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. 1991 Oct 12;303(6807):879–883. doi: 10.1136/bmj.303.6807.879

Mortality from causes amenable and non-amenable to medical care: the experience of eastern Europe.

R J Boys 1, D P Forster 1, P Józan 1
PMCID: PMC1671237  PMID: 1933003

Abstract

OBJECTIVE--To investigate comparative national trends in mortality from conditions amenable to timely, appropriate medical care and from those considered not to be amenable to such care. DESIGN--Analysis of trends in direct age standardised mortality from the 1950s to 1987. SETTING--Four eastern European nations (Hungary, Czechoslovakia, Poland, the German Democratic Republic) and two western European (the Federal Republic of Germany and England and Wales) and two North American nations (United States and Canada). SUBJECTS--The total populations of the relevant countries during the period examined. MAIN OUTCOME MEASURES--Proportional changes over time in age standardised mortality. Mortality from amenable and non-amenable causes was restricted to the age group 0-64. RESULTS--A divergence in the trends for all cause mortality between eastern Europe and the western nations occurred in about 1970, when the rates in western countries steadily declined but those in eastern Europe remained fairly static. In the age group 0-64 mortality from causes considered amenable to medical care fell less quickly in eastern Europe than in the West, particularly after 1970. In the same age group, mortality from non-amenable causes rose in eastern European countries from the late 1960s compared with substantial declines in such mortality in the West. CONCLUSIONS--Non-amenable causes of death seem to be the principal, but not exclusive, reason for lack of improvement in trends in all cause mortality in eastern Europe from 1970. The agenda for action in eastern Europe should give priority to a healthier lifestyle and improvement of the environment though not neglect enhancements in the quality and efficiency of direct health services.

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Selected References

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  1. Forster D. P., Józan P. Health in Eastern Europe. Lancet. 1990 Feb 24;335(8687):458–460. doi: 10.1016/0140-6736(90)90678-x. [DOI] [PubMed] [Google Scholar]
  2. Jedrychowski W., Becher H., Wahrendorf J., Basa-Cierpialek Z. A case-control study of lung cancer with special reference to the effect of air pollution in Poland. J Epidemiol Community Health. 1990 Jun;44(2):114–120. doi: 10.1136/jech.44.2.114. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Kleinman J. C. The continued vitality of vital statistics. Am J Public Health. 1982 Feb;72(2):125–127. doi: 10.2105/ajph.72.2.125. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. 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]
  5. Martini C. J., Allan G. H., Davison J., Backett E. M. Health indexes sensitive to medical care variation. Int J Health Serv. 1977;7(2):293–309. doi: 10.2190/XFYT-R576-0R6C-RJ4M. [DOI] [PubMed] [Google Scholar]
  6. McCormick J., Skrabanek P. Coronary heart disease is not preventable by population interventions. Lancet. 1988 Oct 8;2(8615):839–841. doi: 10.1016/s0140-6736(88)92795-x. [DOI] [PubMed] [Google Scholar]
  7. McKeown T., Record R. G., Turner R. D. An interpretation of the decline of mortality in England and Wales during the twentieth century. Popul Stud (Camb) 1975 Nov;29(3):391–422. [PubMed] [Google Scholar]
  8. McKinlay J. B., McKinlay S. M. The questionable contribution of medical measures to the decline of mortality in the United States in the twentieth century. Milbank Mem Fund Q Health Soc. 1977 Summer;55(3):405–428. [PubMed] [Google Scholar]
  9. 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]
  10. Rechsteiner Martin. The folly of the human genome project. New Sci. 1990 Sep 15;127(1734):20–20. [PubMed] [Google Scholar]
  11. 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]
  12. Rutstein D. D., Berenberg W., Chalmers T. C., Fishman A. P., Perrin E. B., Zuidema G. D. Measuring the quality of medical care: second revision of tables of indexes. N Engl J Med. 1980 May 15;302(20):1146–1146. doi: 10.1056/nejm198005153022012. [DOI] [PubMed] [Google Scholar]
  13. Smart R. G. Is the postwar drinking binge ending? Cross-national trends in per capita alcohol consumption. Br J Addict. 1989 Jul;84(7):743–748. doi: 10.1111/j.1360-0443.1989.tb03053.x. [DOI] [PubMed] [Google Scholar]

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