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Petrelli A, Ventura M, Di Napoli A, Pappagallo M, Simeoni S, Frova L. Socioeconomic inequalities in avoidable mortality in Italy: results from a nationwide longitudinal cohort. BMC Public Health 2024; 24:757. [PMID: 38468229 DOI: 10.1186/s12889-024-18205-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/24/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Disparities in avoidable mortality have never been evaluated in Italy at the national level. The present study aimed to assess the association between socioeconomic status and avoidable mortality. METHODS The nationwide closed cohort of the 2011 Census of Population and Housing was followed up for 2012-2019 mortality. Outcomes of preventable and of treatable mortality were separately evaluated among people aged 30-74. Education level (elementary school or less, middle school, high school diploma, university degree or more) and residence macro area (North-West, North-East, Center, South-Islands) were the exposures, for which adjusted mortality rate ratios (MRRs) were calculated through multivariate quasi-Poisson regression models, adjusted for age at death. Relative index of inequalities was estimated for preventable, treatable, and non-avoidable mortality and for some specific causes. RESULTS The cohort consisted of 35,708,459 residents (48.8% men, 17.5% aged 65-74), 34% with a high school diploma, 33.5% living in the South-Islands; 1,127,760 deaths were observed, of which 65.2% for avoidable causes (40.4% preventable and 24.9% treatable). Inverse trends between education level and mortality were observed for all causes; comparing the least with the most educated groups, a strong association was observed for preventable (males MRR = 2.39; females MRR = 1.65) and for treatable causes of death (males MRR = 1.93; females MRR = 1.45). The greatest inequalities were observed for HIV/AIDS and alcohol-related diseases (both sexes), drug-related diseases and tuberculosis (males), and diabetes mellitus, cardiovascular diseases, and renal failure (females). Excess risk of preventable and of treatable mortality were observed for the South-Islands. CONCLUSIONS Socioeconomic inequalities in mortality persist in Italy, with an extremely varied response to policies at the regional level, representing a possible missed gain in health and suggesting a reassessment of priorities and definition of health targets.
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Affiliation(s)
- Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153, Rome, Italy.
| | - Martina Ventura
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153, Rome, Italy
| | - Anteo Di Napoli
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153, Rome, Italy
| | - Marilena Pappagallo
- National Institute of Statistics (Istat), Viale Liegi 13, 00198, Rome, Italy
| | - Silvia Simeoni
- National Institute of Statistics (Istat), Viale Liegi 13, 00198, Rome, Italy
| | - Luisa Frova
- National Institute of Statistics (Istat), Viale Liegi 13, 00198, Rome, Italy
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Ammi M, Arpin E, Dedewanou FA, Allin S. Do expenditures on public health reduce preventable mortality in the long run? Evidence from the Canadian provinces. Soc Sci Med 2024; 345:116696. [PMID: 38377835 DOI: 10.1016/j.socscimed.2024.116696] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 01/19/2024] [Accepted: 02/13/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Investments in public health - prevention of illnesses, and promotion, surveillance, and protection of population health - may improve population health, however, effects may only be observed over a long period of time. OBJECTIVE To investigate the potential long-run relationship between expenditures on public health and avoidable mortality from preventable causes. METHODS We focused on the country spending the most on public health in the OECD, Canada. We constructed a longitudinal dataset on mortality, health care expenditures and socio-demographic information covering years 1979-2017 for the ten Canadian provinces. We estimated error correction models for panel data to disentangle short-from long-run relationships between expenditures on public health and avoidable mortality from preventable causes. We further explored some specific causes of mortality to understand potential drivers. For comparison, we also estimated the short-run relationship between curative expenditures and avoidable mortality from treatable causes. RESULTS We find evidence of a long-run relationship between expenditures on public health and preventable mortality, and no consistent short-run associations between these two variables. Findings suggest that a 1% increase in expenditures on public health could lead to 0.22% decrease in preventable mortality. Reductions in preventable mortality are greater for males (-0.29%) compared to females (-0.09%). These results are robust to different specifications. Reductions in some cancer and cardiovascular deaths are among the probable drivers of this overall decrease. By contrast, we do not find evidence of a consistent short-run relationship between curative expenditures and treatable mortality, except for males. CONCLUSION This study supports the argument that expenditures on public health reap health benefits primarily in the long run, which, in this case, represents a reduction in avoidable mortality from preventable causes. Reducing public health expenditures on the premise that they have no immediate measurable benefits might thus harm population health outcomes in the long run.
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Affiliation(s)
- Mehdi Ammi
- School of Public Policy and Administration, Carleton University, Richcraft Hall, 1125 Colonel By Dr, Ottawa, ON, K1S 5B6, Canada; Centre for the Business and Economics of Health, University of Queensland, Sir Llew Edwards Building, St Lucia, QLD, 4072, Australia.
| | - Emmanuelle Arpin
- Institute of Health Policy Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - F Antoine Dedewanou
- School of Public Policy and Administration, Carleton University, Richcraft Hall, 1125 Colonel By Dr, Ottawa, ON, K1S 5B6, Canada
| | - Sara Allin
- Institute of Health Policy Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
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Telfar-Barnard L, Baker MG, Wilson N, Howden-Chapman P. The rise and fall of excess winter mortality in New Zealand from 1876 to 2020. Int J Biometeorol 2024; 68:89-100. [PMID: 38010416 PMCID: PMC10752914 DOI: 10.1007/s00484-023-02573-6] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/25/2023] [Accepted: 10/25/2023] [Indexed: 11/29/2023]
Abstract
Excess winter mortality (EWM) has been used as a measure of how well populations and policy moderate the health effects of cold weather. We aimed to investigate long-term changes in the EWM of Aotearoa New Zealand (NZ), and potential drivers of change, and to test for structural breaks in trends. We calculated NZ EWM indices from 1876 (4,698 deaths) to 2020 (33,310 deaths), total and by age-group and sex, comparing deaths from June to September (the coldest months) to deaths from February to May and October to January. The mean age and sex-standardised EWM Index (EWMI) for the full study period, excluding 1918, was 1.22. However, mean EWMI increased from 1.20 for 1886 to 1917, to 1.34 for the 1920s, then reduced over time to 1.14 in the 2010s, with excess winter deaths averaging 4.5% of annual deaths (1,450 deaths per year) in the 2010s, compared to 7.9% in the 1920s. Children under 5 years transitioned from a summer to winter excess between 1886 and 1911. Otherwise, the EWMI age-distribution was J-shaped in all time periods. Structural break testing showed the 1918 influenza pandemic strain had a significant impact on trends in winter and non-winter mortality and winter excess for subsequent decades. It was not possible to attribute the post-1918 reduction in EWM to any single factor among improved living standards, reduced severe respiratory infections, or climate change.
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Affiliation(s)
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nick Wilson
- Department of Public Health, University of Otago, Wellington, New Zealand
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Golinelli D, Guarducci G, Sanna A, Lenzi J, Sanmarchi F, Fantini MP, Montomoli E, Nante N. Regional and sex inequalities of avoidable mortality in Italy: A time trend analysis. Public Health Pract (Oxf) 2023; 6:100449. [PMID: 38028252 PMCID: PMC10643453 DOI: 10.1016/j.puhip.2023.100449] [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] [Received: 06/30/2023] [Revised: 09/18/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives This study provides a comprehensive analysis of avoidable mortality (AM), treatable mortality (TM), and preventable mortality (PM) across Italy, focusing on region- and gender-specific inequalities over a 14-year period. Study design Time-trend analysis (2006-2019). Methods The study was conducted using mortality data from the Italian Institute of Statistics to evaluate the extent and patterns of AM, TM, and PM in Italy. Biennial age-standardized mortality rates were calculated by gender and region using the joint OECD/Eurostat list. Results The overall AM rates showed a large reduction from 2006/7 (221.0 per 100,000) to 2018/9 (166.4 per 100,000). Notably, females consistently displayed lower AM rates than males. Furthermore, both gender differences and the North-South gap of AM decreased during the period studied. The regions with the highest AM rates fluctuated throughout the study period. The highest percentage decrease in AM from 2006/7 to 2018/9, for both males (-41.3 %) and females (-34.2 %), was registered in the autonomous province of Trento, while the lowest reduction was observed in Molise for males (-17.4 %) and in Marche for females (-10.0 %). Conclusions Remarkable gender and regional differences in AM between 2006 and 2019 have been recorded in Italy, although they have decreased over years. Continuous monitoring of AM and the implementation of region- and gender-specific interventions is essential to provide valuable insights for both policy and public health practice. This study contributes to the efforts to improve health equity between Italian regions.
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Affiliation(s)
- Davide Golinelli
- Post Graduate School of Public Health, University of Siena, Italy
- Department of Molecular and Developmental Medicine, University of Siena, Italy
| | | | - Andrea Sanna
- Post Graduate School of Public Health, University of Siena, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Emanuele Montomoli
- Department of Molecular and Developmental Medicine, University of Siena, Italy
- VisMederi S.r.l., Siena, Italy
| | - Nicola Nante
- Post Graduate School of Public Health, University of Siena, Italy
- Department of Molecular and Developmental Medicine, University of Siena, Italy
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Rojas-Botero ML, Fernández-Niño JA, Borrero-Ramírez YE. Unacceptable persistence of territorial inequalities in avoidable under-five mortality in Colombia between 2000 and 2019: a multilevel approach. Public Health 2022; 213:189-197. [PMID: 36446150 DOI: 10.1016/j.puhe.2022.09.019] [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] [Received: 06/08/2022] [Revised: 09/20/2022] [Accepted: 09/29/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed at evaluating territorial inequalities in avoidable mortality in children under 5 years of age in Colombia between 2000 and 2019. STUDY DESIGN This was an ecological study. METHODS An ecological, longitudinal, multigroup study was conducted using secondary sources. Because of the hierarchical structure of the data, the effect of territorial characteristics on the count of avoidable under-five deaths was estimated using a three-level negative binomial regression model with random intercepts for municipality and fixed intercepts for time and departments. RESULTS Between 2000 and 2019, there were 216,809 avoidable under-five deaths in Colombia (91.3% of all registered deaths of children under 5 years of age). A total of 1117 municipalities located in 33 departments were analyzed over five 4-year periods. Ecological relationships were found between avoidable under-five mortality and the percentage of adolescent births, female illiteracy, and multidimensional poverty at the municipal level (standardized mortality ratio: 1.43 95% confidence interval: 1.33-1.54 for the group with the highest level vs the group with the lowest level of poverty). Furthermore, multidimensional poverty was a confounding factor for the association between the percentage of the population living in rural areas and avoidable child mortality. CONCLUSIONS Systematic and avoidable gaps were observed in mortality in children aged under 5 years in Colombia, where the territory constitutes an axis of inequality. Implementing strategies and programs that contribute to improving the conditions of women and socio-economic conditions in the territories should be a priority.
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Affiliation(s)
- M L Rojas-Botero
- Universidad de Antioquia. Facultad Nacional de Salud Pública. Medellín, Colombia
| | - J A Fernández-Niño
- Johns Hopkins Bloomberg School of Public Health. Baltimore MD, USA; Universidad Del Norte, Barranquilla, Colombia.
| | - Y E Borrero-Ramírez
- Universidad de Antioquia. Facultad Nacional de Salud Pública. Medellín, Colombia
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Weber A, Reisig V, Buschner A, Kuhn J. [ Avoidable mortality-a new indicator version for prevention reporting]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 65:116-125. [PMID: 34878567 PMCID: PMC8732977 DOI: 10.1007/s00103-021-03458-y] [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: 06/16/2021] [Accepted: 11/04/2021] [Indexed: 11/30/2022]
Abstract
Hintergrund In der Gesundheitsberichterstattung wird ein Indikator „vermeidbare Sterblichkeit“ geführt. Der Indikator aggregiert ausgewählte Todesursachen. In Deutschland gibt es dazu 2 Varianten, beide sind nicht mehr aktuell. Mit der vorliegenden Arbeit wird eine Neukonzeption vorgeschlagen. Methoden Die Neukonzeption orientiert sich bei der Auswahl der Todesursachen an Vorarbeiten auf europäischer Ebene. Die Umsetzbarkeit und Plausibilität einer konsentierten OECD-Eurostat-Liste werden anhand der Daten der amtlichen Statistik in Bayern für die Jahre 2016–2018 überprüft. Die Analyse umfasst die Untersuchung der Variabilität über die Zeit und innerhalb der bayerischen Regierungsbezirke sowie mögliche systematische Verzerrungen durch regionale Unterschiede im Codierverhalten bzw. Veränderungen im Zeitverlauf. Ergebnisse Die OECD-Eurostat-Liste ist auf regionaler Ebene mit geringfügiger Modifikation umsetzbar. Es ergibt sich eine altersstandardisierte vermeidbare Sterblichkeit von knapp 23 Todesfällen je 10.000 Einwohnerinnen und Einwohner (EW) in Bayern im Jahr 2018, wobei die prävenierbaren Sterbefälle solche, die durch eine Behandlung hätten vermieden werden können, bei Weitem übersteigen. Für Männer liegt die Sterberate aufgrund vermeidbarer Ursachen bei 30 pro 10.000 männlichen EW und ist damit fast doppelt so hoch wie jene für Frauen (16 pro 10.000 weiblichen EW). Regional folgt die vermeidbare Sterblichkeit Befunden zur regionalen Gesundheit aus anderen Studien. Diskussion und Fazit Die Ergebnisse liefern keinen Anlass, von großen Zufallsschwankungen bzw. methodisch bedingten systematischen Verzerrungen auszugehen. Der Indikator wird zur Anwendung in der Gesundheitsberichterstattung vorgeschlagen.
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Affiliation(s)
- Anke Weber
- Hochschule Hamm-Lippstadt, Marker Allee 76-78, 59063, Hamm, Deutschland.
| | - Veronika Reisig
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Oberschleißheim, Deutschland
| | | | - Joseph Kuhn
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Oberschleißheim, Deutschland
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Herrero-Huertas L, Andérica E, Belza MJ, Ronda E, Barrio G, Regidor E. Avoidable mortality for causes amenable to medical care and suicide in physicians in Spain. Int Arch Occup Environ Health 2021. [PMID: 34714394 DOI: 10.1007/s00420-021-01813-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/19/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare avoidable mortality for causes amenable to medical care and suicide in physicians versus other professionals with similar university studies and socioeconomic position in Spain. METHODS All people aged 25-64 years who were employed on 1 November 2001 (8,697,387 men and 5,282,611 women) were included. Their vital status was followed for 10 years and the cause of death of deceased was recorded. Using a Poisson regression to estimate the mortality rate ratio (MRR), we compared mortality due to causes of death amenable to medical care, all other causes, and suicide in physicians versus other professionals. Mortality in physicians was used as a reference. RESULTS The lowest MRR for causes amenable to medical care was observed in engineers/architects (men: 0.84, 95% confidence interval [CI] 0.72, 0.97; women: 0.93, 95% CI 0.64, 1.35) and healthcare professions other than physicians/pharmacists/nurses (men: 0.86, 95% CI 0.56, 1.34; women: 0.69, 95% CI 0.32, 1.46). Regarding mortality for all other causes of death, professionals from these and other occupations presented lower mortality than physicians. Other healthcare professions, entrepreneurs, and managers/executives completed suicide at a higher rate than physicians. CONCLUSION Although the accessibility to the healthcare system and to the pharmacological drugs could suggest that physicians would present low rates for causes amenable to medical care and high rates of suicide, our results show that this is not the case in Spain.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Hervella MI, Carratalá-Munuera C, Orozco-Beltrán D, López-Pineda A, Bertomeu-González V, Gil-Guillén VF, Pascual R, Quesada JA. Trends in premature mortality due to ischemic heart disease in Spain from 1998 to 2018. ACTA ACUST UNITED AC 2021; 74:838-45. [PMID: 33402321 DOI: 10.1016/j.rec.2020.09.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 09/15/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Ischemic heart disease (IHD) is the leading cause of death and one of the leading causes of disability. The aim of this study was to analyze trends in premature mortality due to IHD in patients younger than 75 years in Spain from 1998 to 2018 by region. METHODS Observational study of temporal trends in premature mortality due to IHD in Spain by region and sex from 1998 to 2018. The study population included resident citizens aged between 0 and 74 years. The data sources were the continuous population register and the mortality registry of the National Institute of Statistics. We calculated age-adjusted mortality rates and their average annual percent change estimated by Poisson models. RESULTS During the study period, mortality rates due to IHD decreased, both in the country as a whole and by provinces (53% in men and 61% in women), with an average annual percent change of -3.92% and -5.07%, respectively. In the first year (1998), mortality was unequally distributed among provinces, with higher mortality in the south of Spain. CONCLUSIONS Premature mortality due to IHD significantly decreased in Spain during the study period in both sexes to roughly half of initial cases. This decrease was statistically significant in almost all regions. Interprovincial differences in mortality and their variation also decreased in recent years.
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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. Can J 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Eun SJ. Avoidable, amenable, and preventable mortalities in South Korea, 2000-2017: Age-period-cohort trends and impact on life expectancy at birth. Soc Sci Med 2019; 237:112482. [PMID: 31408768 DOI: 10.1016/j.socscimed.2019.112482] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/24/2019] [Accepted: 08/04/2019] [Indexed: 01/12/2023]
Abstract
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.
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Affiliation(s)
- Sang Jun Eun
- Department of Preventive Medicine, Chungnam National University College of Medicine, 266 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
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Mühlichen M. Avoidable Mortality in the German Baltic Sea Region Since Reunification: Convergence or Persistent Disparities? Eur J Popul 2019; 35:609-637. [PMID: 31372107 PMCID: PMC6639439 DOI: 10.1007/s10680-018-9496-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
The consequences of political reunification for health and mortality have the unique character of a 'natural experiment'. This is particularly true for the formerly divided German Baltic Sea region due to its cultural and geographic commonalities. This paper ascertains the changes and differences in premature mortality at ages 0-74 in urban and rural areas of the German states of Mecklenburg-Vorpommern (MV) and Schleswig-Holstein (SH) since reunification and the contribution made by 'avoidable' mortality. Using official cause-of-death data, the effectiveness of health care and health policies was measured based on the concept of avoidable mortality in terms of both amenable and preventable conditions. Methods of decomposition and standardisation were employed in order to erase the compositional effect from the mortality trend. As a result, mortality differences relate primarily to men and the rural areas of the German Baltic Sea region. Whereas the mortality levels in the urban areas of MV and SH have converged, the rural areas of MV still show higher levels of preventable and amenable mortality. The results show that the accessibility and quality of medical care in the thinly populated areas of MV and the effectiveness of inter-sectoral health policies through primary prevention, particularly with regard to men, have room for improvement.
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Affiliation(s)
- Michael Mühlichen
- Federal Institute for Population Research, Friedrich-Ebert-Allee 4, 65185 Wiesbaden, Germany
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Gómez-Martínez L, Orozco-Beltrán D, Quesada JA, Bertomeu-González V, Gil-Guillén VF, López-Pineda A, Carratalá-Munuera C. Trends in Premature Mortality Due to Heart Failure by Autonomous Community in Spain: 1999 to 2013. ACTA ACUST UNITED AC 2018; 71:531-7. [PMID: 29331563 DOI: 10.1016/j.rec.2017.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 09/21/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Heart failure (HF) is a major public health problem, and the prevalence increases with age. In Spain, there are considerable differences between autonomous communities. The aim of this study was to analyze trends in premature mortality due to HF between 1999 and 2013 in Spain by autonomous community. METHODS We analyzed data on mortality due to HF in Spanish residents aged 0 to 75 years by autonomous community between 1999 and 2013. Data were collected from files provided by the Spanish Statistics Office. Age-adjusted mortality rates were analyzed and the average annual percentage rate was estimated by Poisson models. RESULTS Mortality due to HF represented 10.9% of total mortality. In 2013, the national age-adjusted rate was 2.98 deaths in men and 1.29 deaths in women per 100 000 inhabitants, with an annual mean reduction of 2.27% and 4.53%, respectively. In men, average mortality showed the greatest reduction in Castile-La-Mancha (6.30%). In Cantabria, average mortality significantly increased (3.97%). In women, average mortality showed the greatest decrease in the Chartered Community of Navarre (15.17%). CONCLUSIONS During the study period, mortality due to HF showed an overall average decrease, both nationally and by autonomous community. This decrease was more pronounced in women than in men. Premature mortality significantly decreased in most-but not all-autonomous communities.
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Park J, Tjepkema M, Goedhuis N, Pennock J. Avoidable mortality among First Nations adults in Canada: A cohort analysis. Health Rep 2015; 26:10-16. [PMID: 26288317] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Avoidable mortality is a measure of deaths that potentially could have been averted through effective prevention practices, public health policies, and/or provision of timely and adequate health care. This longitudinal analysis compares avoidable mortality among First Nations and non-Aboriginal adults. DATA AND METHODS Data are from the 1991-to-2006 Canadian Census Mortality and Cancer Follow-up Study. A 15% sample of 1991 Census respondents aged 25 or older was linked to 16 years of mortality data. This study examines avoidable mortality among 61,220 First Nations and 2,510,285 non-Aboriginal people aged 25 to 74. RESULTS During the 1991-to-2006 period, First Nations adults had more than twice the risk of dying from avoidable causes compared with non-Aboriginal adults. The age-standardized avoidable mortality rate (ASMR) per 100,000 person-years at risk for First Nations men was 679.2 versus 337.6 for non-Aboriginal men (rate ratio = 2.01). For women, ASMRs were lower, but the gap was wider. The ASMR for First Nations women was 453.2, compared with 183.5 for non-Aboriginal women (rate ratio = 2.47). Disparities were greater at younger ages. Diabetes, alcohol and drug use disorders, and unintentional injuries were the main contributors to excess avoidable deaths among First Nations adults. Education and income accounted for a substantial share of the disparities. INTERPRETATION The results highlight the gap in avoidable mortality between First Nations and non-Aboriginal adults due to specific causes of death and the association with socioeconomic factors.
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Affiliation(s)
- Jungwee Park
- Health Analysis Division, Statistics Canada, Ottawa, Ontario
| | | | - Neil Goedhuis
- First Nations and Inuit Health Branch, Health Canada, Ottawa, Ontario
| | - Jennifer Pennock
- First Nations and Inuit Health Branch, Health Canada, Ottawa, Ontario
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