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McMinn MA, Seaman R, Dundas R, Pell JP, Leyland AH. Socio-economic inequalities in rates of amenable mortality in Scotland: Analyses of the fundamental causes using the Scottish Longitudinal Study, 1991-2010. Popul Space Place 2022; 28:psp.2385. [PMID: 35411206 PMCID: PMC7612592 DOI: 10.1002/psp.2385] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/02/2020] [Indexed: 05/29/2023]
Abstract
Socio-economic inequalities in amenable mortality rates are increasing across Europe, which is an affront to universal healthcare systems where the numbers of, and inequalities in, amenable deaths should be minimal and declining over time. However, the fundamental causes theory proposes that inequalities in health will be largest across preventable causes, where unequally distributed resources can be used to gain an advantage. Information on individual-level inequalities that may better reflect the fundamental causes remains limited. We used the Scottish Longitudinal Study, with follow-up to 2010 to examine trends in amenable mortality by a range of socioeconomic position measures. Large inequalities were found for all measures of socioeconomic position and were lowest for educational attainment, higher for social class and highest for social connection. To reduce inequalities, amenable mortality needs to be interpreted both as an indicator of healthcare quality and as a reflection of the unequal distribution of socio-economic resources.
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Affiliation(s)
- Megan A. McMinn
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- Usher Institute, University of Edinburgh, Edinburgh,UK
| | - Rosie Seaman
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Jill P. Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alastair H. Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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2
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Sagan A, Karanikolos M, Gałązka-Sobotka M, McKee M, Rozkrut M, Kowalska-Bobko I. The Devil Is in the Data: Can Regional Variation in Amenable Mortality Help to Understand Changes in Health System Performance in Poland? Int J Environ Res Public Health 2022; 19:ijerph19074129. [PMID: 35409812 PMCID: PMC8998952 DOI: 10.3390/ijerph19074129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 01/03/2023]
Abstract
The contribution of health systems to health is commonly assessed using levels of amenable mortality. Few such studies exist for Poland, with analyses of within-the-country patterns being particularly scarce. The aim of this paper is to analyse differences in amenable mortality levels and trends across Poland's regions using the most recent data and to gain a more nuanced understanding of these differences and possible reasons behind them. This can inform future health policy decisions, particularly when it comes to efforts to improve health system performance. We used national and regional mortality data to construct amenable mortality rates between 2002 and 2019. We found that the initially observed decline in amenable mortality stagnated between 2014 and 2019, something not seen elsewhere in Europe. The main driver behind this trend is the change in ischemic heart disease (IHD) mortality. However, we also found that there is a systematic underreporting of IHD as a cause of death in Poland in favour of heart failure, which makes analysis of health system performance using amenable mortality as an indicator less reliable. We also found substantial geographical differences in amenable mortality levels and trends across Poland, which ranged from -3.3% to +8.1% across the regions in 2014-2019. These are much bigger than variations in total mortality trends, ranging from -1.5% to -0.2% in the same period, which suggests that quality of care across regions varies substantially, although some of this effect is also a coding artefact. This means that interpretation of health system performance indicators is not straightforward and may prevent implementation of policies that are needed to improve population health.
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Affiliation(s)
- Anna Sagan
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, London WC2A 2AE, UK
- European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; (M.K.); (M.M.)
- Correspondence:
| | - Marina Karanikolos
- European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; (M.K.); (M.M.)
| | - Małgorzata Gałązka-Sobotka
- Institute of Healthcare Management, Faculty of Economics and Management, Lazarski University, 02-662 Warszawa, Poland;
| | - Martin McKee
- European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; (M.K.); (M.M.)
| | - Monika Rozkrut
- Department of Econometrics and Statistics, Institute of Economics and Finance, University of Szczecin, 70-453 Szczecin, Poland;
| | - Iwona Kowalska-Bobko
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University, 31-007 Kraków, Poland;
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Hirschhorn LR, Frisch M, Ntawukuriryayo JT, VanderZanden A, Donahoe K, Mathewos K, Sayinzoga F, Binagwaho A. Development and application of a hybrid implementation research framework to understand success in reducing under-5 mortality in Rwanda. Gates Open Res 2021; 5:72. [PMID: 35079696 PMCID: PMC8688814 DOI: 10.12688/gatesopenres.13214.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background: We describe the development and testing of a hybrid implementation research (IR) framework to understand the pathways, successes, and challenges in addressing amenable under-5 mortality (U5M) - deaths preventable through health system-delivered evidence-based interventions (EBIs) - in low- and middle-income countries (LMICs). Methods: We reviewed existing IR frameworks to develop a hybrid framework designed to better understand U5M reduction in LMICs from identification of leading causes of amenable U5M, to EBI choice, identification, and testing of strategies, work to achieve sustainability at scale, and key contextual factors. We then conducted a mixed-methods case study of Rwanda using the framework to explore its utility in understanding the steps the country took in EBI-related decision-making and implementation between 2000-2015, key contextual factors which hindered or facilitated success, and to extract actionable knowledge for other countries working to reduce U5M. Results: While relevant frameworks were identified, none individually covered the scope needed to understand Rwanda's actions and success. Building on these frameworks, we combined and adapted relevant frameworks to capture exploration, planning, implementation, contextual factors in LMICs such as Rwanda, and outcomes beyond effectiveness and coverage. Utilizing our hybrid framework in Rwanda, we studied multiple EBIs and identified a common pathway and cross-cutting strategies and contextual factors that supported the country's success in reducing U5M through the health system EBIs. Using these findings, we identified transferable lessons for other countries working to accelerate reduction in U5M. Conclusions: We found that a hybrid framework building on and adapting existing frameworks was successful in guiding data collection and interpretation of results, emerging new insights into how and why Rwanda achieved equitable introduction and implementation of health system EBIs that contributed to the decline in U5M, and generated lessons for countries working to drop U5M.
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Affiliation(s)
- Lisa R. Hirschhorn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Miriam Frisch
- University of Global Health Equity, Kigali, 6955, Rwanda
| | | | | | - Kateri Donahoe
- University of Global Health Equity, Kigali, 6955, Rwanda
| | | | - Felix Sayinzoga
- Maternal, Child, and Community Health Division, Rwanda Biomedical Center, Kigali, 7162, Rwanda
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Hirschhorn LR, Frisch M, Ntawukuriryayo JT, VanderZanden A, Donahoe K, Mathewos K, Sayinzoga F, Binagwaho A. Development and application of a hybrid implementation research framework to understand success in reducing under-5 mortality in Rwanda. Gates Open Res 2021; 5:72. [PMID: 35079696 PMCID: PMC8688814 DOI: 10.12688/gatesopenres.13214.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/09/2023] Open
Abstract
Background: We describe the development and testing of a hybrid implementation research (IR) framework to understand the pathways, successes, and challenges in addressing amenable under-5 mortality (U5M) - deaths preventable through health system-delivered evidence-based interventions (EBIs) - in low- and middle-income countries (LMICs). Methods: We reviewed existing IR frameworks to develop a hybrid framework designed to better understand U5M reduction in LMICs from identification of leading causes of amenable U5M, to EBI choice, identification, and testing of strategies, work to achieve sustainability at scale, and key contextual factors. We then conducted a mixed-methods case study of Rwanda using the framework to explore its utility in understanding the steps the country took in EBI-related decision-making and implementation between 2000-2015, key contextual factors which hindered or facilitated success, and to extract actionable knowledge for other countries working to reduce U5M. Results: While relevant frameworks were identified, none individually covered the scope needed to understand Rwanda's actions and success. Building on these frameworks, we combined and adapted relevant frameworks to capture exploration, planning, implementation, contextual factors in LMICs such as Rwanda, and outcomes beyond effectiveness and coverage. Utilizing our hybrid framework in Rwanda, we studied multiple EBIs and identified a common pathway and cross-cutting strategies and contextual factors that supported the country's success in reducing U5M through the health system EBIs. Using these findings, we identified transferable lessons for other countries working to accelerate reduction in U5M. Conclusions: We found that a hybrid framework building on and adapting existing frameworks was successful in guiding data collection and interpretation of results, emerging new insights into how and why Rwanda achieved equitable introduction and implementation of health system EBIs that contributed to the decline in U5M, and generated lessons for countries working to drop U5M.
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Affiliation(s)
- Lisa R. Hirschhorn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Miriam Frisch
- University of Global Health Equity, Kigali, 6955, Rwanda
| | | | | | - Kateri Donahoe
- University of Global Health Equity, Kigali, 6955, Rwanda
| | | | - Felix Sayinzoga
- Maternal, Child, and Community Health Division, Rwanda Biomedical Center, Kigali, 7162, Rwanda
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Hirschhorn LR, Frisch M, Ntawukuriryayo JT, VanderZanden A, Donahoe K, Mathewos K, Sayinzoga F, Binagwaho A. Development and application of a hybrid implementation research framework to understand success in reducing under-5 mortality in Rwanda. Gates Open Res 2021; 5:72. [PMID: 35079696 PMCID: PMC8688814 DOI: 10.12688/gatesopenres.13214.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 11/09/2023] Open
Abstract
Background: We describe the development and testing of a hybrid implementation research (IR) framework to understand the pathways, successes, and challenges in addressing amenable under-5 mortality (U5M) - deaths preventable through health system-delivered evidence-based interventions (EBIs) - in low- and middle-income countries (LMICs). Methods: We reviewed existing IR frameworks to develop a hybrid framework designed to better understand U5M reduction in LMICs from identification of leading causes of amenable U5M, to EBI choice, identification and testing of strategies, work to achieve sustainability at scale and key contextual factors. We then conducted a mixed-methods case study of Rwanda using the framework to explore its utility in understanding the steps the country took in EBI-related decision-making and implementation between 2000-2015, key contextual factors which hindered or facilitated success, and extract actionable knowledge for other countries working to reduce U5M. Results: While relevant frameworks were identified, none individually covered the scope needed to understand Rwanda's actions and success. Building on these frameworks, we combined and adapted relevant frameworks to capture exploration, planning, implementation, contextual factors in LMICs such as Rwanda, and outcomes beyond effectiveness and coverage. Utilizing our hybrid framework in Rwanda, we studied multiple EBIs and identified a common pathway and cross-cutting strategies and contextual factors that supported the country's success in reducing U5M through the health system EBIs. Using these findings, we identified transferable lessons for other countries working to accelerate reduction in U5M. Conclusions: We found that a hybrid framework building on and adapting existing frameworks was successful in guiding data collection and interpretation of results, emerging new insights into how and why Rwanda achieved equitable introduction and implementation of health system EBIs that contributed to the decline in U5M, and generated lessons for countries working to drop U5M.
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Affiliation(s)
- Lisa R. Hirschhorn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Miriam Frisch
- University of Global Health Equity, Kigali, 6955, Rwanda
| | | | | | - Kateri Donahoe
- University of Global Health Equity, Kigali, 6955, Rwanda
| | | | - Felix Sayinzoga
- Maternal, Child, and Community Health Division, Rwanda Biomedical Center, Kigali, 7162, Rwanda
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Deák MS, Csató G, Pápai G, Dombrádi V, Nagy A, Nagy C, Juhász A, Bíró K. Investigating the Geographic Disparities of Amenable Mortality and Related Ambulance Services in Hungary. Int J Environ Res Public Health 2021; 18:1065. [PMID: 33504113 DOI: 10.3390/ijerph18031065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/29/2022]
Abstract
The aim of this study was to investigate how amenable mortality and related ambulance services differ on a county level in Hungary. The differences in mortality rates and ambulance services could identify counties where stronger ambulance services are needed. The datasets for 2018 consisted of county level aggregated data of citizens between the ages 15–64. The study examined how both the mortality rates and the ambulance rescue deliveries differ from the national average. The analyses were narrowed down to disease groups, such as acute myocardial infarction, hemorrhagic and ischemic stroke. Inequalities were identified regarding the distribution of number of ambulance deliveries, several counties had rates more than double that of the national average. For both mortality and ambulance services some of the counties had significantly better results and others had significantly worse compared to the national average. In Borsod-Abaúj-Zemplén county’s case, hemorrhagic stroke mortality was significantly higher (1.73 [1.35–2.11]), while ambulance deliveries were significantly lower (0.58 [0.40–0.76]) compared to the national average. The research has shown that regarding the investigated mortality rates and ambulance services there are considerable differences between the counties in Hungary. In this regard policy makers should implement policies to tackle these discrepancies.
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Chen BK, Jindal D, Yang YT, Hair N, Yang CY. Associations Between Physician Supply Levels and Amenable Mortality Rates: An Analysis of Taiwan Over Nearly 4 Decades. Health Serv Insights 2020; 13:1178632920954878. [PMID: 32973374 PMCID: PMC7495524 DOI: 10.1177/1178632920954878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/06/2020] [Indexed: 11/29/2022] Open
Abstract
Access to health care is an important determinant of health, but it remains unclear whether having more physicians reduces mortality. In this study, we used Taiwan’s population-level National Death Certification Registry data to investigate whether a greater supply of physicians is associated with lower rates of amenable mortality, defined as deaths that can be delayed with appropriate and timely medical treatment. Our baseline regression analysis adjusting only for age and sex shows that an increase in the number of physicians per 1000 is associated with a reduction of 1.7 (P < .01) and 0.97 (P < .01) age-standardized deaths per 100 000 for men and women, respectively. However, in our full analyses that control for socioeconomic factors and Taiwan’s health insurance expansion, we find that physician supply is no longer statistically associated with amenable mortality rates. Nevertheless, we found that greater physician supply levels are associated with a reduction in deaths from ischemic heart disease (−0.13 (P < .05) for men, and −0.066 (P < .05) for women). These findings suggest that overall, physician supply is not associated with amenable mortality rates after controlling for socioeconomic factors but may help reduce amenable mortality rates in specific causes of death.
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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, Columbia, SC, USA
| | - Dakshu Jindal
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Y Tony Yang
- Center for Health Policy and Media Engagement, George Washington University, Ashburn, VA, USA
| | - Nicole Hair
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Chun-Yuh Yang
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung
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Pereyra-Zamora P, Copete JM, Oliva-Arocas A, Caballero P, Moncho J, Vergara-Hernández C, Nolasco A. Changes in Socioeconomic Inequalities in Amenable Mortality after the Economic Crisis in Cities of the Spanish Mediterranean Coast. Int J Environ Res Public Health 2020; 17:ijerph17186489. [PMID: 32899994 PMCID: PMC7559182 DOI: 10.3390/ijerph17186489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022]
Abstract
Several studies have described a decreasing trend in amenable mortality, as well as the existence of socioeconomic inequalities that affect it. However, their evolution, particularly in small urban areas, has largely been overlooked. The aim of this study is to analyse the socioeconomic inequalities in amenable mortality in three cities of the Valencian Community, namely, Alicante, Castellon, and Valencia, as well as their evolution before and after the start of the economic crisis (2000–2007 and 2008–2015). The units of analysis have been the census tracts and a deprivation index has been calculated to classify them according to their level of socioeconomic deprivation. Deaths and population were also grouped by sex, age group, period, and five levels of deprivation. The specific rates by sex, age group, deprivation level, and period were calculated for the total number of deaths due to all causes and amenable mortality and Poisson regression models were adjusted in order to estimate the relative risk. This study confirms that the inequalities between areas of greater and lesser deprivation in both all-cause mortality and amenable mortality persisted along the two study periods in the three cities. It also shows that these inequalities appear with greater risk of death in the areas of greatest deprivation, although not uniformly. In general, the risks of death from all causes and amenable mortality have decreased significantly from one period to the other, although not in all the groups studied. The evolution of death risks from before the onset of the crisis to the period after presented, overall, a general pro-cyclical trend. However, there are population subgroups for which the trend was counter-cyclical. The use of the deprivation index has made it possible to identify specific geographical areas with vulnerable populations in all three cities and, at the same time, to identify the change in the level of deprivation (ascending or descending) of the geographical areas throughout the two periods. It is precisely these areas where more attention is needed in order to reduce inequalities.
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Affiliation(s)
- Pamela Pereyra-Zamora
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain; (J.M.C.); (A.O.-A.); (P.C.); (J.M.); (A.N.)
- Correspondence:
| | - José M. Copete
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain; (J.M.C.); (A.O.-A.); (P.C.); (J.M.); (A.N.)
| | - Adriana Oliva-Arocas
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain; (J.M.C.); (A.O.-A.); (P.C.); (J.M.); (A.N.)
| | - Pablo Caballero
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain; (J.M.C.); (A.O.-A.); (P.C.); (J.M.); (A.N.)
| | - Joaquín Moncho
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain; (J.M.C.); (A.O.-A.); (P.C.); (J.M.); (A.N.)
| | - Carlos Vergara-Hernández
- Área de Desigualdades en Salud, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), 46035 Valencia, Spain;
| | - Andreu Nolasco
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain; (J.M.C.); (A.O.-A.); (P.C.); (J.M.); (A.N.)
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Abstract
It is uncertain whether Latin America and Caribbean (LAC) countries are approaching a single mortality regime. Over the last three decades, LAC has experienced major public health interventions and the highest number of homicides in the world. However, these interventions and homicide rates are not evenly shared across countries. This study documents trends in life expectancy and lifespan variability for 20 LAC countries, 2000-14. By extending a previous method, we decompose differences in lifespan variability between LAC and a developed world benchmark into cause-specific effects. For both sexes, dispersion of amenable diseases through the age span makes the largest contribution to the gap between LAC and the benchmark. Additionally, for males, the concentration of homicides, accidents, and suicides in mid-life further impedes mortality convergence. Great disparity exists in the region: while some countries are rapidly approaching the developed regime, others remain far behind and suffer a clear disadvantage in population health.
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Affiliation(s)
| | - José Manuel Aburto
- University of Southern Denmark.,Max Planck Institute for Demographic Research
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Aldridge RW, Menezes D, Lewer D, Cornes M, Evans H, Blackburn RM, Byng R, Clark M, Denaxas S, Fuller J, Hewett N, Kilmister A, Luchenski S, Manthorpe J, McKee M, Neale J, Story A, Tinelli M, Whiteford M, Wurie F, Hayward A. Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England. Wellcome Open Res 2019; 4:49. [PMID: 30984881 PMCID: PMC6449792 DOI: 10.12688/wellcomeopenres.15151.1] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Homelessness has increased by 165% since 2010 in England, with evidence from many settings that those affected experience high levels of mortality. In this paper we examine the contribution of different causes of death to overall mortality in homeless people recently admitted to hospitals in England with specialist integrated homeless health and care (SIHHC) schemes. Methods: We undertook an analysis of linked hospital admission records and mortality data for people attending any one of 17 SIHHC schemes between 1st November 2013 and 30th November 2016. Our primary outcome was death, which we analysed in subgroups of 10th version international classification of disease (ICD-10) specific deaths; and deaths from amenable causes. We compared our results to a sample of people living in areas of high social deprivation (IMD5 group). Results: We collected data on 3,882 individual homeless hospital admissions that were linked to 600 deaths. The median age of death was 51.6 years (interquartile range 42.7-60.2) for SIHHC and 71.5 for the IMD5 (60.67-79.0). The top three underlying causes of death by ICD-10 chapter in the SIHHC group were external causes of death (21.7%; 130/600), cancer (19.0%; 114/600) and digestive disease (19.0%; 114/600). The percentage of deaths due to an amenable cause after age and sex weighting was 30.2% in the homeless SIHHC group (181/600) compared to 23.0% in the IMD5 group (578/2,512). Conclusion: Nearly one in three homeless deaths were due to causes amenable to timely and effective health care. The high burden of amenable deaths highlights the extreme health harms of homelessness and the need for greater emphasis on prevention of homelessness and early healthcare interventions.
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Affiliation(s)
- Robert W Aldridge
- Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Collaborative Centre for Inclusion Health, Institute of Epidemiology & Health Care, University College London, London, NW1 2DA, UK
| | - Dee Menezes
- Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Dan Lewer
- Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Collaborative Centre for Inclusion Health, Institute of Epidemiology & Health Care, University College London, London, NW1 2DA, UK
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE1 1UL, UK
| | - Michelle Cornes
- Health and Social Care Workforce Research Unit, King's College London, London, SE1 1UL, UK
| | - Hannah Evans
- Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Ruth M Blackburn
- Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Richard Byng
- Community and Primary Care Research Group, University of Plymouth, Plymouth, Devon, PL6 8BX, UK
| | - Michael Clark
- Personal Social Services Research Unit, London School of Economics, London, WC2A 2AE, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - James Fuller
- NIHR Health and Social Care Workforce Research Unit, King's College London, London, SE1 1UL, UK
| | - Nigel Hewett
- Pathway Charity, Pathway Charity, London, NW1 2PG, UK
| | - Alan Kilmister
- Health and Social Care Workforce Research Unit, King's College London, London, SE1 1UL, UK
| | - Serena Luchenski
- Collaborative Centre for Inclusion Health, Institute of Epidemiology & Health Care, University College London, London, NW1 2DA, UK
| | - Jill Manthorpe
- Health and Social Care Workforce Research Unit, King's College London, London, SE1 1UL, UK
| | - Martin McKee
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Joanne Neale
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE1 1UL, UK
| | - Alistair Story
- Collaborative Centre for Inclusion Health, Institute of Epidemiology & Health Care, University College London, London, NW1 2DA, UK
- Tropical and Infectious Diseases, University College London Hospitals NHS Trust, London, NW1 2PG, UK
| | - Michela Tinelli
- Personal Social Services Research Unit, London School of Economics, London, WC2A 2AE, UK
| | - Martin Whiteford
- Health Services Research, University of Liverpool, Liverpool, L69 3BX, UK
| | | | - Andrew Hayward
- Collaborative Centre for Inclusion Health, Institute of Epidemiology & Health Care, University College London, London, NW1 2DA, UK
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12
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Nolasco A, Pereyra-Zamora P, Sanchis-Matea E, Tamayo-Fonseca N, Caballero P, Melchor I, Moncho J. Economic Crisis and Amenable Mortality in Spain. Int J Environ Res Public Health 2018; 15:E2298. [PMID: 30347682 PMCID: PMC6211017 DOI: 10.3390/ijerph15102298] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/09/2018] [Accepted: 10/16/2018] [Indexed: 12/24/2022]
Abstract
Background: Both overall mortality and avoidable mortality have decreased in recent years in most European countries. It has become clear that less privileged socioeconomic groups have an increased risk of death. In 2008, most countries went into a severe economic recession, whose effects on the health of the population are still ongoing. While on the one hand, some evidence associates the economic crisis with positive health outcomes (pro-cyclical effect), on the other hand, some other evidence suggests that the economic crisis may pose serious public health problems (counter-cyclical effect), which has given rise to controversy. Objectives: To describe the evolution of overall mortality and amenable mortality in Spain between 2002⁻2007 (before the economic crisis) and 2008⁻2013 (during the economic crisis), nationally and by province, as well as to analyse trends in the risks of death and their association with indicators of the impact of the crisis. Methods: Ecological study of overall mortality and amenable mortality describing the evolution of the risks of death between 2002⁻2007 and 2008⁻2013. Age Standardised Rates were calculated, as well as their percentage change between periods. The association between percentage changes and provincial indicators of the impact of the crisis was analysed. Amenable mortality was studied both overall and categorised into five groups. Results: Amenable mortality represented 8.25% of overall mortality in 2002⁻2007, and 6.93% in 2008⁻2013. Age Standardised Rates for overall mortality and global amenable mortality generally declined, with the sharpest decline in amenable mortality. Decreases in overall mortality and amenable mortality were directly related to vulnerability indicators. The most significant decreases were registered in ischaemic heart disease, cerebrovascular disease, and other amenable causes. The relationship with vulnerability indices varied from direct (cancer) to inverse (hypertensive disease). Conclusions: Amenable mortality shows a more significant decrease than overall mortality between both study periods, albeit unevenly between provinces causes of death. Higher vulnerability indicators entail greater declines, although this trend varied for different causes. Mortality trends and their relationship with socioeconomic indicators in a situation of crisis must be conducted cautiously, taking into consideration a possible pro-cyclical effect.
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Affiliation(s)
- Andreu Nolasco
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Campus de San Vicente del Raspeig s/n, Ap. 99-03080 Alicante, Spain.
| | - Pamela Pereyra-Zamora
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Campus de San Vicente del Raspeig s/n, Ap. 99-03080 Alicante, Spain.
| | - Elvira Sanchis-Matea
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Campus de San Vicente del Raspeig s/n, Ap. 99-03080 Alicante, Spain.
| | - Nayara Tamayo-Fonseca
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Campus de San Vicente del Raspeig s/n, Ap. 99-03080 Alicante, Spain.
| | - Pablo Caballero
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Campus de San Vicente del Raspeig s/n, Ap. 99-03080 Alicante, Spain.
| | - Inmaculada Melchor
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Campus de San Vicente del Raspeig s/n, Ap. 99-03080 Alicante, Spain.
- Mortality Register of the Valencian Community, section of Epidemiological Studies and Health Statistics, General Sub-directorate of Epidemiology and Health Monitoring, General Directorate of Public Health, Health Ministry of the Valencian Government, 03010 Alicante, Spain.
| | - Joaquín Moncho
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Campus de San Vicente del Raspeig s/n, Ap. 99-03080 Alicante, Spain.
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Jarčuška P, Janičko M, Barták M, Gavurová B, Vagašová T. Mortality Amenable to Health Care in European Union Countries and Its Limitations. Cent Eur J Public Health 2018. [PMID: 29524365 DOI: 10.21101/cejph.a4956] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM The concept of amenable mortality is intended to assess health care system performance. It is defined as "premature deaths that should not occur in the presence of timely and effective health care". The purpose of paper is to analyse differences in amenable mortality across European Union countries and to determine the associations between amenable mortality and life expectancy at birth. METHODS This is a cross-country and time trend analysis. Data on deaths by cause, and five-year age groups were obtained from the World Health Organization database for the 20 European Union countries, throughout the period from 2002 to 2013. The rates of amenable mortality were expressed by the age-standardised death rates per 100,000 inhabitants. We applied the method of direct standardisation using the European Standard Population. RESULTS Throughout the explored period, the statistically significant variations of the age-standardised death rates in a relation to the European Union average fluctuated from 78.7 per 100,000 inhabitants (95% CI 72.4-84.9) in France to 374.3 per 100,000 inhabitants (95% CI 350.8-397.7) in Latvia. The leading causes of amenable mortality were ischaemic heart disease, cerebrovascular diseases, and colorectal cancer that accounted for, respectively, 42.2%, 19.5%, and 11.3% of overall amenable mortality. As expected, statistically significant strong negative relationship (R2=0.95; ρ=-0.98) between amenable mortality and life expectancy at birth was proved by linear regression. The concept has several limitations relating to the selection of causes of death and setting age threshold over time, not consideration actually available health care resources in each country, as well as differences in the prevalence of diseases among countries. CONCLUSIONS We found an explicit divide in amenable mortality rates between more developed countries of Western, Northern and Southern Europe, and less developed countries of Central and Eastern Europe. Increasing of amenable mortality may suggest deterioration in health care system performance.
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Affiliation(s)
- Peter Jarčuška
- 1st Department of Internal Medicine, University Hospital and Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Košice, Slovak Republic
| | - Martin Janičko
- 1st Department of Internal Medicine, University Hospital and Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Košice, Slovak Republic
| | - Miroslav Barták
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Beáta Gavurová
- Faculty of Economics, Technical University of Košice, Košice, Slovak Republic
| | - Tatiana Vagašová
- Faculty of Economics, Technical University of Košice, Košice, Slovak Republic
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Surenjav E, Sovd T, Yoshida Y, Yamamoto E, Reyer JA, Hamajima N. Trends in amenable mortality rate in the Mongolian population, 2007-2014. Nagoya J Med Sci 2016; 78:55-68. [PMID: 27019528 PMCID: PMC4767514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Amenable mortality (AM) is an indicator of medical care quality. This study aimed to assess the trend and magnitude of AM in Mongolia, with the purpose of providing evidence for decisions on resource allocation. This is the first study on AM trends in Mongolia. Retrospective analysis was done on mortality statistics for the period 2007-2014. Causes of death were coded according to the 10th revision of the International Classification of Diseases (ICD-10). Nolte & McKee's classification of AM was used for the estimation of amenable mortality rates (AMRs) in Mongolia. During the study period, a total of 130,402 deaths were registered in Mongolia, of which 44,800 (34.4%) deaths were classified as being amenable. The age-standardized AMR per 100,000 population was highest in 2007 (226.6), and declined continuously until the level of 169.2 in 2014. The rate remained consistently higher in males than in females. Cerebrovascular diseases, ischemic heart diseases, perinatal deaths, influenza/pneumonia/asthma and tuberculosis were the leading causes of AM in the past eight years in Mongolia. The AMR was higher in remote western provinces with harsh weather conditions, high poverty rates, lack of human resources for health, and poor infrastructure. In addition, the provinces where Mongolia's ethnic minorities live tended to have a higher AMR. The government of Mongolia needs to critically look at the regional differences in AM in order to allocate health resources, including human resources, effectively. Further studies are needed to look into the causes of regional disparities in AM, individual-level risk factors to amenable deaths, and validity of death coding in health sector.
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Affiliation(s)
- Enkhjin Surenjav
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tugsdelger Sovd
- Swiss Tropical and Public Health Institute, University of Basel, Switzerland
| | - Yoshitoku Yoshida
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Joshua A. Reyer
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Manderbacka K, Arffman M, Sund R, Karvonen S. Multiple social disadvantage does it have an effect on amenable mortality: a brief report. Int J Equity Health 2014; 13:67. [PMID: 25085285 PMCID: PMC4237818 DOI: 10.1186/s12939-014-0067-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 07/16/2014] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Most studies on inequalities in health and health-care focus on single indicators of social position, e.g. income or education. Recent research has suggested that multiple social circumstances need to be analysed simultaneously to disentangle their influence on health. In past decades mortality amenable to health-care, i.e. premature mortality that should not occur given timely and effective health-care, has increasingly been used to study the effect of health-care on health outcomes. This study elaborates the effect of social and regional deprivation and unemployment on the association between income and mortality amenable to health-care in Finland. METHODS Individual-level data for deaths were gathered by disease category between 1992 and 2008 for the resident Finnish population aged 25 to 59 years. Differences in amenable mortality and changes over time were assessed using individual-level linked register data. We used gender- and age-standardised rates and Poisson regression models to examine the simultaneous effect of these indicators on amenable mortality. RESULTS Altogether 22,663 persons aged 25-59 years died from causes amenable to health-care during the study period. An inverse pattern was found in amenable mortality for income. The mortality rate in the lowest income quintile was 98 (93-104) per 100,000 in the period 1991-1996 while in the highest group the figure was 40 (38-42) for the same period. Whereas the level of amenable mortality decreased, mortality differences between income groups steepened and amenable mortality increased in the lowest income group towards the end of the study period. Those in poor labour market position or living alone had significantly larger income differences in amenable mortality. Risk of regional deprivation was not associated with amenable mortality. CONCLUSIONS In order to prevent and treat at an early phase conditions that otherwise may lead to premature and unnecessary deaths more attention should be focused on groups with increased social and economic deprivation risk in municipal health centres with the aim at improving access to primary care. Our results also call for joint action by both health-care and social services, since health services alone cannot deal with the risks posed by accumulating social disadvantage.
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Affiliation(s)
- Kristiina Manderbacka
- National Institute for Health and Welfare, Service System Research Unit, Helsinki, FI-00271, Finland
| | - Martti Arffman
- National Institute for Health and Welfare, Service System Research Unit, Helsinki, FI-00271, Finland
| | - Reijo Sund
- National Institute for Health and Welfare, Service System Research Unit, Helsinki, FI-00271, Finland
| | - Sakari Karvonen
- Department of Social and Health Policy and Economics, Helsinki, FI-00271, Finland
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