Changes in life expectancy due to avoidable and non-avoidable deaths in Argentina, Chile, Colombia and Mexico, 2000-2011

Intraurban Geographic and Socioeconomic Inequalities of Mortality in Four Cities in Colombia

Mortality inequalities have been described across Latin American countries, but less is known about inequalities within cities, where most populations live. We aimed to identify geographic and socioeconomic inequalities in mortality within the urban areas of four main cities in Colombia. We analyzed mortality due to non-violent causes of diseases in adults between 2015 and 2019 using census sectors as unit of analysis in Barranquilla, Bogotá, Cali, and Medellín. We calculated smoothed Bayesian mortality rates as main health outcomes and used concentration indexes (CInd) for assessing inequalities using the multidimensional poverty index (MPI) as the socioeconomic measure. Moran eigenvector spatial filters were calculated to capture the spatial patterns of mortality and then used in multivariable models of the association between mortality rates and quintiles of MPI. Social inequalities were evident but not consistent across cities. The most disadvantaged groups showed the highest mortality rates in Cali. Geographic inequalities in mortality rates, regardless of the adults and poverty distribution, were identified in each city, suggesting that other social, environmental, or individual conditions are impacting the spatial distribution of mortality rates within the four cities.

Healthcare for older people in Central and South America

Latin American countries (LAC), with their culturally and ethnically diverse populations, form a region that is difficult to define and to understand. The region’s health systems are deeply fragmented, which poses great challenges to overall equity levels in health. This is also one of the fastest ageing regions in the world, with increasing demands as well for acute and long-term care (LTC). Demographic and epidemiological transitions across the region are heterogeneous. In this context, health systems are in general, largely unprepared to face the challenge of promoting healthy ageing. This unpreparedness has been magnified by the Coronavirus disease-2019 pandemic. Here, we analyse the burden of disease in the older population and identify priorities to improve the care and quality of life for people living in LAC. Besides an adequately prepared workforce, we must remediate disparities and inequities; develop and implement integrated care; achieve patient-centred care and further develop palliative and end-of-life care; simultaneously, we must develop the structure and financing of LTC services and strengthen the role of public health making healthy ageing an essential component.

Avoidable deaths in Sweden, 1997-2018: temporal trend and the contribution to the gender gap in life expectancy

Background

Avoidable mortality is considered as a potential indicator of the influences of public health policies and healthcare quality on population health. This study aimed to examine the trend in avoidable mortality and its influence on rising life expectancy (LE) and declining gender gap in LE (GGLE) in Sweden.

Methods

We extracted data on causes of death by age, sex, and year from national registry from 1997 to 2018. The UK Office for National Statistics definition was used to divide causes of death into five mutually exclusive categories: amenable, preventable, amenable & preventable, ischemic heart disease (IHD), and non-avoidable causes. We applied Joinpoint regression to analyse temporal trends in age-standardized mortality rates. The Arriaga method was applied to decompose changes in LE and GGLE by age group and causes of death.

Results

Average annual reductions in avoidable vs. non-avoidable mortality were 2.6% (95% CI:2.5, 2.7) vs. 1.4% (95% CI:1.3, 1.5) in men, and 1.6% (95% CI:1.4, 1.9) vs. 0.9% (95% CI:0.7, 1.0) in women over the study period. LE in men rose by 4.1 years between 1997 and 2018 (from 72.8 to 76.9 years), of which 2.4 years (59.3%) were attributable to reductions in avoidable mortality. Corresponding LE gain was 2.3 years in women (from 78.0 in 1997 to 80.3 in 2018) and avoidable mortality accounted for 1.0 year (45.6%) of this gain. Between 1997 and 2018, the GGLE narrowed by 1.9 years, of which 1.4 years (77.7%) were attributable to avoidable causes. Among avoidable causes, while preventable causes had the largest contribution to the GGLE, IHD had the greatest contributions to LE gains and the narrowing GGLE.

Conclusions

Our findings showed that avoidable causes had a substantial contribution to gain in LE with more profound gain in men than in women, resulting in narrowing the GGLE. Lower pace of reductions in preventable than amenable mortality highlights the need for improving the effectiveness of inter-sectoral health policies aimed at behavioural changes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10567-5.

The Contribution of Avoidable Mortality to the Life Expectancy Gains in Korea between 1998 and 2017

This study evaluated the contribution of avoidable causes of death to gains in life expectancy between 1998 and 2017 in Korea. This is a multi-year, cross-sectional study using national data. Death certificate data from 1998 to 2017 were obtained from Statistics Korea. The difference in life expectancy between 1998 and 2017 by age and cause of death were decomposed using Arriaga’s method. Life expectancy rose 7.73 years over 20 years in Korea, which was largely (more than 50%) due to changes in avoidable causes of death. As age increased, the contribution to changes in life expectancy increased, and the gain in life expectancy due to avoidable causes also tended to increase. The major factors that drove that gain in life expectancy were avoidable causes such as cerebrovascular diseases and traffic accidents. The gain in life expectancy from preventable diseases was greater in men than in women. The results of this study indicate that active public health programs have been effective in improving life expectancy in Korea. Moreover, avoidable mortality could be further improved with good public health policy. Health policy aimed at reducing amenable and preventable deaths should be further implemented to promote population health.

The adult mortality profile by cause of death in 10 Latin American countries (2000-2016)

Objective

To investigate the adult mortality profile from eight causes of death in 10 Latin American countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico, Paraguay, Peru, and Uruguay) from 2000 to 2016.

Methods

The cause of death effect in adult mortality was calculated as the hypothetical gain in the average number of years lived in adulthood (15 to 60 years old), in a cause-deleted life table. Mortality information by cause, sex, and age group came from the World Health Organization.

Results

Although the adult mortality levels are very different among the 10 countries, the pattern of mortality by cause of death is very similar. All the countries are in the intermediate stages of the epidemiological transition, with chronic degenerative diseases being predominant. Among males, circulatory system diseases and external causes are the most important causes of death in terms of the average number of years lived in adulthood. Among females, the leading causes are circulatory system diseases and neoplasms.

Conclusions

Some studies have pointed out that Latin America exhibits severe difficulties in moving through some epidemiological transition phases, given the continuing high mortality from chronic diseases and violent deaths. However, between 2000 and 2016, there was a convergence among the 10 analyzed countries around the theoretical limit in the average number of years lived in adulthood. Countries that include Brazil, Colombia, Ecuador, Mexico, Paraguay, and Peru are still further away from this limit, but they have an enormous potential to increase the number of years lived in adulthood in the future.

Avoidable, amenable, and preventable mortalities in South Korea, 2000-2017: Age-period-cohort trends and impact on life expectancy at birth

This study aimed to estimate age-period-cohort effects on avoidable mortality and quantify the impact of avoidable mortality changes on life expectancy (LE) at birth in the South Korean population aged 0-74 years. Using death certificate and resident population data from 2000 to 2017, trends in age-standardized avoidable mortality rates were analyzed with joinpoint regression. Intrinsic estimator regression analysis was conducted to estimate age-period-cohort effects on avoidable mortality. Arriaga's method was used to measure the contributions of avoidable causes to changes in LE gaps between adjacent three-year periods by age and avoidable cause of death groups. Avoidable mortality decreased annually by 4.6% between 2000 and 2017. There were strong age and cohort effects and a weak period effect on avoidable mortality. In the overall decreasing trend, avoidable mortality declined less in cohorts born after the 1950-1953 Korean War and economic recession in the 1970s, with further reductions in cohorts born after the 1987 democratic reform and 1997-1998 economic crisis. Avoidable mortality was reduced after implementation of major health policies, but the decrease stagnated during the 2008-2009 financial crisis. Avoidable mortality reduction resulted in LE gains of 3.1 years, which accounted for 80% of total LE gains. Contribution to LE gains by causes of death was the largest for cerebrovascular disease. Major social changes and health policies influenced the avoidable mortality trend through cohort and period effects. Health care and public health policies implemented since the 2000s might have contributed substantially to gains in LE.