Avoidable mortality

Background

Avoidable, or unnecessarily premature mortality proposed in the mid-1970s, is an indicator which measures the quality and effectiveness of health services, and allows their evaluation and monitoring. Since the first theoretical work on avoidable mortality by Rustein in 1976, various classifications of the causes or groups of causes (preventable, treatable, etc.) have been proposed with the aim of being used as indicators of success in providing medical care and/or health policy. In the study of avoidable mortality, socio-economic factors are incorporated to help explain existing inequalities in its distribution between different groups of the population. Moreover, if, as previously justified, there are few studies of total mortality which analyse the trends in these inequalities in the context of cities and at the same time employ a level of desegregation as small as the census tract, in the case of avoidable mortality there are even fewer such studies.

Objectives

To describe and analyse the evolution of inequalities in avoidable mortality in geographical areas of various cities in Spain between 1996 and 2007, as well as its relationship with indicators of socio-economic level.

Methodology

• Elaboration of a list of avoidable causes of mortality, adaptable to different classifications of avoidable mortality (treatable, preventable, by causes, etc.).
• For each city, period (3 periods) and sex, to elaborate a description and representation of indicators of avoidable mortality.
• For each city, sex, selected cause of death, and level of the deprivation index (or grouping of census tracts by indicators of socio-economic level), to calculate the annual and period rates, standardised by the direct method. Adjustment of Poisson regression models with effects of age, period (1996-1999,2000-2003,2004-2007) and socio-economic level in order to estimate relative risks by socio-economic level, and determine their evolution over time.

References

Nolasco A, Melchor I, Pina JA, Pereyra-Zamora P, Moncho J, Tamayo N, García-Senchermés C, Zurriaga O, Martínez-Beneito MA. Preventable avoidable mortality: Evolution of socioeconomic inequalities in urban areas in Spain, 1996-2003. Health & Place. 2009; 15:702-711