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Aim This study aims to evaluate the trend of avoidable mortality and of mortality from all other causes of death in urban and rural areas in Spain, throughout the first 2 decades of the twenty-first century. Methods Data deaths and population by age and sex, according to the area of residence, were obtained from the National Institute of Statistics. Avoidable mortality refers to premature deaths (≤ 75 years old) for which there is reasonable scientific consensus that they should not occur in the presence of timely health care. In large urban, small urban, and rural areas, annual age-standardized mortality rates from avoidable causes and from all other causes of death were calculated from 2003 to 2019. The annual percentage change (APC) in the mortality rate in each area was estimated using linear regression models and taking age-standardized mortality rates as dependent variable. Results Mortality rates decreased between the beginning and the end of the period analysed. Large urban areas and rural areas showed the largest and smallest reduction in mortality rate respectively. The APC in avoidable mortality was −3.5% in men and −3.0% in women in large urban areas, and −2.7% in men and −2.6% in women in rural areas. The APC in the mortality rate from all other causes of death was −2.4% in men and −1.2% in women in large urban areas, and −1.4% in men and −1.0% in women in rural areas. Conclusion In Spain, avoidable mortality and mortality from other causes of death in rural and urban areas show similar trends, which suggests the presence of a common factor responsible for such findings.

A pandemia do COVID-19 foi a demostración definitiva da importancia crucial da saúde para a poboación mundial e a necesidade de contar con sistemas sanitarios eficientes que permitan garantir e mellorar a saúde da poboación. Tamén puxo de manifesto a importancia que pode chegar a ter a saúde na economía, tanto a nivel nacional como internacional. Estudar conxuntamente ambos os enfoques permite identificar as posibilidades de mellora do sistema e tamén coñecer as implicacións económicas de posibles medidas ou investimentos a realizar no sector. O noso obxectivo é contribuír a esta análise conxunta, achegando novos enfoques e resultados. Este estudo, desenvolve unha avaliación do desempeño para 75 países, calculando a mortalidade previble e tratable para todos eles. O cálculo realízase desagregando ambos tipos de mortalidade e obtéñense resultados detallados para 12 causas ou grupos de enfermidades diferentes. Tamén se identificaron diferentes clústers e subclústers de países en función desta distribución de mortalidade previble e tratable. Os resultados obtidos móstrannos unha importante heteroxeneidade entre países e tamén ofrecen información interesante desde o punto de vista do benchmarking, en canto ao deseño de políticas ou medidas relacionadas coa saúde a través da prevención e o tratamento.

Quality health care is an important factor of health status and mortality in each country. The aim of EU cohesion policy is to reduce health care disparities among EU countries. The importance of good health of the population, functioning health systems, and quality health care now has been significantly strengthened in the context of the global Covid-19 pandemic. The main aim of this article is to assess inequalities in unmet healthcare needs and in treatable and preventable mortality in EU-27 countries for different groups of inhabitants by gender, age, education, and income amount. Graphical methods of descriptive statistics and methods of multidimensional comparison using synthetic variable have been used based on the most up-to-date available data for 2018 and 2019 year. In the future, it will certainly be interesting to compare the results obtained in this article with the results of analogous analyses based on data from the pandemic and the post-pandemic period caused by COVID-19 disease., Kvalitní zdravotní péče je důležitým faktorem stavu zdraví a úmrtnosti v každé zemi. Cílem kohezní politiky EU je snižovat rozdíly v péči o zdraví mezi zeměmi EU. Význam dobrého zdraví populace, fungující zdravotní systémy a kvalitní zdravotní péče jsou nyní výrazně posíleny v kontextu celosvětové pandemie Covid-19. Hlavním cílem tohoto článku je posoudit nerovnosti v nenaplněných zdravotních potřebách a v léčitelné a preventivní úmrtnosti v zemích EU-27 u různých skupin obyvatel podle pohlaví, věku, vzdělání a výše příjmu. Byly použity grafické metody deskriptivní statistiky a metody vícerozměrného porovnávání pomocí syntetické proměnné na základě nejaktuálnějších dostupných dat za rok 2018 a 2019. V budoucnu bude jistě zajímavé porovnat výsledky získané v tomto článku s výsledky analogických analýz založených na datech z pandemie a postpandemického období způsobeného onemocněním COVID-19.

INTRODUCTION: Public authorities daily deal with the negative consequences of drinking alcohol. Alcohol consumption results in morbidity and mortality, that economically presents lost productivity. Mortality and morbidity related to alcohol differs in regions and in populations. AIMS: This study aims to find out which regions of the Czech Republic are similar in mortality attributable to alcohol. There are many diagnoses specified by the International Classification of Diseases, that relate to alcohol wholly or partially, therefore this study estimates which diagnoses mostly relate to alcoholic death. As there are differences in alcohol attributable fractions, this study provides an insight into the examined issues separately for males and females. METHODS: The mortality attributable to alcohol was calculated based on attributable fractions. To identify similar regions in mortality attributable to alcohol, the cluster analysis was conducted. SAMPLE: The sample consisted of 111 443 deaths (out of which 50.65% deaths attributable to men, 49.35% deaths attributable to women) that occurred in the Czech Republic in 2017. RESULTS: Five clusters were identified as optimal in regard to alcohol mortality not only for men but also for women. The analysis shows differences in mortality related to alcohol between men and women. Diseases of liver and malignant neoplasms of digestive organs were mostly related to alcohol mortality in 2017. CONCLUSIONS: Based on the results it might be conclude that differences in mortality related to alcohol does not reflect the differences in economic development of the Czech regions. © 2021, Sdruzeni SCAN. All rights reserved.

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.

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.

INTRODUCTION: Public authorities daily deal with the negative consequences of drinking alcohol. Alcohol consumption results in morbidity and mortality, that economically presents lost productivity. Mortality and morbidity related to alcohol differs in regions and in populations. AIMS: This study aims to find out which regions of the Czech Republic are similar in mortality attributable to alcohol. There are many diagnoses specified by the International Classification of Diseases, that relate to alcohol wholly or partially, therefore this study estimates which diagnoses mostly relate to alcoholic death. As there are differences in alcohol attributable fractions, this study provides an insight into the examined issues separately for males and females. METHODS: The mortality attributable to alcohol was calculated based on attributable fractions. To identify similar regions in mortality attributable to alcohol, the cluster analysis was conducted. SAMPLE: The sample consisted of 111 443 deaths (out of which 50.65% deaths attributable to men, 49.35% deaths attributable to women) that occurred in the Czech Republic in 2017. RESULTS: Five clusters were identified as optimal in regard to alcohol mortality not only for men but also for women. The analysis shows differences in mortality related to alcohol between men and women. Diseases of liver and malignant neoplasms of digestive organs were mostly related to alcohol mortality in 2017. CONCLUSIONS: Based on the results it might be conclude that differences in mortality related to alcohol does not reflect the differences in economic development of the Czech regions. © 2021, Sdruzeni SCAN. All rights reserved.

Does austerity in health care affect health and healthcare outcomes? We examine the intended and unintended effects of the Italian austerity policy Piano di Rientro aimed at containing the cost of the healthcare sector. Using an instrumental variable strategy that exploits the temporal and geographical variation induced by the policy rollout, we find that the policy was successful in alleviating deficits by reducing expenditure, mainly in the southern regions, but also resulted in a 3% rise in avoidable deaths among both men and women, a reduction in hospital capacity and a rise in south-to-north patient migration. These findings suggest that—even

The objective is to evaluate the relations between gender health inequalities and economic prosperity in the Organisation for Economic Co-operation and Development (OECD) countries. The groups included health indicators in the specification of men, women and gender inequalities: Life expectancy, causes of mortality and avoidable mortality. The variable determining the economic prosperity was represented by the Gross Domestic Product (GDP). The analytical processing included descriptive analysis, analysis of differences and analysis of relationships. The regression analysis was presented as the main output of the research. Most of the significant gender differences in health showed a more positive outcome for women. It is possible to identify a certain relation between gender health inequalities and economic prosperity. If there is some reduction in gender inequalities in health, the economic prosperity will increase. The reduction seems to be more effective on the part of men than women. The output of the cluster analysis showed the relations of indicators evaluating the inequalities and the prosperity. The countries such as Luxembourg, Norway or Switzerland showed very positive outputs, on the other hand, the countries with a potential for the improvement are Lithuania, Latvia or Estonia. Overall, the policies should focus on reducing the inequalities in avoidable mortality as well as reducing the frequent diseases in younger people. © 2020 by the authors. Licensee MDPI, Basel, Switzerland.

The objective is to evaluate the relations between gender health inequalities and economic prosperity in the Organisation for Economic Co-operation and Development (OECD) countries. The groups included health indicators in the specification of men, women and gender inequalities: Life expectancy, causes of mortality and avoidable mortality. The variable determining the economic prosperity was represented by the Gross Domestic Product (GDP). The analytical processing included descriptive analysis, analysis of differences and analysis of relationships. The regression analysis was presented as the main output of the research. Most of the significant gender differences in health showed a more positive outcome for women. It is possible to identify a certain relation between gender health inequalities and economic prosperity. If there is some reduction in gender inequalities in health, the economic prosperity will increase. The reduction seems to be more effective on the part of men than women. The output of the cluster analysis showed the relations of indicators evaluating the inequalities and the prosperity. The countries such as Luxembourg, Norway or Switzerland showed very positive outputs, on the other hand, the countries with a potential for the improvement are Lithuania, Latvia or Estonia. Overall, the policies should focus on reducing the inequalities in avoidable mortality as well as reducing the frequent diseases in younger people. © 2020 by the authors. Licensee MDPI, Basel, Switzerland.

Objetivo: analizar la mortalidad evitable en los estados de la frontera del norte de México entre 1998 y 2007 para indirectamente evaluar la calidad de los servicios de salud en la región. Metodología: se analizó la información sobre mortalidad del Sistema Nacional de Información en Salud (SINAIS). La unidad de análisis fue la causa básica de la defunción codificada según la décima revisión de la CIE. La mortalidad evitable fue clasificada según el catálogo de causas de muerte propuesto por Gómez. Se hizo un análisis exploratorio de la relación entre la mortalidad evitable y la derechohabiencia y el nivel socioeconómico de los municipios correspondientes a las muertes. Resultados: la tasa de mortalidad evitable global fue de 350,2 muertes por mil habitantes en la región. La mortalidad evitable por diagnóstico y tratamiento médico precoz, violencia y VIH/SIDA tuvo tasas de 223, 60 y 5 por mil habitantes, respectivamente, presentando variaciones de magnitud, sociodemográficas y por derechohabiencia entre estados. Discusión y conclusiones: las poblaciones de los estados de la frontera norte de México se caracterizan por tener una dinámica sociodemográfica y de los servicios de salud muy intensa. Los resultados sugieren que el sistema de salud está siendo rebasado en su respuesta a una alta frecuencia de enfermedades no transmisibles. En el aspecto social existen condiciones estructurales en México que favorecen la presencia de narcotráfico y su consecuente causa de violencia y consumo de drogas ilegales que podrían estar relacionadas con la frecuencia de muertes violentas y en forma subsidiaria con las causadas por el VIH/SIDA., Objective: to analyze avoidable mortality between 1998 and 2007 in the border states of Northern Mexico to evaluate, indirectly, the quality of the region's health care services. Methodology: the information on mortality provided by the National Health Information System (SINAIS) was analyzed. The unit of analysis was the basic cause of death. The cause was coded in accordance with the ICD-10.Avoidable mortality was classified according to Gomez’s death causes catalog. Likewise, an exploratory analysis was conducted which focused on the relationship between avoidable mortality and eligibility and the socioeconomic level of the municipalities in which the deaths took place. Results:The global rate of avoidable mortality was of 350.2 deaths per 1000 inhabitants in the region. The rates of avoidable mortality by early diagnosis and medical treatment, violence, and HIV/AIDS were 223, 60 and 5 per 1000 inhabitants respectively. These causes of avoidable mortality showed variations between states in terms of magnitude, eligibility and socio-demographic characteristics. Discussion and conclusions: The population living in the states located in the Northern border of Mexico have a very intense epidemiological and sociodemographical dynamics. The The results of this study suggest that the Mexican health system is being overcome by the high frequency of non-communicable diseases in this region. In social terms, Mexico has structural conditions that facilitate the development of illegal drugs traffic through theNorthern states of Mexico. This could be related to the frequency of violent avoidable deaths and, in a subsidiary manner, in HIV/AIDS deaths., Objetivo: Analisar a mortalidade evitável nos estados da fronteira do norte do México entre 1998 e 2007 a fim de avaliar indiretamente a qualidade dos serviços de saúde na região. Metodologia: Foi analisada a informação sobre mortalidade do Sistema Nacional de Informação em Saúde. A unidade de análise foi a causa básica da defunção codificada segundo a décima revisão da CIE.A mortalidade evitável foi classificada de acordo com o catálogo de causas de morte proposto por Gómez. Fez-se uma análise exploratória da relação entre a mortalidade evitável e a herança dos direitos e o nível socioeconômico dos municípios correspondentes às mortes. Resultados: A taxa de mortalidade evitável global foi de 350.2 mortes por mil habitantes na região. A mortalidade evitável por diagnóstico e tratamento médico precoce, violência e HIV/AIDS teve taxas de 223, 60 e 5 por mil habitantes, respectivamente, apresentando variações de magnitude, sociodemográficas e por herança de direitos entre estados. Discussão e conclusões: As populações dos estados da fronteira norte do México caracterizam-se por terem uma dinâmica sociodemográfica e dos serviços de saúde muito forte. Os resultados sugerem que o sistema de saúde está sendo excedido na sua resposta a uma alta frequência de doenças não transmissíveis. No aspecto social existem condições estruturais no México que favorecem a presença de tráfico de drogas, causante de violência e consumo de drogas ilegais que poderiam estar ligadas à frequência de mortes violentas e em forma subsidiária com as causadas pelo HIV/AIDS.

Objetivo: analizar la mortalidad evitable en los estados de la frontera del norte de México entre 1998 y 2007 para indirectamente evaluar la calidad de los servicios de salud en la región. Metodología: se analizó la información sobre mortalidad del Sistema Nacional de Información en Salud (SINAIS). La unidad de análisis fue la causa básica de la defunción codificada según la décima revisión de la CIE. La mortalidad evitable fue clasificada según el catálogo de causas de muerte propuesto por Gómez. Se hizo un análisis exploratorio de la relación entre la mortalidad evitable y la derechohabiencia y el nivel socioeconómico de los municipios correspondientes a las muertes. Resultados: la tasa de mortalidad evitable global fue de 350,2 muertes por mil habitantes en la región. La mortalidad evitable por diagnóstico y tratamiento médico precoz, violencia y VIH/SIDA tuvo tasas de 223, 60 y 5 por mil habitantes, respectivamente, presentando variaciones de magnitud, sociodemográficas y por derechohabiencia entre estados. Discusión y conclusiones: las poblaciones de los estados de la frontera norte de México se caracterizan por tener una dinámica sociodemográfica y de los servicios de salud muy intensa. Los resultados sugieren que el sistema de salud está siendo rebasado en su respuesta a una alta frecuencia de enfermedades no transmisibles. En el aspecto social existen condiciones estructurales en México que favorecen la presencia de narcotráfico y su consecuente causa de violencia y consumo de drogas ilegales que podrían estar relacionadas con la frecuencia de muertes violentas y en forma subsidiaria con las causadas por el VIH/SIDA., Objective: to analyze avoidable mortality between 1998 and 2007 in the border states of Northern Mexico to evaluate, indirectly, the quality of the region's health care services. Methodology: the information on mortality provided by the National Health Information System (SINAIS) was analyzed. The unit of analysis was the basic cause of death. The cause was coded in accordance with the ICD-10.Avoidable mortality was classified according to Gomez’s death causes catalog. Likewise, an exploratory analysis was conducted which focused on the relationship between avoidable mortality and eligibility and the socioeconomic level of the municipalities in which the deaths took place. Results:The global rate of avoidable mortality was of 350.2 deaths per 1000 inhabitants in the region. The rates of avoidable mortality by early diagnosis and medical treatment, violence, and HIV/AIDS were 223, 60 and 5 per 1000 inhabitants respectively. These causes of avoidable mortality showed variations between states in terms of magnitude, eligibility and socio-demographic characteristics. Discussion and conclusions: The population living in the states located in the Northern border of Mexico have a very intense epidemiological and sociodemographical dynamics. The The results of this study suggest that the Mexican health system is being overcome by the high frequency of non-communicable diseases in this region. In social terms, Mexico has structural conditions that facilitate the development of illegal drugs traffic through theNorthern states of Mexico. This could be related to the frequency of violent avoidable deaths and, in a subsidiary manner, in HIV/AIDS deaths., Objetivo: Analisar a mortalidade evitável nos estados da fronteira do norte do México entre 1998 e 2007 a fim de avaliar indiretamente a qualidade dos serviços de saúde na região. Metodologia: Foi analisada a informação sobre mortalidade do Sistema Nacional de Informação em Saúde. A unidade de análise foi a causa básica da defunção codificada segundo a décima revisão da CIE.A mortalidade evitável foi classificada de acordo com o catálogo de causas de morte proposto por Gómez. Fez-se uma análise exploratória da relação entre a mortalidade evitável e a herança dos direitos e o nível socioeconômico dos municípios correspondentes às mortes. Resultados: A taxa de mortalidade evitável global foi de 350.2 mortes por mil habitantes na região. A mortalidade evitável por diagnóstico e tratamento médico precoce, violência e HIV/AIDS teve taxas de 223, 60 e 5 por mil habitantes, respectivamente, apresentando variações de magnitude, sociodemográficas e por herança de direitos entre estados. Discussão e conclusões: As populações dos estados da fronteira norte do México caracterizam-se por terem uma dinâmica sociodemográfica e dos serviços de saúde muito forte. Os resultados sugerem que o sistema de saúde está sendo excedido na sua resposta a uma alta frequência de doenças não transmissíveis. No aspecto social existem condições estruturais no México que favorecem a presença de tráfico de drogas, causante de violência e consumo de drogas ilegais que poderiam estar ligadas à frequência de mortes violentas e em forma subsidiária com as causadas pelo HIV/AIDS.

Objetivo: analizar la mortalidad evitable en los estados de la frontera del norte de México entre 1998 y 2007 para indirectamente evaluar la calidad de los servicios de salud en la región. Metodología: se analizó la información sobre mortalidad del Sistema Nacional de Información en Salud (SINAIS). La unidad de análisis fue la causa básica de la defunción codificada según la décima revisión de la CIE. La mortalidad evitable fue clasificada según el catálogo de causas de muerte propuesto por Gómez. Se hizo un análisis exploratorio de la relación entre la mortalidad evitable y la derechohabiencia y el nivel socioeconómico de los municipios correspondientes a las muertes. Resultados: la tasa de mortalidad evitable global fue de 350,2 muertes por mil habitantes en la región. La mortalidad evitable por diagnóstico y tratamiento médico precoz, violencia y VIH/SIDA tuvo tasas de 223, 60 y 5 por mil habitantes, respectivamente, presentando variaciones de magnitud, sociodemográficas y por derechohabiencia entre estados. Discusión y conclusiones: las poblaciones de los estados de la frontera norte de México se caracterizan por tener una dinámica sociodemográfica y de los servicios de salud muy intensa. Los resultados sugieren que el sistema de salud está siendo rebasado en su respuesta a una alta frecuencia de enfermedades no transmisibles. En el aspecto social existen condiciones estructurales en México que favorecen la presencia de narcotráfico y su consecuente causa de violencia y consumo de drogas ilegales que podrían estar relacionadas con la frecuencia de muertes violentas y en forma subsidiaria con las causadas por el VIH/SIDA., Objective: to analyze avoidable mortality between 1998 and 2007 in the border states of Northern Mexico to evaluate, indirectly, the quality of the region's health care services. Methodology: the information on mortality provided by the National Health Information System (SINAIS) was analyzed. The unit of analysis was the basic cause of death. The cause was coded in accordance with the ICD-10.Avoidable mortality was classified according to Gomez’s death causes catalog. Likewise, an exploratory analysis was conducted which focused on the relationship between avoidable mortality and eligibility and the socioeconomic level of the municipalities in which the deaths took place. Results:The global rate of avoidable mortality was of 350.2 deaths per 1000 inhabitants in the region. The rates of avoidable mortality by early diagnosis and medical treatment, violence, and HIV/AIDS were 223, 60 and 5 per 1000 inhabitants respectively. These causes of avoidable mortality showed variations between states in terms of magnitude, eligibility and socio-demographic characteristics. Discussion and conclusions: The population living in the states located in the Northern border of Mexico have a very intense epidemiological and sociodemographical dynamics. The The results of this study suggest that the Mexican health system is being overcome by the high frequency of non-communicable diseases in this region. In social terms, Mexico has structural conditions that facilitate the development of illegal drugs traffic through theNorthern states of Mexico. This could be related to the frequency of violent avoidable deaths and, in a subsidiary manner, in HIV/AIDS deaths., Objetivo: Analisar a mortalidade evitável nos estados da fronteira do norte do México entre 1998 e 2007 a fim de avaliar indiretamente a qualidade dos serviços de saúde na região. Metodologia: Foi analisada a informação sobre mortalidade do Sistema Nacional de Informação em Saúde. A unidade de análise foi a causa básica da defunção codificada segundo a décima revisão da CIE.A mortalidade evitável foi classificada de acordo com o catálogo de causas de morte proposto por Gómez. Fez-se uma análise exploratória da relação entre a mortalidade evitável e a herança dos direitos e o nível socioeconômico dos municípios correspondentes às mortes. Resultados: A taxa de mortalidade evitável global foi de 350.2 mortes por mil habitantes na região. A mortalidade evitável por diagnóstico e tratamento médico precoce, violência e HIV/AIDS teve taxas de 223, 60 e 5 por mil habitantes, respectivamente, apresentando variações de magnitude, sociodemográficas e por herança de direitos entre estados. Discussão e conclusões: As populações dos estados da fronteira norte do México caracterizam-se por terem uma dinâmica sociodemográfica e dos serviços de saúde muito forte. Os resultados sugerem que o sistema de saúde está sendo excedido na sua resposta a uma alta frequência de doenças não transmissíveis. No aspecto social existem condições estruturais no México que favorecem a presença de tráfico de drogas, causante de violência e consumo de drogas ilegais que poderiam estar ligadas à frequência de mortes violentas e em forma subsidiária com as causadas pelo HIV/AIDS.

Objetivo: determinar la prevalencia y los factores relacionados con la adherencia no farmacológica en pacientes con hipertensión arterial (hta) y diabetes mellitus (dm). Metodología: estudio observacional transversal en pacientes adultos mayores de 35 años con diagnóstico de hta o dm, atendidos en un programa de Renoprotección en cuidado primario en Cali, Colombia. Se excluyeron aquellos pacientes con enfermedad renal crónica en estadío kdoqi 4-5, los que presentaran comorbilidades adicionales que deterioraran la función renal o con trastornos neuropsiquiátricos diagnosticados previamente. La adherencia no farmacológica se determinó mediante un cuestionario de autoreporte y los factores asociados a la misma se determinaron mediante regresión de Poisson con varianza robusta. Resultados: la prevalencia de la adherencia no farmacológica fue de 9,4%. La inactividad física estuvo presente en 75% de los pacientes, y más del 19% de la población consumía sal frecuentemente. Entre los diabéticos, 18% consumía carbohidratos con frecuencia. Los hombres mostraron ser menos adherentes que las mujeres (RP: 0,21; p = 0,002). Los factores asociados positivamente con la adherencia no farmacológica fueron: estar estudiando, desempleado o pensionado (RP: 4,42; p = 0,019), recibir apoyo del equipo de salud (RP: 3,17; p = 0,032), tener diagnóstico de diabetes (RP: 7,79; p = 0,000) y la función renal en KDOQI-3 (RP: 5,14; p = 0,008). Conclusión: la adherencia no farmacológica fue muy baja en la población de estudio, en particular en relación con la inactividad física. Los factores asociados positivamente a la adherencia fueron el sexo femenino, tener una ocupación diferente al hogar, diagnostico de diabetes, enfermedad renal en KDOQI-3 y contar con apoyo del equipo de salud., Objective: to analyze avoidable mortality between 1998 and 2007 in the border states of Northern Mexico to evaluate, indirectly, the quality of the region's health care services. Methodology: the information on mortality provided by theNational Health Information System (sinais) was analyzed. The unit of analysis was the basic cause of death. The cause was coded in accordance with the ICD-10.Avoidable mortality was classified according to Gomez’s death causes catalog. Likewise, an exploratory analysis was conducted which focused on the relationship between avoidable mortality and eligibility and the socioeconomic level of the municipalities in which the deaths took place. Results: the global rate of avoidable mortality was of 350.2 deaths per 1000 inhabitants in the region. the rates of avoidable mortality by early diagnosis and medical treatment, violence, and HIV/AIDS were 223, 60 and 5 per 1000 inhabitants respectively. These causes of avoidable mortality showed variations betweenstates in terms of magnitude, eligibility and socio-demographic characteristics. Discussion and conclusions: the population living in the states located in the northern border of Mexico have a very intense epidemiological and sociodemographical dynamics. The results of this study suggest that the Mexican health system is being overcome by the high frequency of noncommunicable diseases in this region. In social terms, Mexicohas structural conditions that facilitate the development of illegal drugs traffic through the Northern states of Mexico. This could be related to the frequency of violent avoidable deaths and, in a subsidiary manner, in HIV/AIDS deaths.

Objective: to analyze avoidable mortality between 1998 and 2007 in the border states of Northern Mexico to evaluate, indirectly, the quality of the region's health care services. Methodology: the information on mortality provided by the National Health Information System (SINAIS) was analyzed. The unit of analysis was the basic cause of death. The cause was coded in accordancewith the ICD-10.Avoidable mortality was classified according to Gomez’s death causes catalog. Likewise, an exploratory analysis was conducted which focused on the relationship between avoidable mortality and eligibility and the socioeconomic level of the municipalities in which the deaths took place. Results:The global rate of avoidable mortality was of 350.2 deaths per 1000inhabitants in the region. the rates of avoidable mortality by early diagnosis and medical treatment, violence, and HIV/AIDS were 223, 60 and 5 per 1000 inhabitants respectively. These causes of avoidable mortality showed variations between states in terms of magnitude, eligibility and socio-demographic characteristics. Discussion and conclusions: The population living in the stateslocated in the northern border of Mexico have a very intense epidemiological and sociodemographical dynamics. The results of this study suggest that the Mexican health system is being overcome by the high frequency of non-communicable diseases in this region. In social terms, Mexico has structural conditions that facilitate the development of illegal drugs traffic through theNorthern states of Mexico. This could be related to the frequency of violent avoidable deaths and, in a subsidiary manner, in HIV/AIDS deaths., Objetivo: analizar la mortalidad evitable en los estados de la frontera del norte de México entre 1998 y 2007 para indirectamente evaluar la calidad de los servicios de salud en la región. Metodología: se analizó la información sobre mortalidad del Sistema Nacional de Información en Salud (sinais). La unidad de análisis fue la causa básica de la defunción codificada según la décima revisión de la CIE. La mortalidad evitable fue clasificada según el catálogo de causas de muerte propuesto por Gómez. Se hizo un análisis exploratorio de la relación entre la mortalidad evitable y la derechohabiencia y el nivel socioeconómico de los municipios correspondientes a las muertes. Resultados: la tasa de mortalidad evitable global fue de 350,2 muertes por mil habitantes en la región. La mortalidad evitable por diagnóstico y tratamiento médico precoz, violencia y VIH/SIDA tuvo tasas de 223, 60 y 5 por mil habitantes, respectivamente, presentando variaciones de magnitud, sociodemográficas y por derechohabiencia entre estados. Discusión y conclusiones: las poblaciones de los estados de la frontera norte de México se caracterizan por tener una dinámica sociodemográfica y de los servicios de salud muy intensa. Los resultados sugieren que el sistema de salud está siendo rebasado en su respuesta a una alta frecuencia de enfermedades no transmisibles. En el aspecto social existen condiciones estructurales en México que favorecen la presencia de narcotráfico y su consecuente causa de violencia y consumo de drogas ilegales que podrían estar relacionadas con la frecuencia de muertes violentas y en forma subsidiaria con las causadas por el VIH/SIDA.

Objetivo: analizar la mortalidad evitable en los estados de la frontera del norte de México entre 1998 y 2007 para indirectamente evaluar la calidad de los servicios de salud en la región. Metodología: se analizó la información sobre mortalidad del Sistema Nacional de Información en Salud (SINAIS). La unidad de análisis fue la causa básica de la defunción codificada según la décima revisión de la CIE. La mortalidad evitable fue clasificada según el catálogo de causas de muerte propuesto por Gómez. Se hizo un análisis exploratorio de la relación entre la mortalidad evitable y la derechohabiencia y el nivel socioeconómico de los municipios correspondientes a las muertes. Resultados: la tasa de mortalidad evitable global fue de 350,2 muertes por mil habitantes en la región. La mortalidad evitable por diagnóstico y tratamiento médico precoz, violencia y VIH/SIDA tuvo tasas de 223, 60 y 5 por mil habitantes, respectivamente, presentando variaciones de magnitud, sociodemográficas y por derechohabiencia entre estados. Discusión y conclusiones: las poblaciones de los estados de la frontera norte de México se caracterizan por tener una dinámica sociodemográfica y de los servicios de salud muy intensa. Los resultados sugieren que el sistema de salud está siendo rebasado en su respuesta a una alta frecuencia de enfermedades no transmisibles. En el aspecto social existen condiciones estructurales en México que favorecen la presencia de narcotráfico y su consecuente causa de violencia y consumo de drogas ilegales que podrían estar relacionadas con la frecuencia de muertes violentas y en forma subsidiaria con las causadas por el VIH/SIDA., Objective: to analyze avoidable mortality between 1998 and 2007 in the border states of Northern Mexico to evaluate, indirectly, the quality of the region's health care services. Methodology: the information on mortality provided by the National Health Information System (SINAIS) was analyzed. The unit of analysis was the basic cause of death. The cause was coded in accordance with the ICD-10.Avoidable mortality was classified according to Gomez’s death causes catalog. Likewise, an exploratory analysis was conducted which focused on the relationship between avoidable mortality and eligibility and the socioeconomic level of the municipalities in which the deaths took place. Results:The global rate of avoidable mortality was of 350.2 deaths per 1000 inhabitants in the region. The rates of avoidable mortality by early diagnosis and medical treatment, violence, and HIV/AIDS were 223, 60 and 5 per 1000 inhabitants respectively. These causes of avoidable mortality showed variations between states in terms of magnitude, eligibility and socio-demographic characteristics. Discussion and conclusions: The population living in the states located in the Northern border of Mexico have a very intense epidemiological and sociodemographical dynamics. The The results of this study suggest that the Mexican health system is being overcome by the high frequency of non-communicable diseases in this region. In social terms, Mexico has structural conditions that facilitate the development of illegal drugs traffic through theNorthern states of Mexico. This could be related to the frequency of violent avoidable deaths and, in a subsidiary manner, in HIV/AIDS deaths., Objetivo: Analisar a mortalidade evitável nos estados da fronteira do norte do México entre 1998 e 2007 a fim de avaliar indiretamente a qualidade dos serviços de saúde na região. Metodologia: Foi analisada a informação sobre mortalidade do Sistema Nacional de Informação em Saúde. A unidade de análise foi a causa básica da defunção codificada segundo a décima revisão da CIE.A mortalidade evitável foi classificada de acordo com o catálogo de causas de morte proposto por Gómez. Fez-se uma análise exploratória da relação entre a mortalidade evitável e a herança dos direitos e o nível socioeconômico dos municípios correspondentes às mortes. Resultados: A taxa de mortalidade evitável global foi de 350.2 mortes por mil habitantes na região. A mortalidade evitável por diagnóstico e tratamento médico precoce, violência e HIV/AIDS teve taxas de 223, 60 e 5 por mil habitantes, respectivamente, apresentando variações de magnitude, sociodemográficas e por herança de direitos entre estados. Discussão e conclusões: As populações dos estados da fronteira norte do México caracterizam-se por terem uma dinâmica sociodemográfica e dos serviços de saúde muito forte. Os resultados sugerem que o sistema de saúde está sendo excedido na sua resposta a uma alta frequência de doenças não transmissíveis. No aspecto social existem condições estruturais no México que favorecem a presença de tráfico de drogas, causante de violência e consumo de drogas ilegais que poderiam estar ligadas à frequência de mortes violentas e em forma subsidiária com as causadas pelo HIV/AIDS.

Objetivo: analizar la mortalidad evitable en los estados de la frontera del norte de México entre 1998 y 2007 para indirectamente evaluar la calidad de los servicios de salud en la región. Metodología: se analizó la información sobre mortalidad del Sistema Nacional de Información en Salud (SINAIS). La unidad de análisis fue la causa básica de la defunción codificada según la décima revisión de la CIE. La mortalidad evitable fue clasificada según el catálogo de causas de muerte propuesto por Gómez. Se hizo un análisis exploratorio de la relación entre la mortalidad evitable y la derechohabiencia y el nivel socioeconómico de los municipios correspondientes a las muertes. Resultados: la tasa de mortalidad evitable global fue de 350,2 muertes por mil habitantes en la región. La mortalidad evitable por diagnóstico y tratamiento médico precoz, violencia y VIH/SIDA tuvo tasas de 223, 60 y 5 por mil habitantes, respectivamente, presentando variaciones de magnitud, sociodemográficas y por derechohabiencia entre estados. Discusión y conclusiones: las poblaciones de los estados de la frontera norte de México se caracterizan por tener una dinámica sociodemográfica y de los servicios de salud muy intensa. Los resultados sugieren que el sistema de salud está siendo rebasado en su respuesta a una alta frecuencia de enfermedades no transmisibles. En el aspecto social existen condiciones estructurales en México que favorecen la presencia de narcotráfico y su consecuente causa de violencia y consumo de drogas ilegales que podrían estar relacionadas con la frecuencia de muertes violentas y en forma subsidiaria con las causadas por el VIH/SIDA., Objective: to analyze avoidable mortality between 1998 and 2007 in the border states of Northern Mexico to evaluate, indirectly, the quality of the region's health care services. Methodology: the information on mortality provided by the National Health Information System (SINAIS) was analyzed. The unit of analysis was the basic cause of death. The cause was coded in accordance with the ICD-10.Avoidable mortality was classified according to Gomez’s death causes catalog. Likewise, an exploratory analysis was conducted which focused on the relationship between avoidable mortality and eligibility and the socioeconomic level of the municipalities in which the deaths took place. Results:The global rate of avoidable mortality was of 350.2 deaths per 1000 inhabitants in the region. The rates of avoidable mortality by early diagnosis and medical treatment, violence, and HIV/AIDS were 223, 60 and 5 per 1000 inhabitants respectively. These causes of avoidable mortality showed variations between states in terms of magnitude, eligibility and socio-demographic characteristics. Discussion and conclusions: The population living in the states located in the Northern border of Mexico have a very intense epidemiological and sociodemographical dynamics. The The results of this study suggest that the Mexican health system is being overcome by the high frequency of non-communicable diseases in this region. In social terms, Mexico has structural conditions that facilitate the development of illegal drugs traffic through theNorthern states of Mexico. This could be related to the frequency of violent avoidable deaths and, in a subsidiary manner, in HIV/AIDS deaths., Objetivo: Analisar a mortalidade evitável nos estados da fronteira do norte do México entre 1998 e 2007 a fim de avaliar indiretamente a qualidade dos serviços de saúde na região. Metodologia: Foi analisada a informação sobre mortalidade do Sistema Nacional de Informação em Saúde. A unidade de análise foi a causa básica da defunção codificada segundo a décima revisão da CIE.A mortalidade evitável foi classificada de acordo com o catálogo de causas de morte proposto por Gómez. Fez-se uma análise exploratória da relação entre a mortalidade evitável e a herança dos direitos e o nível socioeconômico dos municípios correspondentes às mortes. Resultados: A taxa de mortalidade evitável global foi de 350.2 mortes por mil habitantes na região. A mortalidade evitável por diagnóstico e tratamento médico precoce, violência e HIV/AIDS teve taxas de 223, 60 e 5 por mil habitantes, respectivamente, apresentando variações de magnitude, sociodemográficas e por herança de direitos entre estados. Discussão e conclusões: As populações dos estados da fronteira norte do México caracterizam-se por terem uma dinâmica sociodemográfica e dos serviços de saúde muito forte. Os resultados sugerem que o sistema de saúde está sendo excedido na sua resposta a uma alta frequência de doenças não transmissíveis. No aspecto social existem condições estruturais no México que favorecem a presença de tráfico de drogas, causante de violência e consumo de drogas ilegais que poderiam estar ligadas à frequência de mortes violentas e em forma subsidiária com as causadas pelo HIV/AIDS.

Objetivo: analizar la mortalidad evitable en los estados de la frontera del norte de México entre 1998 y 2007 para indirectamente evaluar la calidad de los servicios de salud en la región. Metodología: se analizó la información sobre mortalidad del Sistema Nacional de Información en Salud (SINAIS). La unidad de análisis fue la causa básica de la defunción codificada según la décima revisión de la CIE. La mortalidad evitable fue clasificada según el catálogo de causas de muerte propuesto por Gómez. Se hizo un análisis exploratorio de la relación entre la mortalidad evitable y la derechohabiencia y el nivel socioeconómico de los municipios correspondientes a las muertes. Resultados: la tasa de mortalidad evitable global fue de 350,2 muertes por mil habitantes en la región. La mortalidad evitable por diagnóstico y tratamiento médico precoz, violencia y VIH/SIDA tuvo tasas de 223, 60 y 5 por mil habitantes, respectivamente, presentando variaciones de magnitud, sociodemográficas y por derechohabiencia entre estados. Discusión y conclusiones: las poblaciones de los estados de la frontera norte de México se caracterizan por tener una dinámica sociodemográfica y de los servicios de salud muy intensa. Los resultados sugieren que el sistema de salud está siendo rebasado en su respuesta a una alta frecuencia de enfermedades no transmisibles. En el aspecto social existen condiciones estructurales en México que favorecen la presencia de narcotráfico y su consecuente causa de violencia y consumo de drogas ilegales que podrían estar relacionadas con la frecuencia de muertes violentas y en forma subsidiaria con las causadas por el VIH/SIDA., Objective: to analyze avoidable mortality between 1998 and 2007 in the border states of Northern Mexico to evaluate, indirectly, the quality of the region's health care services. Methodology: the information on mortality provided by the National Health Information System (SINAIS) was analyzed. The unit of analysis was the basic cause of death. The cause was coded in accordance with the ICD-10.Avoidable mortality was classified according to Gomez’s death causes catalog. Likewise, an exploratory analysis was conducted which focused on the relationship between avoidable mortality and eligibility and the socioeconomic level of the municipalities in which the deaths took place. Results:The global rate of avoidable mortality was of 350.2 deaths per 1000 inhabitants in the region. The rates of avoidable mortality by early diagnosis and medical treatment, violence, and HIV/AIDS were 223, 60 and 5 per 1000 inhabitants respectively. These causes of avoidable mortality showed variations between states in terms of magnitude, eligibility and socio-demographic characteristics. Discussion and conclusions: The population living in the states located in the Northern border of Mexico have a very intense epidemiological and sociodemographical dynamics. The The results of this study suggest that the Mexican health system is being overcome by the high frequency of non-communicable diseases in this region. In social terms, Mexico has structural conditions that facilitate the development of illegal drugs traffic through theNorthern states of Mexico. This could be related to the frequency of violent avoidable deaths and, in a subsidiary manner, in HIV/AIDS deaths., Objetivo: Analisar a mortalidade evitável nos estados da fronteira do norte do México entre 1998 e 2007 a fim de avaliar indiretamente a qualidade dos serviços de saúde na região. Metodologia: Foi analisada a informação sobre mortalidade do Sistema Nacional de Informação em Saúde. A unidade de análise foi a causa básica da defunção codificada segundo a décima revisão da CIE.A mortalidade evitável foi classificada de acordo com o catálogo de causas de morte proposto por Gómez. Fez-se uma análise exploratória da relação entre a mortalidade evitável e a herança dos direitos e o nível socioeconômico dos municípios correspondentes às mortes. Resultados: A taxa de mortalidade evitável global foi de 350.2 mortes por mil habitantes na região. A mortalidade evitável por diagnóstico e tratamento médico precoce, violência e HIV/AIDS teve taxas de 223, 60 e 5 por mil habitantes, respectivamente, apresentando variações de magnitude, sociodemográficas e por herança de direitos entre estados. Discussão e conclusões: As populações dos estados da fronteira norte do México caracterizam-se por terem uma dinâmica sociodemográfica e dos serviços de saúde muito forte. Os resultados sugerem que o sistema de saúde está sendo excedido na sua resposta a uma alta frequência de doenças não transmissíveis. No aspecto social existem condições estruturais no México que favorecem a presença de tráfico de drogas, causante de violência e consumo de drogas ilegais que poderiam estar ligadas à frequência de mortes violentas e em forma subsidiária com as causadas pelo HIV/AIDS.

Background: Health and inequalities in health among inhabitants of European cities are of major importance for European public health and there is great interest in how different health care systems in Europe perform in the reduction of health inequalities. However, evidence on the spatial distribution of cause-specific mortality across neighbourhoods of European cities is scarce. This study presents maps of avoidable mortality in European cities and analyses differences in avoidable mortality between neighbourhoods with different levels of deprivation.Methods: We determined the level of mortality from 14 avoidable causes of death for each neighbourhood of 15 large cities in different European regions. To address the problems associated with Standardised Mortality Ratios for small areas we smooth them using the Bayesian model proposed by Besag, York and Mollié. Ecological regression analysis was used to assess the association between social deprivation and mortality.Results: Mortality from avoidable causes of death is higher in deprived neighbourhoods and mortality rate ratios between areas with different levels of deprivation differ between gender and cities. In most cases rate ratios are lower among women. While Eastern and Southern European cities show higher levels of avoidable mortality, the association of mortality

Objetivos: Estudiar la evolución temporal y la distribución geográfica de la mortalidad evitable en la Comunidad Valenciana y en sus Departamentos de Salud por sexo, en los períodos 1990-1994, 1995-1999 y 2000-2004. Material y método: Se han analizado 21 causas de mortalidad evitable agrupándolas en tratables y prevenibles. Las defunciones analizadas corresponden a residentes en la Comunidad Valenciana durante el período 1990-2004. Se han calculado las tasas ajustadas por edad (método directo) y las razones de mortalidad comparativas para el estudio de la evolución temporal en los ámbitos geográficos indicados por período y sexo. Las razones de mortalidad estandarizadas (método indirecto) se han utilizado en el análisis de la distribución geográfica. Resultados: El total de defunciones evitables son 38.061 (un 7,1% de la mortalidad global), el 76,2% corresponden a varones y el 23,8% a mujeres. Por grupos, el 82,4% son prevenibles y el 17,6% tratables. En varones, las prevenibles representan un 86,5%, y en mujeres un 69,4%. En la Comunidad Valenciana se observan descensos significativos de la mortalidad evitable en ambos sexos, más acusados en las tratables, y en hombres. La mortalidad por cáncer de pulmón en mujeres presenta un aumento significativo. En 2000-2004 ningún departamento de salud presenta excesos de mortalidad estadísticamente significativos en las tratables. Conclusiones: La mortalidad evitable desciende más que la mortalidad general en la Comunidad Valenciana. Cabe destacar el aumento de la mortalidad por cáncer de pulmón en las mujeres., Objectives: To analyze time trends and the geographical distribution of avoidable mortality in the autonomous community of Valencia and its health departments by sex in the periods 1990-1994, 1995-1999, and 2000-2004. Material and method: Twenty-one causes of avoidable mortality were analyzed. The deaths analyzed corresponded to residents in the autonomous community of Valencia between 1990 and 2004. Age-standardized mortality rates were calculated using the direct method. To study time trends in the geographical area of interest for each period and sex, comparative mortality ratios were calculated. To analyze geographical distribution, standardized mortality rates were calculated by the indirect method. Results: The total number of avoidable deaths was 38,061 (7.1% of overall deaths). Men accounted for 76.2% and women for 23.8%. By groups, 82.4% were preventable and 17.6% were treatable. Preventable deaths represented 86.5% of deaths in men and 69.4% of those in women. Avoidable mortality in Valencia significantly decreased in both sexes, this decrease being more marked in the group of treatable deaths and in men. Mortality from lung cancer in women significantly increased. Between 2000 and 2004, none of the health departments showed a significant excess of treatable mortality. Conclusions: In the autonomous community of Valencia, there was a greater decrease in avoidable mortality than in general mortality. The increase in lung cancer in women was notable.

We investigate the extent to which health care has contributed to the decline in mortality rates in Australia over recent decades by examining trends in avoidable mortality between 1968 and 2001. Avoidable mortality refers to deaths from certain conditions that are considered to be largely avoidable given timely and effective health care. Using unit record mortality data, we classified deaths into three avoidable categories: conditions amenable to medical care (‘medical care indicators’ (MCI)), conditions responsive to health policy but that are considered to lack effective treatment once the condition has developed (‘health policy indicators’ (HPI)), and ischaemic heart disease(IHD). ‘Nonavoidable’ deaths included the remaining causes of death. Our findings suggest that the Australian health care system has made substantial contributions to the reduction in mortality over the past three decades. This is shown in the steady decline in avoidable mortality rates with slower declines in nonavoidable mortality rates. Between 1968 and 2001, total avoidable death rates fell around 70% (68.4% in females, 72.2% in males) and nonavoidable rates fell around 34% (34.6% in females, 33.2% in males). Using Poisson regression, the annual declines in avoidable mortality rates were as follows (95% CIs in parentheses): 3.47% (3.44-3.50%) in females and 3.89% (3.86-3.91%) in males. For nonavoidable mortality rates, the annual declines were 1.09% (1.05-1.13%) in females and 0.95% (0.92-0.98%) in males. The trends in avoidable mortality in Australia were similar to those of other European countries, with Australia improving it’s ranking between 1980 and 1998, performing particularly well with respect to MCI. In females, declines in MCI death rates made the largest contribution to the decline in avoidable mortality rates (54%) with the IHD contribution being 45%. In males, reductions in IHD death rates made the largest contribution (57%), with the MCI contribution being 32%. For both sex

The so-called 'Avoidable Death Indicators' method has been developed to monitor medical care and health systems. Avoidable death refers to premature mortality for causes amenable to medical care or to health promotion. This method has been mainly used to make geographic comparisons and is useful to detect higher levels of mortality which are regarded as a warning signal. The Atlas 1985-89 contains the maps and tables showing these indicators at the district level. The methods used are strictly comparable with those in the previous atlas for the years 1974-78 and 1980-84 in order to enable comparisons. For the period 1985-89, the tests of heterogeneity of the standardised mortality ratios (SMR) between the 43 districts are statistically significant for all avoidable causes of death except two: malignant neoplasm of cervix, uteri and body of uterus (15-54 years) and infant mortality (female). Comparisons between the Belgian atlas for the years 1974-78, 1980-84 and 1985-89, have led to observe some large geographic areas with SMR significantly higher than 100 at each period. It is particularly the case of areas situated in South-West of the country for 'cirrhosis of the liver' (males, females, 15-64 years), and in the provinces of Limburg, Luxembourg and Namur for motor vehicle accidents (males, all ages). Since these unfavourable results are observed with continuity they must be considered as warning signals which warrant further investigations on determinants of the geographic variations of the specific mortality., info:eu-repo/semantics/published

The so-called 'Avoidable Death Indicators' method has been developed to monitor medical care and health systems. Avoidable death refers to premature mortality for causes amenable to medical care or to health promotion. This method has been mainly used to make geographic comparisons and is useful to detect higher levels of mortality which are regarded as a warning signal. The Atlas 1985-89 contains the maps and tables showing these indicators at the district level. The methods used are strictly comparable with those in the previous atlas for the years 1974-78 and 1980-84 in order to enable comparisons. For the period 1985-89, the tests of heterogeneity of the standardised mortality ratios (SMR) between the 43 districts are statistically significant for all avoidable causes of death except two: malignant neoplasm of cervix, uteri and body of uterus (15-54 years) and infant mortality (female). Comparisons between the Belgian atlas for the years 1974-78, 1980-84 and 1985-89, have led to observe some large geographic areas with SMR significantly higher than 100 at each period. It is particularly the case of areas situated in South-West of the country for 'cirrhosis of the liver' (males, females, 15-64 years), and in the provinces of Limburg, Luxembourg and Namur for motor vehicle accidents (males, all ages). Since these unfavourable results are observed with continuity they must be considered as warning signals which warrant further investigations on determinants of the geographic variations of the specific mortality., info:eu-repo/semantics/published

This paper presents two different yet complementary on-going studies related to the understanding of the mechanisms leading to social inequalities in health. The first part is devoted to a differential morbidity survey held in southern Belgium. It confirms that striking differences exist in the period around birth between social categories, and between the three districts under study. In a multivariate approach, differences remain between the social categories and between the district samples, which classically studied socio-demographical, behavioural and medical characteristics cannot fully explain. The role of cultural factors is analysed and discussed through the concept of 'health culture' and alternative hypotheses are reviewed in the light of the results. The second part reviews the studies conducted on the so-called avoidable mortality in the EEC and more specifically in Belgium. The concept of avoidable mortality is discussed, as well as its utility from the standpoint of the present concern on social inequalities. Differences between EEC countries are large, and even within Belgium there are important disparities between the districts. The role of health care supply has not been demonstrated yet in these two contexts. For Belgium, it appears that a major part of the unequally distributed mortality is constituted by causes of death considered as avoidable. Moreover, the most discriminating causes of death are overrepresented in socially deprived districts. The two perspectives are confronted in order to delineate perspectives for future research and operational outcomes for policy making and interventions. © 1990., SCOPUS: ar.j, info:eu-repo/semantics/published