Abstract
STUDY OBJECTIVE--The aim was to analyse trends in "avoidable" mortality in Sweden, and to contribute to the methodology of avoidable mortality as an index of the quality of care. SETTING AND PARTICIPANTS--All deaths of Swedish citizens and other residents in Sweden during the period 1974-1985 were analysed as to causes of death between ages 0 and 64 years. MEASUREMENTS AND MAIN RESULTS--Total mortality delined during the 12 year period studied. Avoidable causes of death were grouped into preventable and treatable causes according to Rutstein's classification. In men, treatable diseases declined more during the 12 year period studied than did total mortality. When lung cancer was excluded, preventable diseases declined for both sexes. Certain avoidable causes of death decreased compared to total mortality, while some others showed an increase. The death rate increased for some avoidable causes of death such as pneumonia other than viral. In women death rates increased for chronic bronchitis and emphysema as well as for malignant neoplasms of trachea, bronchus, and lung, while for boys aged 1-14 years bronchitis NOS and asthma showed an increasing death rate. CONCLUSIONS--The study indicates that the avoidable mortality method is sensitive enough to describe important changes in the mortality pattern. The explicit definition of treatable and preventable causes of death constitutes a methodological development in epidemiological analysis of this type. Further studies on the quality of care should combine this method with other methods examining the structure and process of health care.
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- Beaglehole R. Medical management and the decline in mortality from coronary heart disease. Br Med J (Clin Res Ed) 1986 Jan 4;292(6512):33–35. doi: 10.1136/bmj.292.6512.33. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bonita R., Beaglehole R. Does treatment of hypertension explain the decline in mortality from stroke? Br Med J (Clin Res Ed) 1986 Jan 18;292(6514):191–192. doi: 10.1136/bmj.292.6514.191. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Brook R. H., Davies-Avery A., Greenfield S., Harris L. J., Lelah T., Solomon N. E., Ware J. E., Jr Assessing the quality of medical care using outcome measures: an overview of the method. Med Care. 1977 Sep;15(9 Suppl):suppl–165. [PubMed] [Google Scholar]
- Charlton J. R., Hartley R. M., Silver R., Holland W. W. Geographical variation in mortality from conditions amenable to medical intervention in England and Wales. Lancet. 1983 Mar 26;1(8326 Pt 1):691–696. doi: 10.1016/s0140-6736(83)91981-5. [DOI] [PubMed] [Google Scholar]
- Charlton J. R., Velez R. Some international comparisons of mortality amenable to medical intervention. Br Med J (Clin Res Ed) 1986 Feb 1;292(6516):295–301. doi: 10.1136/bmj.292.6516.295. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Diderichsen F., Lindberg G. Better health--but not for all: the Swedish Public Health Report, 1987. Int J Health Serv. 1989;19(2):221–255. doi: 10.2190/N1NJ-LW6J-URLA-D1EL. [DOI] [PubMed] [Google Scholar]
- Donabedian A. Criteria and standards for quality assessment and monitoring. QRB Qual Rev Bull. 1986 Mar;12(3):99–108. doi: 10.1016/s0097-5990(16)30021-5. [DOI] [PubMed] [Google Scholar]
- Goldman L., Cook E. F. The decline in ischemic heart disease mortality rates. An analysis of the comparative effects of medical interventions and changes in lifestyle. Ann Intern Med. 1984 Dec;101(6):825–836. doi: 10.7326/0003-4819-101-6-825. [DOI] [PubMed] [Google Scholar]
- Hemminki E., Paakkulainen A. The effect of antibiotics on mortality from infectious diseases in Sweden and Finland. Am J Public Health. 1976 Dec;66(12):1180–1184. doi: 10.2105/ajph.66.12.1180. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Holland W. Avoidable death as a measure of quality. Qual Assur Health Care. 1990;2(3-4):227–233. doi: 10.1093/intqhc/2.3-4.227. [DOI] [PubMed] [Google Scholar]
- Lynge E. Regional trends in incidence of cervical cancer in Denmark in relation to local smear-taking activity. Int J Epidemiol. 1983 Dec;12(4):405–413. doi: 10.1093/ije/12.4.405. [DOI] [PubMed] [Google Scholar]
- Mackenbach J. P., Bouvier-Colle M. H., Jougla E. "Avoidable" mortality and health services: a review of aggregate data studies. J Epidemiol Community Health. 1990 Jun;44(2):106–111. doi: 10.1136/jech.44.2.106. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mackenbach J. P., Kunst A. E., Looman C. W., Habbema J. D., van der Maas P. J. Regional differences in mortality from conditions amenable to medical intervention in The Netherlands: a comparison of four time periods. J Epidemiol Community Health. 1988 Dec;42(4):325–332. doi: 10.1136/jech.42.4.325. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mackenbach J. P., Looman C. W., Kunst A. E., Habbema J. D., van der Maas P. J. Post-1950 mortality trends and medical care: gains in life expectancy due to declines in mortality from conditions amenable to medical intervention in The Netherlands. Soc Sci Med. 1988;27(9):889–894. doi: 10.1016/0277-9536(88)90278-x. [DOI] [PubMed] [Google Scholar]
- Poikolainen K., Eskola J. The effect of health services on mortality: decline in death rates from amenable and non-amenable causes in Finland, 1969-81. Lancet. 1986 Jan 25;1(8474):199–202. doi: 10.1016/s0140-6736(86)90664-1. [DOI] [PubMed] [Google Scholar]
- Pyörälä K., Epstein F. H., Kornitzer M. Changing trends in coronary heart disease mortality; possible explanations. Cardiology. 1985;72(1-2):5–10. doi: 10.1159/000173835. [DOI] [PubMed] [Google Scholar]
- Rutstein D. D., Berenberg W., Chalmers T. C., Child C. G., 3rd, Fishman A. P., Perrin E. B. Measuring the quality of medical care. A clinical method. N Engl J Med. 1976 Mar 11;294(11):582–588. doi: 10.1056/NEJM197603112941104. [DOI] [PubMed] [Google Scholar]