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Objective: This study analyzed the mortality trends from avoidable causes in Korea from 1997 to 2021, to estimate its contribution to the overall mortality in different subgroups, including. Gender, age, and cause of disease. Methods: The all-cause and avoidable mortality were presented as a time series plot and average annual percent change. Trend of avoidable mortality was also analyzed by subgroups, disease causes and the percentage attributed to each causes. Results: The decline in avoidable mortality accounted for 82.6% of all-cause mortality reduction. Preventable mortality showed a more pronounced decline than treatable mortality, explaining 72.3% of the avoidable mortality reduction. In 1997-2001, avoidable death occurred in 72.2% (537,024 cases) of all-cause deaths, which declined to 60.0% (342,979 cases) in 2017-2021. The contribution of avoidable mortality in the decline of all-cause morality was greater in males (83.6%) than in females (79.3%). Conclusion: The decline in avoidable mortality and its contribution to the all-cause mortality reduction implies general improvement of the population health in Korea. Nevertheless, the heterogenous trend within different subgroups warrants more equitable design and implementation of health services and policies. [ABSTRACT FROM AUTHOR]

Summary: Background: Twenty years after the 2004 European Union (EU) enlargement, life expectancy differences between established (EMS) and new member states (NMS) remain large. Contributing to this gap are deaths that can be avoided through preventive services or adequate medical treatment. We estimate the impact of reducing avoidable mortality on life expectancy and lifespan disparities in the enlarged EU. Methods: Using World Health Organization mortality database data, we analysed the potential of reducing avoidable mortality, as defined by Eurostat and the Organisation for Economic Cooperation and Development, to close the mortality gap between NMS and EMS. We decomposed the changes in life expectancy and lifespan disparity by age and cause using linear integral decomposition. Findings: Averting all avoidable deaths across the EU from 2005 to 2019 would decrease the average life expectancy gap from 5.8 to 2.4 years in men and 3.3–2 years in women and eliminate the lifespan disparity gap. Had NMS achieved the average EMS avoidable mortality rates during the same period, the average life expectancy gap would have been reduced to 1.8 years in men and 1.6 years in women, and the lifespan disparities gap would have been reversed. Avoidable circulatory and injury-related deaths in middle and older age drove the observed mortality changes. Interpretation: Our results suggest that the gap in life expectancy and lifespan disparity across the EU could be reduced by strengthening health systems and investing in averting circulatory and injury-related deaths in middle and older age in NMS. Funding: None.

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.

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. [ABSTRACT FROM AUTHOR]

Increasing the life expectancy of the Russian population is the most important goal of the country’s national policy. Due to the COVID-19 pandemic, this indicator has decreased in most countries worldwide, including Russia, which necessitates research in this domain. Life expectancy levels greatly vary across Russian regions. The goal of this study is to evaluate the extent to which the targeted life expectancy goals have been attained in the Arctic regions of the Russian Federation. The study relies on the systems approach, the critical approach, content analysis, and demographic analysis. The novelty of the study lies in the conclusion that the life expectancy target outlined in the Strategy for the Development of the Arctic Zone of the Russian Federation and Provision of National Security for the Period up to 2035, aimed at reaching the level of 78 years by 2024, will not be met. This assertion is substantiated by an analysis of long-term trends. The Arctic regions are categorized based on their progress toward the strategic life expectancy goal: the Yamalo-Nenets Autonomous District has come closest to achieving it, while the Krasnoyarsk Territory, the Republic of Karelia, and the Arkhangelsk Region face the most challenging circumstances. We have identified key avenues for increasing life expectancy in each Arctic region, with measures to prevent mortality from external causes showing significant potential for reducing premature deaths. A comparative analysis shows that at the current state of healthcare infrastructure development in Russia, regional differences do not exert a decisive impact on life expectancy. Therefore, it is recommended to strengthen efforts to encourage regular medical check-ups, making them an annual practice for all age groups. This approach would facilitate the early diagnosis of critical illnesses and reduce premature mortality. As a rule, the availability of medical services in the Russian Arctic is higher than the average around the country, as evidenced by statistical data on the development of a network of medical institutions and their medical staffing. Also, most Arctic regions have a lower proportion of the rural population than the national average, with the exception of the Republic of Sakha (Yakutia) and the Chukotka Autonomous Okrug. Telemedicine and mobile healthcare services should be used more actively, particularly in locations such as remote settlements, onshore and offshore oil platforms, and nomadic routes. There is a need for an effective mechanism of government support for corporate employee wellness programs that make a real contribution to reducing the loss of work time due to sick leaves. It is also vital to promote a healthy lifestyle, engaging the population in physical activities and sports, as the Russian Arctic already has the necessary facilities and conditions.

Gulnara Junusbekova,1 Meiramgul Tundybayeva,1 Nazgul Akhtaeva,2 Lyazzat Kosherbayeva3,4 1Cardiology Department, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan; 2Biostatistics and Fundamentals of Scientific Research, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan; 3Health Policy and Management department, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan; 4ALimRE (Advancing Learning Through the Innovation Methods in Research and Education), Almaty oblast, KazakhstanCorrespondence: Lyazzat Kosherbayeva; Meiramgul Tundybayeva, Email kosherbaeva.l@kaznmu.kz; miratundybayeva@gmail.comIntroduction: Cardiovascular diseases (CVD) are the leading cause of mortality in Kazakhstan. In the last decade, Kazakhstan has carried out a number of reforms in the healthcare sector, in particular, to reduce mortality from significant diseases, including CVD. This study aimed to provide the trend of avoidable mortality from CVD in Kazakhstan.Methods: We extracted data from the Bureau of National Statistics of the Agency for Strategic Planning and Reforms of the Republic of Kazakhstan on population by age; mortality rates from chronic rheumatic heart disease (I05-I09); hypertensive diseases (I10-I15); ischaemic heart disease (I20-I25); cerebrovascular diseases (I60-I69) from 2011 to 2021, by gender and 5-year age group (0, 1– 4, 5– 9, 74). We applied join point regression to calculate the average annual percentage change (AAPC). In addition, crude mortality and trends were calculated per 100,000 population.Results: The avoidable mortality rates, including treatable and preventable mortality decreased between 2011 and 2019 and then increased in the last two years (2020 and 2021) in all four studied disease groups. The AAPC showed that total avoidable mortality rates decreased between 2011 and 2021– 6.0 points (− 10.6 to – 1.1) (p = 0.017), whereas in males − 4.2 (− 8.3 to 0.1) and females – 5.1 (− 8.8 to − 1.3) (p = 0.009). Avoidable mortality rates from ischemic heart disease, cerebrovascular and hypertensive disease has been reduced stronger in male compared to female. The crude mortality declined over the period given; however, among young people mortality is still high.Discussion: Our findings showed that avoidable mortality from CVD decreased over the last years, which could be related to the policy on strengthening the primary care on early diagnosis and detection of CVD and its risk factors. However, primary healthcare facilities need to improve activities on health literacy (drug adherence, risk factors) of the population, including the prevention of CVD.Keywords: cardiovascular diseases, heart disease, avoidable mortality, trends, Kazakhstan

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.

Summary: Background: Prior research provides suggestive evidence on an association between stress-related disorders and mortality. No previous study has however addressed the role of familial confounding on such association. Methods: We conducted a nationwide cohort study of 189,757 individuals with a first-onset stress-related disorder between January 1, 1981 and December 31, 2016 in Sweden (i.e., exposed patients), 1,896,352 matched unexposed individuals, and 207,479 unaffected full siblings of the exposed patients. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause and cause-specific mortality. Findings: During a mean follow-up of 9.42 years, an elevated risk of all-cause mortality was observed during the entire follow-up among patients with stress-related disorders, compared with either unexposed individuals or their unaffected full siblings. Such excess risk was most pronounced within the first year after diagnosis of stress-related disorders (HR, 3.19 [95% CI, 2.87-3.54] in population-based comparison; HR, 3.21 [95% CI, 2.56-4.02] in sibling-based comparison). The excess risk decreased but remained statistically significant thereafter (HR, 1.64 [95% CI, 1.60-1.67] in population-based comparison; HR, 1.61 [95% CI, 1.54-1.68] in sibling-based comparison). An increased risk was observed for almost all cause-specific mortality, with greater risk increase for deaths from unnatural causes, especially suicide, and potentially avoidable causes. Interpretation: Stress-related disorders were associated with an increased risk of all-cause mortality and multiple cause-specific mortality, and the risk elevation was independent of familial confounding. The excess mortality attributable to unnatural causes and potentially avoidable causes highlights the importance of clinical surveillance of major health hazards among patients with stress-related disorders. Funding: EU Horizon 2020 Research and Innovation Action Grant, 1.3.5 Project for Disciplines of Excellence at West China Hospital of Sichuan University, National Natural Science Foundation of China, Icelandic Research Fund (Grant of Excellence), ERC Consolidator Grant, and Swedish Research Council.

In this article, we carry out the cost-analysis of the total premature mortality and avoidable causes of death for Moldova by applying the human capital approach. The results show that the indirect costs of avoidable mortality represent slightly over 85% of total economic losses due to premature mortality in Moldova. The highest economic losses are due to injuries, cardiovascular diseases, and alcohol and drug-related deaths. For males, the leading cause is represented by injuries, whereas for females the two leading causes include cardiovascular diseases and alcohol and drug-related deaths. The results of this study can be used for a cost-benefit analysis to design economic mitigation strategies aimed at lowering the avoidable mortality in Moldova.

This article analyses the mortality caused by road accidents in Moldova depending on the degree of involvement of pedestrians, cyclists, motorcyclists, drivers and passengers of transport units, depending on age and sex. Results suggest that traffic-related mortality in Moldova has shown an increased incidence among the young and working-age population, where a significant difference between males and females is observed. Among the youth, traffic-related deaths register between 10-27% of the overall mortality in both sexes. The risk exposure of dying in a traffic accident decreases with age and is less significant in the retired ages. During the years 1998-2015, avoidance of trafficrelated deaths would have assured an increase in life expectancy between 0.40-0.56 years in males, and 0.09-0.23 years in females. The continuous increase in the number of transport units on public roads, as well as in the number of hours spent in traffic, influences the degree of exposure to the risk of death or injury as a result of road traffic accidents. Trauma resulting from road accidents increases the incidence of premature mortality and disability among the population, which is reflected by the decrease of healthy life expectancy. It is ascertained that the road accident mortality requires a detailed and comprehensive analysis given the multitude of factors influencing deaths and injuries related to a traffic accident among the population. Thus, in order to improve road safety and reduce mortality incidence among traffic participants, a range of actions has to be implemented by the liable actors, including through the international experience.

Background: Certain causes of death can be avoided with access to timely prevention and treatment. We quantified trends in avoidable deaths from cardiovascular diseases for European Union (EU) countries from 1995 to 2020 and examined variations by demographics, disease characteristics, and geography., Methods: Retrospective secondary data analysis of avoidable cardiovascular mortality using the WHO Mortality Database. Avoidable causes of death were identified from the OECD and Eurostat list (which uses an age threshold of 75 years). Regression models were used to identify changes in the trends of age-standardized mortality rates and potential years of life lost., Findings: From 1995 to 2020, 11.4 million deaths from cardiovascular diseases in Europe were avoidable, resulting in 213.1 million potential life years lost. Avoidable deaths were highest among males (7.5 million), adults 65-74 years (6.8 million), and with the leading cause of death being ischemic heart disease (6.1 million). From its peak in 1995 until 2020, avoidable mortality from cardiovascular diseases has decreased by 57% across the EU. The difference in avoidable cardiovascular diseases mortality between females and males, and between Eastern and Western Europe has reduced greatly, however gaps continue to persist., Interpretation: Avoidable mortality from cardiovascular diseases has decreased substantially among EU countries, although improvement has not been uniform across diseases, demographic groups or regions. These trends suggest additional policy interventions are needed to ensure that improvements in mortality are continued., Funding: World Health Organization, Regional Office for Europe., Competing Interests: ZT reports a previous summer internship with Novo Nordisk. MM reports consulting fees from Abbott, Cadrenal, Paragonix, Second Heart Assist, Medtronic, Janssen, Natera, and Moderna, and participation on the advisory boards of Mesoblast, Fineheart, Leviticus, and NupulseCV., (© 2024 The Author(s).)

Objectives: This study aimed to identify trends in avoidable mortality (AVM) in 16 provincial and metropolitan regions of South Korea and determine the factors influencing AVM., Methods: First, the AVM rate (AVMR) was calculated using the Statistics Korea cause-of-death and population data by age and region from 2013 to 2022. Second, a health determinants model was built, and we identified the factors influencing AVM using generalized estimating equations analysis., Results: Although the AVMR per 100,000 people displayed a steadily decreasing trend from 2013 to 2020, it began to increase in 2021. Meanwhile, Jeonnam, Jeonbuk, Gyeongnam, Gyeongbuk, Chungnam, Chungbuk, and Gangwon Provinces showed a higher AVMR than the national average. The analysis revealed that each 1-unit increase in the older adult population, smoking, perceived stress, or nonlocal medical utilization was associated with an increase in the AVMR. Conversely, 1-unit increases in the male-to-female ratio, marriage rate, positive self-rated health, local medical utilization, doctor population, influenza vaccination rate, cancer screening rate, or financial independence were associated with decrease in the AVMR., Conclusions: This study established that the AVMR, which had been continuously decreasing across the 16 regions, shifted to an increasing trend in 2021. We also identified several factors influencing AVM. Further studies are needed to confirm the reasons for this shift in the AVMR and explore the factors that influence AVM across Korea's 16 provincial and metropolitan regions.

Background: Twenty years after the 2004 European Union (EU) enlargement, life expectancy differences between established (EMS) and new member states (NMS) remain large. Contributing to this gap are deaths that can be avoided through preventive services or adequate medical treatment. We estimate the impact of reducing avoidable mortality on life expectancy and lifespan disparities in the enlarged EU., Methods: Using World Health Organization mortality database data, we analysed the potential of reducing avoidable mortality, as defined by Eurostat and the Organisation for Economic Cooperation and Development, to close the mortality gap between NMS and EMS. We decomposed the changes in life expectancy and lifespan disparity by age and cause using linear integral decomposition., Findings: Averting all avoidable deaths across the EU from 2005 to 2019 would decrease the average life expectancy gap from 5.8 to 2.4 years in men and 3.3-2 years in women and eliminate the lifespan disparity gap. Had NMS achieved the average EMS avoidable mortality rates during the same period, the average life expectancy gap would have been reduced to 1.8 years in men and 1.6 years in women, and the lifespan disparities gap would have been reversed. Avoidable circulatory and injury-related deaths in middle and older age drove the observed mortality changes., Interpretation: Our results suggest that the gap in life expectancy and lifespan disparity across the EU could be reduced by strengthening health systems and investing in averting circulatory and injury-related deaths in middle and older age in NMS., Funding: None., Competing Interests: We declare no competing interests., (© 2024 The Author(s).)

In this article, we carry out the cost-analysis of the total premature mortality and avoidable causes of death for Moldova by applying the human capital approach. The results show that the indirect costs of avoidable mortality represent slightly over 85% of total economic losses due to premature mortality in Moldova. The highest economic losses are due to injuries, cardiovascular diseases, and alcohol and drug-related deaths. For males, the leading cause is represented by injuries, whereas for females the two leading causes include cardiovascular diseases and alcohol and drug-related deaths. The results of this study can be used for a cost-benefit analysis to design economic mitigation strategies aimed at lowering the avoidable mortality in Moldova. [ABSTRACT FROM AUTHOR]

Objective: This study analyzed the mortality trends from avoidable causes in Korea from 1997 to 2021, to estimate its contribution to the overall mortality in different subgroups, including. Gender, age, and cause of disease., Methods: The all-cause and avoidable mortality were presented as a time series plot and average annual percent change. Trend of avoidable mortality was also analyzed by subgroups, disease causes and the percentage attributed to each causes., Results: The decline in avoidable mortality accounted for 82.6% of all-cause mortality reduction. Preventable mortality showed a more pronounced decline than treatable mortality, explaining 72.3% of the avoidable mortality reduction. In 1997-2001, avoidable death occurred in 72.2% (537,024 cases) of all-cause deaths, which declined to 60.0% (342,979 cases) in 2017-2021. The contribution of avoidable mortality in the decline of all-cause morality was greater in males (83.6%) than in females (79.3%)., Conclusion: The decline in avoidable mortality and its contribution to the all-cause mortality reduction implies general improvement of the population health in Korea. Nevertheless, the heterogenous trend within different subgroups warrants more equitable design and implementation of health services and policies., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2024 Jeong and Seo.)

Objective: Policies being implemented to fight against noncommunicable diseases such as managing avoidable mortality and profiling avoidable mortality are commonly used as a performance outcome of the health care system. The objective of this study is to examine avoidable causes of cancer mortality in Turkey from 2009 to 2018. Materials and Methods: Data was collected from Turkish Statistical Institute official website. Avoidable, amenable, and preventable causes of cancer deaths are classified according to the 10th Revision of the International Classification Disease codes and specific age groups compiled by the Eurostat Task Force on Satellite Lists. Trends in gender-standardized death rates were calculated, and amenable and preventable causes of cancer mortality for male and female groups were illustrated on a heatmap. Results: Avoidable, amenable, and preventable causes of cancer mortality in Turkey have considerably increased from 2013 to 2018. Preventable cause of cancer mortality is more intense among the male population. Increases in death rates due to malignant neoplasm of the larynx and trachea/bronchus/lung among men and cancer of the breast among females were observed. Conclusions: The increase in cancer mortality reflected the impact of implementing preventive health policy and nursing interventions. This emphasizes the need for more effective public health policies to fight with increasing cancer mortality.

Background: Regional comparisons of cancer-related mortality in Germany are traditionally focused on disparities between East and West Germany. Recent improvements in all-cause and cancer-related mortality show a diverse regional pattern beyond the known East-West mortality divide. A generalized approach of the avoidable/amenable cancer mortality definition is applied for suitable regional comparisons of long-term trends.Methods: Standardized death rates of preventable and amenable cancer mortality for men and women were computed for the period 1990–2014 to observe sex-specific excess mortality due to specific cancers after the German reunification. For regional comparison, three German super regions were defined in Eastern, Northwestern, and Southwestern Germany to account for similarities in long-term regional premature and cancer-related mortality patterns, socioeconomic characteristics, and age structure.Results: Since preventable and amenable cancer mortality rates typically have driven the recent trends in premature mortality, our findings underline the current regional pattern of preventable cancer mortality for males with disadvantages for Eastern Germany, and advantages for Southwestern Germany. Among women, the preventable cancer mortality has increased in Northwestern and Southwestern Germany after the German reunification but has decreased in Eastern Germany and converged to the pattern of Southwestern Germany. Similar patterns can be observed for females in amenable cancer mortality.Conclusions: Although the “traditional” East-West gap in preventable cancer mortality was still evident in males, our study provides some hints for more regional diversity in avoidable cancer mortality in women. An establishing north-south divide in avoidable cancer mortality could alter the future trends in regional cancer-related mortality in Germany.

We investigated the availability of health system performance indicator data in Canada’s 18 northern regions and the feasibility of using the performance framework developed by the Canadian Institute for Health Information [CIHI]. We examined the variation in 24 indicators across regions and factors that might explain such variation. The 18 regions vary in population size and various measures of socioeconomic status, health-care delivery, and health status. The worst performing health systems generally include Nunavut and the northern regions of Québec, Manitoba and Saskatchewan where indigenous people constitute the overwhelming majority of the population, ranging from 70% to 90%, and where they also fare worst in terms of adverse social determinants. All northern regions perform worse than Canada nationally in hospitalisations for ambulatory care sensitive conditions and potentially avoidable mortality. Population size, socioeconomic status, degree of urbanisation and proportion of Aboriginal people in the population are all associated with performance. The North is far from homogenous. Inter-regional variation demands further investigation. The more intermediate pathways, especially between health system inputs, outputs and outcomes, are largely unexplored. Improvement of health system performance for northern and remote regions will require the engagement of indigenous leadership, communities and patient representatives.

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. [ABSTRACT FROM AUTHOR]

RESUMEN 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 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. / ABSTRACT 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 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, Mexico has 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.

RESUMEN 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. / ABSTRACT 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 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 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.

Abstract Aim: To determine how many Māori and non‐Māori deaths might have been avoidable if cancer survival in New Zealand were as high as in Australia. Methods: Age‐sex‐tumour specific five‐year relative survival ratios were calculated for cancer patients diagnosed with 27 tumour sites (representing about 92% of all cancers) in 2006–10. These were used to estimate the number of Māori, non‐Māori and total deaths (and proportion of excess deaths) that would have been avoidable within five years of diagnosis had New Zealand's relative survival been equivalent to Australia's. Results: A total of 3,631 cancer deaths (726/year; 13.4% of excess deaths) could have been avoidable. Among 25 tumours where ethnic‐specific results were estimated, there were 851 potentially avoidable deaths in Māori (24.9%) and 2,758 in non‐Māori (11.8%). Breast, bowel, lung and prostate tumours made up 64% of avoidable deaths. Those with the highest proportions of avoidable deaths were thyroid (44.7%), prostate (35.5%), breast (30.0%) and uterus (23.5%). More than 50% of Māori melanoma, prostate, testis and thyroid cancer deaths were avoidable. Conclusion: A significant number of cancer deaths could be avoidable if New Zealand achieved Australia's relative survival ratios. The proportion is much higher for Māori than for non‐Māori. Implications: There is considerable scope to improve cancer outcomes in New Zealand.

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., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

This study examines whether mothers who had a child taken into care by child protection services have higher mortality rates compared with rates seen in their biological sisters who did not have a child taken into care. We conducted this retrospective cohort study using linkable administrative data from 3,948 mothers whose oldest child was born in Manitoba, Canada, between April 1, 1992, and March 31, 2015. These mothers were from 1,974 families in which one sister had a child taken into care and one sister did not. We computed rate differences and hazard ratios of all-cause, avoidable, and unavoidable mortality. There were an additional 24 deaths per 10,000 person-years among mothers who had had a child taken into care. Mothers who had a child taken into care had higher rates of mortality due to avoidable causes (hazard ratio = 3.46; 95%c onfidence interval: 1.41, 8.48) and unavoidable causes (hazard ratio = 2.92; 95% confidence interval: 1.01, 8.44). The number of children taken into care did not affect mortality rates among mothers with at least 1 child taken into care. The higher mortality rates--particularly avoidable mortality--among mothers who had a child taken into care indicate a need for more specific interventions for these mothers. [ABSTRACT FROM AUTHOR]

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The paper published in the January 2015 issue of this journal by Gusmano and colleagues entitled “Shanghai rising: health improvements as measured by avoidable mortality since 2000” has spurred this commentary. We discuss controversial issues surrounding the concept of avoidable mortality in health service research in general and Gusmano’s study in particular. The impact of overall social development on mortality may be underappreciated in Gusmano’s report; the innovative efforts of healthcare professionals to use cutting-edge technology and evidenceapproved preventive strategies to reduce healthcare cost and improve the life quality of community members may not necessarily come to fruition in death reduction, and might be undervalued, too. More critically, the shape and magnitude of emerging health issues in Shanghai, such as accidents and injuries, pollution-related cancers, may be camouflaged in Gusmano’s report. We conclude this commentary by suggesting the most urgent questions to be addressed in the future studies.

BackgroundAvoidable mortality as an indicator for assessing the health system performance has caught the attention of researchers for a long time. In this study we aimed to compare the health system performance using this indicator in rural and urban areas of one of Iran’s southern provinces. MethodsAll deaths (29916) which happened during 2004–2011 in Bushehr province were assessed. Nolte and McKee’s avoidable deaths model was used to distinguish avoidable and unavoidable conditions. Accordingly, all deaths were classified into four categories including three avoidable death categories and one unavoidable death category. STATA software was used to conduct Poisson Regression Test and age-standardized death rate. ResultsFindings showed that avoidable mortality rates declined in both urban and rural areas at 3.33% per year, but decline rates were influenced by Ischemic Heart Disease (IHD) and preventable death categories to treatable death category. Annual decline rate for IHD category in rural and urban areas was nearly the same as 8%, but in preventable death category, rural areas experienced more decreases than urban ones (7% vs 5% respectively). However, decline rate in treatable mortality neither in urban and nor in rural areas was statistically significant. ConclusionDespite the annual decline in the rate of avoidable deaths, policy making initiatives especially screening and inter-sectoral measures targeting cause of deaths such as colon and breast cancers, hypertension, lung cancer and traffic accidents, can still further decrease avoidable deaths in both areas.

The current trends of avoidable mortality, which is an integral indicator of health system performance, were analyzed. The paper discusses the regional heterogeneity of levels and trends in avoidable mortality in the Russian Federation. Also, it contains the analysis of impact of the financial costs of public health on avoidable mortality in regions with different levels of economic development. The last 20-years period was studied, which includes a stage of crisis as well as a social recovery phase. The official data of the State Statistics Committee were analyzed. In Russia, all death cases are registered in accordance to the international classification ICD-10. Special computer program summarizes death cases from preventable causes, and calculates the standardized rates for the population aged from 5 to 64 years. The old European standard of population age structure is used. Estimates of avoidable mortality were made in accordance with the European approach, under which avoidable mortality accumulates deaths of persons aged from 5 to 64 years due to 34 causes and 4 classes of causes. These 38 causes are divided into 3 groups according to three levels of diseases prevention. The level of avoidable mortality in the different regions varies up to 8 times. That is comparable to the difference between Russia and the countries of European Union in 1994. This gap is due to the coexistence of different stages of epidemiological development among the regions in Russia. When death rates increased, it is shown that mortality from causes which are preventable by measures of primary and tertiary prevention increased to a greater extent than mortality from the causes which depend from measures of secondary prevention. Therein, the largest growth of observed mortality was due to low quality of medical care in case of males (group 3), and due to causes which are preventable by measures of primary prevention in case of females (group 1). When mortality was reduced, the rates of change for causes in groups 1 and 3 were approximately the same for both sexes. Avoidable mortality due to late detection of malignant tumors (group 2) has been changed the least. Preventable component defines over 80% of the regional differences in death rates. In 2009, the level of avoidable mortality differed more than fourfold among different regions of the Russia. Similarly, the difference in the level of unavoidable mortality was 1.3-fold and 1.7-fold, for males and females respectively. Proportion of deaths from preventable causes in the total sum of death cases varies from 40% till 75%. Funding for comprehensive programs of public health to a greater extent stimulates the reduction in mortality from preventable causes of the first group. Mortality connected with quality of medical care is more determined by socio-political situation in the country than by regional health care expenses. Based on these results, it is concluded that the action plans to reduce mortality in Russia must have a strong regional specificity, different targets and indicators. Using the proportion of preventable causes, it is possible to separate the regions into groups with different ratios of death determinants, which, therefore, require different approaches to reduce mortality.

Objetivo: La comparación de la mortalidad que puede ser evitada por intervención médica (mortalidad evitable) en áreas geográficas pequeñas proporciona una herramienta útil para analizar con detalle la calidad de los servicios sanitarios. No hay estudios que analicen para toda España la distribución geográfica de la mortalidad evitable en áreas pequeñas. El objetivo de este estudio es describir la distribución geográfica de la mortalidad evitable y no evitable en áreas pequeñas según el sexo para el período 1990-2001. Métodos: Se consideraron 2.218 áreas pequeñas formadas por municipios o municipios agregados de todo el territorio español. Se analizaron las muertes evitables producidas en 1990-2001. Se estimó el riesgo relativo de muerte ajustado por edad utilizando un modelo bayesiano empírico. Los riesgos relativos se representaron en mapas para cada grupo de causas de muerte según el sexo. Resultados: La distribución geográfica de la mortalidad evitable en ambos sexos es heterogénea. Se observan áreas de mayor riesgo de mortalidad en el sur y el noroeste de España. Esta distribución se presenta claramente diferenciada, principalmente en hombres, para las causas de hipertensión, enfermedades y enfermedad isquémica del corazón. La distribución geográfica de la mortalidad no evitable, en ambos sexos, es similar a la de las tres causas mencionadas. Conclusiones La descripción de la mortalidad evitable en áreas pequeñas de toda España ha permitido identificar zonas geográficas con una elevada mortalidad. Para determinar los factores asociados a la distribución cerebrales vasculares de la mortalidad evitable se deberían realizar estudios más detallados.Objective: Comparison of mortality amenable to medical intervention (avoidable mortality) in small geographical areas provides a useful tool to analyse quality of health care services. Currently there are no studies that analyse avoidable mortality by geographical distribution in small areas for the whole of Spain. The aim of this study is to describe the geographical distribution of avoidable and non-avoidable mortality in small areas in Spain by sex for the period 1990-2001. Methods: The 2.218 small areas considered consisted of municipalities or aggregated municipalities in the entirety of the Spanish territory. Avoidable deaths were analysed for the period 1990¿2001. Empirical Bayes model-based estimates of age-adjusted relative risk were displayed in small-area maps for each group of causes of death by sex. Results: There is an heterogeneous geographical distribution of avoidable mortality for both sexes. Areas with greater mortality are located in the south and northwest of Spain. Especially for hypertension, cerebrovascular disease and ischaemic heart disease in men there is a clear aggregation of deaths in these areas. Geographical distribution of non avoidable mortality in both sexes is similar to that described for these three causes. Conclusions: Geographical study of avoidable mortality in small areas for the whole of Spain permits the identification of areas with elevated mortality. Further research is necessary to clarify those factors related to avoidable mortality distribution.

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.

Resumen Justificación y objetivo: El cáncer cervicouterino constituye una de las principales causas de muerte en las mujeres costarricense y más de la mitad de su ocurrencia tiene lugar antes de los 65 años de edad. El objetivo del presente estudio es identificar patrones de alta mortalidad evitable en las áreas de salud mediante un análisis temporal y espacial, con el fin de priorizar intervenciones desde los servicios de salud. Métodos: Para analizar la evolución temporal se utilizó la tasa anual de mortalidad estandarizada y el porcentaje de cambio anual estimado mediante un modelo de regresión de Poisson. En el análisis espacial se utilizó la representación geográfica del índice de mortalidad estandarizada y de las áreas que registraron una mortalidad significativamente diferente al promedio nacional. Resultados: Entre 1970 y 2005 la mortalidad evitable por cáncer cervicouterino decreció aproximadamente un 2%. Se determinó la existencia de alta variabilidad entre áreas de salud (la tasa de mortalidad del área ubicada en el percentil 95 es 18 veces mayor que el área de salud ubicada en el percentil 5) y la sugerencia de un patrón con tasas de mortalidad superiores al promedio nacional en la zona atlántica y el sur del país. Conclusión: Las decenas de muertes evitables anualmente y la alta variabilidad geográfica en las tasas de mortalidad entre áreas de salud por cáncer cervicouterino, son una alerta de potenciales problemas de atención de los servicios de salud. Se recomienda mejorar el proceso de detección temprana y abordaje oportuno del cáncer cervicouterino, priorizando intervenciones en las áreas de salud con altas tasas de mortalidad.Abstract Justification and objective: Uterine cervical cancer is one of the main causes of death in Costa Rican women, more than half of those deaths occur before 65 years of age. The main objective of this investigation was to identify patterns of avoidable high mortality in different health areas following a a temporo-spacial analysis in order to prioritize interventions right from the health services level. Methods: To analyze the evolution we utilized the standardized annual mortality rate and the annual percentage of change estimated by a regression model according to Poisson. For the geographical analysis we used the geographic representation of the standardized mortality ratio and the areas with a mortality rate significantly different from the national average. Results: Between 1970 and 2005 avoidable mortality by uterine cervical cancer decreased approximately 2% and a mortality gradient was registered according to the age. With the geographical analysis we determined the existence of high variability between health areas (the mortality rate of the area located in percentile 95 is 18 times greater than the health area located in percentile 5) and a suggestion of a geographical pattern with rates of mortality superior to the national average both in the atlantic zone and the southern part of the country. Conclusions: The annual occurrence of tens of avoidable deaths and the geographical variability in mortality rate between health areas, should constitute an alert sign of potential problems of attention regarding this entity. We recommended improving the detection process and the opportune approach to uterine cervical cancer, prioritizing interventions in the health areas with high mortality rates.

The fundamental criticism of the analyses of relations between the allocated sources into healthcare system and general indicators of health status (represented by mortality) form a concept of avoidable mortality. The concept is a result of a reaction of many specialists in this field. The efficient concept of avoidable mortality that consists of treatable and preventable mortality components should provide prominent information that is not directly absorbed in the metrics of general mortality rate traditionally used for measuring the healthcare systems’ outputs. Permanent evaluation of the concept is based on confrontation of actual and relevant facts and supported by significant evidence from analytical outputs. This evaluation may help to form an efficient tool for measuring the amenable mortality with system connections as within health care system so in social policy, long-term health care policy, etc. The aim of this article is an analysis and evaluation of avoidable mortality development at conceptual and evaluative level and a specification of advantages and limitations that result from this concept. The analyses’ outputs represent a valuable platform for revision of strategic framework of the Slovak healthcare as well as for formation of targeted policies that focus on increase of healthcare system efficiency.

Avoidable mortality is an important analysis in publichealth. This paper presents the analysis of avoidable mortality between 1997-2003 in Santander aiming to guide the health policiesin the state. Methods: Descriptive, longitudinal and retrospectiveanalysis of avoidable mortality in Santander 1997-2003 based onthe mortality records of the National Department of Statisitcs andtaking as reference the clasification of Taucher. Mortality ratesfor avoidability group, year and provice were calculated and themedian rates were plotted in maps for each group. Sex and agespecific rates and potencially lost years of life were calculated for2003 data. Results: In Santander 35% of deaths were avoidablebetween 1997-2003. The groups with the highest median rateswere: accidents, poisoning and violence (F), preventable diseases ininfants (E) and preventable disease with early diagnosis or treatment(B). The general ratio man:woman was 2:1 but 4:1 in the group F.Carare-Opón and Soto Norte were the provinces with the highestburden of avoidable mortality. Conclusions: There is an inequityin the way how the avoidable mortality affects the population. Thedata suggest to review the quality of the promotion and preventionprogramms and to continue the action against violence in Santander