the time period studied, a substantial portion of black-white disparities in mortality could be reduced given more equitable access to medical care and health interventions.
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Affiliation(s)
- Irma T. Elo
- Population Studies Center, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104, USA
| | - Hiram Beltrán-Sánchez
- Center for Demography and Ecology, University of Wisconsin, 4329 Sewell Social Science, Madison, WI, USA
| | - James Macinko
- New York University, 411 Lafayette Street 5th Floor, New York, NY 10003, USA
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Omranikhoo H, Pourreza A, Ardebili HE, Heydari H, Forushani AR. Avoidable Mortality Differences between Rural and Urban Residents During 2004-2011: A Case Study in Iran. Int J Health Policy Manag 2013; 1:287-93. [PMID: 24596886 DOI: 10.15171/ijhpm.2013.58] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 10/26/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Avoidable mortality as an indicator for assessing the health system performance has caught the attention of researchers for a long time. In this study we aimed to compare the health system performance using this indicator in rural and urban areas of one of Iran's southern provinces. METHODS All deaths (29916) which happened during 2004-2011 in Bushehr province were assessed. Nolte and McKee's avoidable deaths model was used to distinguish avoidable and unavoidable conditions. Accordingly, all deaths were classified into four categories including three avoidable death categories and one unavoidable death category. STATA software was used to conduct Poisson Regression Test and age-standardized death rate. RESULTS Findings showed that avoidable mortality rates declined in both urban and rural areas at 3.33% per year, but decline rates were influenced by Ischemic Heart Disease (IHD) and preventable death categories to treatable death category. Annual decline rate for IHD category in rural and urban areas was nearly the same as 8%, but in preventable death category, rural areas experienced more decreases than urban ones (7% vs 5% respectively). However, decline rate in treatable mortality neither in urban and nor in rural areas was statistically significant. CONCLUSION Despite the annual decline in the rate of avoidable deaths, policy making initiatives especially screening and inter-sectoral measures targeting cause of deaths such as colon and breast cancers, hypertension, lung cancer and traffic accidents, can still further decrease avoidable deaths in both areas.
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Affiliation(s)
- Habib Omranikhoo
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; Department of Health Promotion, School of Health, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Abolghasem Pourreza
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Eftekhar Ardebili
- Department of Health Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Heydari
- Institute for Trade Studies and Research, Ministry of Industry, Mine and Trade, Tehran, Iran
| | - Abbas Rahimi Forushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Chen BK, Yang CY. Temporal trend analysis of avoidable mortality in Taiwan, 1971-2008: overall progress, with areas for further medical or public health investment. BMC Public Health 2013; 13:551. [PMID: 23742049 PMCID: PMC3744173 DOI: 10.1186/1471-2458-13-551] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 04/17/2013] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Avoidable mortality (AM), or "unnecessary untimely death," is considered an indicator of health care quality. We investigated trends in the age-standardized mortality rates (ASMRs) and associated standard expected years of life lost (SEYLL) for deaths amenable to medical care or public health measures in Taiwan from 1971-2008, with an emphasis on identifying areas where additional medical or public health investment may help reduce the burden of AM. METHODS Taiwan's ASMRs per 100,000 for AM and other causes of death were calculated using data from the National Death Certificate Registry in five-year bins from 1971 to 2008. SEYLL rates per 100,000 were calculated annually from 1971 to 2008 using the same data source. RESULTS ASMR for almost all AM and other causes of death declined dramatically from 1971 to 2008 except for lung cancer (16.6% and 7.4% increase among men and women, respectively) and breast cancer (109.8% increase among women). In the same period, SEYLL due to lung cancer increased from 269.2 to 555.7 for men and 249.7 to 342.5 for women. For women, SEYLL due to breast cancer increased from 263.5 in 1971 to 659.3 in 2008. There were gender-specific differences in the reduction (or increase) in AM rates, with women showing larger rates of reduction or smaller rates of increase. Among men, AM fell by 65.9% from 1971-1975 to 2006-2008, and deaths from other causes increased by 15.6%. Among women, AM and deaths from other causes fell by 80.8% and 59.8% respectively. SEYLL decreased, respectively among males and females, from 23,147.3 and 24,081.1 in 1971 to 11,261.8 and 5,929.6 in 2008. CONCLUSION From 1971 to 2008, Taiwan experienced a dramatic reduction in most AM and corresponding SEYLL except for lung cancer (for both males and females) and breast cancer (for females). Additional effort should be devoted to public health measures to combat the rising prevalence of smoking in Taiwan, which may be responsible for the increasing AM from lung cancer. If AM in breast cancer continues unabated in the future, greater policy emphasis on the early detection and treatment of breast cancer may also be warranted.
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Affiliation(s)
- Brian K Chen
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 800 Sumter Street #116, Columbia, SC 29208, USA.
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Lavergne MR, McGrail K. What, if anything, does amenable mortality tell us about regional health system performance? Healthc Policy 2013; 8:79-90. [PMID: 23968629 PMCID: PMC3999562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVES Amenable mortality is proposed as a health system performance measure, and has been used in comparisons across countries and socio-economic strata. We assess its utility as a health region–level indicator in Canada. APPROACH We classified all deaths in British Columbia from 2002 to 2009 using two common definitions of amenable mortality. Counts and standardized rates were calculated for 16 health regions. To assess reliability, sensitivity and validity, we compared rates across regions and over time, and examined correlations with premature and all-cause mortality. RESULTS Of the 238,849 deaths in the study period, 6.6% or 13.7% were classified as amenable (depending on the definition used). Rates were stable or falling in more populated regions, but unstable with large confidence intervals elsewhere. Correlation with overall mortality was strong. CONCLUSION Though amenable mortality is appealing as a feasible, understandable indicator, we question whether it is appropriate for comparisons at a subprovincial level.
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Affiliation(s)
- M Ruth Lavergne
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
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McCallum AK, Manderbacka K, Arffman M, Leyland AH, Keskimäki I. Socioeconomic differences in mortality amenable to health care among Finnish adults 1992-2003: 12 year follow up using individual level linked population register data. BMC Health Serv Res 2013; 13:3. [PMID: 23286878 PMCID: PMC3602718 DOI: 10.1186/1472-6963-13-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 11/23/2012] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Finland decentralised its universal healthcare system and introduced market reforms in the 1990s. Despite a commitment to equity, previous studies have identified persistent socio-economic inequities in healthcare, with patterns of service use that are more pro-rich than in most other European countries. To examine whether similar socio-economic patterning existed for mortality amenable to intervention in primary or specialist care, we investigated trends in amenable mortality by income group from 1992-2003. METHODS We analysed trends in all cause, total disease and mortality amenable to health care using individual level data from the National Causes of Death Register for those aged 25 to 74 years in 1992-2003. These data were linked to sociodemographic data for 1990-2002 from population registers using unique personal identifiers. We examined trends in causes of death amenable to intervention in primary or specialist healthcare by income quintiles. RESULTS Between 1992 and 2003, amenable mortality fell from 93 to 64 per 100,000 in men and 74 to 54 per 100,000 in women, an average annual decrease in amenable mortality of 3.6% and 3.1% respectively. Over this period, all cause mortality declined less, by 2.8% in men and 2.5% in women. By 2002-2003, amenable mortality among men in the highest income group had halved, but the socioeconomic gradient had increased as amenable mortality reduced at a significantly slower rate for men and women in the lowest income quintile. Compared to men and women in the highest income quintile, the risk ratio for mortality amenable to primary care had increased to 14.0 and 20.5 respectively, and to 8.8 and 9.36 for mortality amenable to specialist care. CONCLUSIONS Our findings demonstrate an increasing socioeconomic gradient in mortality amenable to intervention in primary and specialist care. This is consistent with the existing evidence of inequity in healthcare use in Finland and provides supporting evidence of changes in the socioeconomic gradient in health service use and in important outcomes. The potential adverse effect of healthcare reform on timely access to effective care for people on low incomes provides a plausible explanation that deserves further attention.
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Affiliation(s)
- Alison K McCallum
- Directorate of Public Health and Health Policy, NHS Lothian, Waverley Gate, 2-4 Waterloo Place, Edinburgh, EH1 3EG, Scotland
| | - Kristiina Manderbacka
- National Institute for Health and Welfare, (THL), P.O. Box 30, Helsinki, FI-00271, Finland
| | - Martti Arffman
- National Institute for Health and Welfare, (THL), P.O. Box 30, Helsinki, FI-00271, Finland
| | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, Lilybank Gardens, Glasgow, G12 8RZ, Scotland
| | - Ilmo Keskimäki
- National Institute for Health and Welfare, (THL), P.O. Box 30, Helsinki, FI-00271, Finland
- School of Health Sciences, University of Tampere, Kalevantie 4, Tampere, 33014, Finland
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Sundmacher L. Trends and levels of avoidable mortality among districts: "healthy" benchmarking in Germany. Health Policy 2012; 109:281-9. [PMID: 22883387 DOI: 10.1016/j.healthpol.2012.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 06/29/2012] [Accepted: 07/06/2012] [Indexed: 11/26/2022]
Abstract
All developed nations use indicators to monitor the health of their populations, but few nations provide a systematic monitoring of indicators for small regional units. The present study aims to contribute to the literature a single graph that provides a quick and comprehensive overview of the level of and trend in avoidable mortality in each German district as compared to the national average and development. Using mortality data from the German Federal Statistical Office, I calculated the age-standardized number of avoidable deaths, separately for men and women, in each of the 413 local districts in Germany between 2000 and 2008. For men, the graph illustrates that the districts with the highest rates of avoidable mortality are still located in the former East German states, but that some of these districts have improved significantly between the years 2000 and 2008 and are approaching the nationwide average. The graph for women shows slightly different results. Here, many urban areas show high rates of avoidable mortality with both favorable and unfavorable trends. Health professionals could use the graph to establish realistic benchmarks that are based on countrywide comparisons of districts to a national average and trend, which may in turn help them to identify local districts in need of primary or secondary prevention programs or a more effective provision of health care.
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Affiliation(s)
- Leonie Sundmacher
- Department of Health Care Management, Berlin University of Technology, Strasse des 17. Juni 135, 10623 Berlin, Germany.
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Sundmacher L, Busse R. The impact of physician supply on avoidable cancer deaths in Germany. A spatial analysis. Health Policy 2011; 103:53-62. [DOI: 10.1016/j.healthpol.2011.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 07/27/2011] [Accepted: 08/13/2011] [Indexed: 10/17/2022]
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Ollandezos M, Constantinidis T, Athanasakis K, Lionis C, Kyriopoulos J. Trends of mortality in Greece 1980-2007: a focus on avoidable mortality. Hippokratia 2011; 15:330-334. [PMID: 24391415 PMCID: PMC3876849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Avoidable mortality (AM) refers to deaths from certain conditions considered avoidable given timely and effective health care. AM rates in Greece between 1980 and 2007 were examined in order to investigate the extent to which health care has contributed to the decline in mortality rates in Greece over recent decades and detect possible shortcomings in the Greek healthcare system. METHODS Mortality data from the General Secretariat of the National Statistic Service were used. The list of avoidable conditions was the basis of the analysis in which avoidable deaths were classified into conditions amenable to medical care (treatable avoidable mortality) and conditions responsive to health policy (preventable avoidable mortality). Ischaemic heart disease (IHD) was examined separately following relevant studies. Age standardized mortality rates were calculated according to the European Community standard population. RESULTS A steady decline of the percentage of AM over all-cause mortality was documented (1980-1984:27%; 2000- 2007:22.9%). AM rate fell by 30.5% (1980-1984:217.4/100,000 population; 2000-2007: 151.1/100,000). Treatable mortality rate fell by 48.1%, marking the largest contribution to the decline in AM (1980-1984:110.9/100,000; 2000- 2007:57.5/100,000). Ischaemic heart disease death rate fell by 13.1% (1980-1984:52.7/100,000; 2000-2007:45.8/100,000). Preventable mortality rates fell by 11%, marking a modest contribution to the decline in AM (1980-1984: 53.7/100,000; 2000-2007: 47.8/100,000). CONCLUSIONS Trends in AM in Greece between 1980-2007 were similar to those of other European countries, with Greece performing particularly well with respect to treatable mortality. Although the decline in AM may also reflect changes in factors that influence mortality, such as disease occurrence, environment and socioeconomic conditions, they are suggestive of the health care system being an important determinant of health improvements in Greece during the recent decades. Further studies are needed in order to access the quality of care and to examine the structure and adequacy of health care in Greece.
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Affiliation(s)
- M Ollandezos
- Department of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis 68100, Greece ; Department of Health Economics, National School of Public Health, 196 Alexandras Av., Athens 11521, Greece
| | - Th Constantinidis
- Department of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - K Athanasakis
- Department of Health Economics, National School of Public Health, 196 Alexandras Av., Athens 11521, Greece
| | - Ch Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion 71003, Greece
| | - J Kyriopoulos
- Department of Health Economics, National School of Public Health, 196 Alexandras Av., Athens 11521, Greece
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Mustard CA, Bielecky A, Etches J, Wilkins R, Tjepkema M, Amick BC, Smith PM, Aronson KJ. Avoidable mortality for causes amenable to medical care, by occupation in Canada, 1991-2001. Canadian Journal of Public Health 2011. [PMID: 21370790 DOI: 10.1007/bf03403973] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe the incidence of avoidable mortality for causes amenable to medical care among occupation groups in Canada. METHOD A cohort study over an 11-year period among a representative 15% sample of the non-institutionalized population of Canada aged 30-69 at cohort inception. Age-standardized mortality rates for causes amenable to medical care and all other causes of death were calculated for occupationally-active men and women in five categories of skill level and 80 specific occupational groups as well as for persons not occupationally active. RESULTS Age-standardized mortality rates per 100,000 person-years at risk for causes amenable to medical care and for all other causes were 132.3 and 218.6, respectively, for occupationally-active women, and 216.6 and 449.3 for occupationally-active men. For causes amenable to medical care and for all other causes, for both sexes, there was a gradient in mortality relative to the five-level ranking by occupational skill level, but the gradient was less strong for women than for men. Across the 80 occupation minor groups, for both men and women, there was a linear relationship between the rates for causes amenable to medical care and the rates for all other causes. CONCLUSIONS For occupationally-active adults, this study found similar gradients in mortality for causes amenable to medical care and for all other causes of mortality over the period 1991-2001. Avoidable mortality is a valuable indicator of population health, providing information on outcomes pertinent to the organization and delivery of health care services.
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