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Copyright of Lege Artis Medicine (LAM) is the property of LifeTime Media Kft. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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.

Objectives: To compare the ranks of the 10 leading causes of death (CODs) between a traditional government list (traditional list) and the 2006 World Health Organization (WHO) list. Methods: From open data sets, COD data were collected for the years 2011, 2016, and 2021 to estimate the number of deaths for each ranking category. Subgroup analyses by age and sex were performed. Results: According to the traditional list, the leading COD was malignant neoplasm in individuals of all ages except for those aged ≥85 years. However, according to the WHO list, the leading CODs in 2011, 2016, and 2021 were, respectively, transport injury, suicide, and suicide in individuals aged 15–44 years; liver cancer, liver cancer, and lung cancer in those aged 45–64 years; stroke, stroke, and diabetes in those aged 65–84 years; and influenza/pneumonia, influenza/ pneumonia, and influenza/pneumonia in those aged ≥85 years. Among individuals aged 15–44 years, liver cancer was the fourth most prevalent COD in 2011; however, liver cancer obtained was ranked seventh in 2016 and was absent from the list in 2021. Conclusions: Insights into the top 10 CODs from the aforementioned two lists may facilitate mortality prevention and healthrelated policymaking. [ABSTRACT FROM AUTHOR]

Summary: Background: The role of morbidity and mortality conferences (M&MC) in surgical departments is to provide education and improve patient care. However, there is sparse evidence in the literature that M&MCs reduce preventable deaths. Therefore, this study aimed to assess the impact of routine M&MC on reducing the preventable death rate over 4 years at a tertiary hospital in Botswana. Methods: This study used a quantitative research methodology. In this retrospective audit of the M&MC data, we collected all mortality data for the surgery department from the time the database started, July 2016, to December 2019. The department adopted and adapted the criteria and definitions of preventability based on the World Health Organization (WHO) guidelines for trauma quality improvement programs. We used the Pearson correlation statistic to evaluate the correlation between the time (years) since the start of routine M&MC and the preventable death rate. Ethical approval for the study was obtained. Results: There were 4660 registered admissions from July 2016 to December 2019. Of these, 267 deaths were recorded, resulting in a crude mortality rate of 6%. Overall, the department considered 23% (61/267) of the deaths as preventable. A strong linear correlation (R2 = 0.982, p = 0.009) was found between the preventable death rate and time (years) since the commencement of routine M&MC. Trauma was the leading cause of preventable deaths (24.6%, 15/61). Conclusion: Our findings suggest that routine M&MCs have the desired effect of reducing preventable death rates. Further studies are required to investigate this observed effect. [ABSTRACT FROM AUTHOR]

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

An efficient health care system is a priority for all developed countries, and it is an important prerequisite for economic prosperity. Efficiency is measured by the ratio of inputs to outputs of a given system. In the case of health care, inputs include health care expenditure and human and material resources. There are several outputs that can be used to assess efficiency. Among the most important and frequently used are avoidable mortality rates. The consequences of avoidable mortality are understandably very unpleasant for those involved. From a national perspective, avoidable mortality also has serious macroeconomic consequences. The aim of this paper is to assess the efficiency of the health care systems of the member states of the European Union using avoidable mortality rates. Data were taken from the latest available online datasets on avoidable mortality published by Eurostat in 2019. Correlation analysis and multivariate statistical analysis were used. [ABSTRACT FROM AUTHOR]

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.

This study aimed at evaluating territorial inequalities in avoidable mortality in children under 5 years of age in Colombia between 2000 and 2019. This was an ecological study. An ecological, longitudinal, multigroup study was conducted using secondary sources. Because of the hierarchical structure of the data, the effect of territorial characteristics on the count of avoidable under-five deaths was estimated using a three-level negative binomial regression model with random intercepts for municipality and fixed intercepts for time and departments. Between 2000 and 2019, there were 216,809 avoidable under-five deaths in Colombia (91.3% of all registered deaths of children under 5 years of age). A total of 1117 municipalities located in 33 departments were analyzed over five 4-year periods. Ecological relationships were found between avoidable under-five mortality and the percentage of adolescent births, female illiteracy, and multidimensional poverty at the municipal level (standardized mortality ratio: 1.43 95% confidence interval: 1.33–1.54 for the group with the highest level vs the group with the lowest level of poverty). Furthermore, multidimensional poverty was a confounding factor for the association between the percentage of the population living in rural areas and avoidable child mortality. Systematic and avoidable gaps were observed in mortality in children aged under 5 years in Colombia, where the territory constitutes an axis of inequality. Implementing strategies and programs that contribute to improving the conditions of women and socio-economic conditions in the territories should be a priority. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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.

Copyright of Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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).)

Constipation is common in people with intellectual disability, with case reports of associated deaths. Risk factors include lifestyle factors, health conditions, and certain medications. We aimed to explore constipation in a sample of people with intellectual disability who died in 2021. We described prevalence of constipation, causes of death and the risk of secondary constipation from prescribed medications. Medications were scored based on the risk of constipation indicated in the drug profile. Forty-eight percent of the sample had constipation. Half of the sample were prescribed at least two medications that are commonly associated with side effects of constipation. There were high rates of antipsychotic (30%) and laxative (40%) drug prescription. Five people with a history of constipation died of causes of death associated with constipation. Our findings highlight the risk of secondary constipation due to prescribed medication and the seriousness of the condition in people with intellectual disability., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Approaches to assessing the role of health care in reducing mortality in Russia from the standpoint of controlling manageable causes are discussed. Based on the concept of avoidable mortality, trends in regional variability of mortality, the nosological and gender characteristics for the years 2000–2019 have been analyzed. The patterns revealed indicate the following: a significant contribution of medicine and health care to the decrease in the premature reduction in the life expectancy of the population, the expediency of developing a regional classification of the list of avoidable causes of mortality, and the decisive role of prevention and the improvement of the lifestyle of the population of young and middle ages in the past two decades against the background of a slow increase in the capacity of clinical medicine in the diagnostics and treatment of diseases. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to analyse how socio‐economic inequalities in mortality (total and avoidable) evolved in Portugal from the 1990s onwards by looking at differences by gender, age group, poverty and cause of death. Results show that mortality in younger age groups is decreasing faster in the most deprived municipalities. Yet, avoidable deaths do not follow this pattern, particularly with respect to treatable mortality amenable to the health care services. Although total and avoidable mortality are decreasing across all age groups and both genders, decreases in treatable deaths during and after the 2011–14 economic crisis slowed down among the young, with a sharpening of socio‐economic inequalities in avoidable mortality among adults and the elderly. This provides evidence that, in some respects, focusing programmes on those living in poor circumstances has been successful over time. However, the impact of the Great Recession on health care services might have contributed to a significant increase in some treatable causes of death associated with these services. [ABSTRACT FROM AUTHOR]

We analyse the trends in inequality in mortality across poverty groups at different ages over the period 1996–2016 in the Netherlands. In addition, we examine whether these trends are related to unequal changes in avoidable mortality, separated by preventable and treatable causes of death. We find that while inequalities in mortality have decreased at ages up to 65, inequalities increased for the oldest age groups. The decline in inequality at the younger ages can, to a large extent, be explained by a strong decrease of mortality from preventable and cardiovascular causes among the poor. The link between inequality and avoidable mortality at the oldest ages is less straightforward. The increasing inequality at old age might be the result of the inequalities shifting from the young to the older age groups, or of the rich benefiting more from the recent health (care) improvements than the poor. [ABSTRACT FROM AUTHOR]

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]

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. [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.)

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 in a high‐income country with relatively low avoidable mortality like Italy—spending cuts can hurt survival. [ABSTRACT FROM AUTHOR]

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Avoidable mortality (AM) is a health indicator used to examine trends in avoidable deaths amenable to public health and medical interventions. AM is more likely amongst marginalized populations. Our objective was to examine trends in AM rates by level of neighborhood marginalization. Decedents under age 75 years in Ontario from 1993 to 2014 (n = 691,453) were assigned to a quintile-level of each Ontario Marginalization (ON-Marg) Index dimension: material deprivation, residential instability, dependency, and ethnic concentration. We calculated ON-Marg Index dimension and quintile specific age- and sex-standardized AM incidence rates. We then calculated annual AM rate ratios between the most (Q5) and least (Q1) marginalized quintiles for each ON-Marg dimension. To describe the inequity gap in AM over time we calculated the absolute difference in the Q5/Q1 rate ratio between 2014 and 1993 for each dimension. AM rates in Ontario were almost halved (48.6%) from 1993 to 2014 (216 vs. 111 per 100,000 population). This decline was greater for treatable AM (75 vs. 36 per 100,000 population) than preventable AM (128 vs. 88 per 100,000 population). The inequity gap in AM Q5/Q1 rate ratios (RR) between 1993 and 2014 widened for all marginalization dimensions: dependency (RR 2.11–2.58), ethnic concentration (RR 0.59–0.48), material deprivation (RR 1.63–2.23), and residential instability (RR 2.01–2.43). To attain further declines in AM, policymakers and governments must address AM due to preventable deaths in neighborhoods highly marginalized by dependency, material deprivation, and residential instability. [ABSTRACT FROM AUTHOR]

Investments in public health – prevention of illnesses, and promotion, surveillance, and protection of population health – may improve population health, however, effects may only be observed over a long period of time. To investigate the potential long-run relationship between expenditures on public health and avoidable mortality from preventable causes. We focused on the country spending the most on public health in the OECD, Canada. We constructed a longitudinal dataset on mortality, health care expenditures and socio-demographic information covering years 1979–2017 for the ten Canadian provinces. We estimated error correction models for panel data to disentangle short-from long-run relationships between expenditures on public health and avoidable mortality from preventable causes. We further explored some specific causes of mortality to understand potential drivers. For comparison, we also estimated the short-run relationship between curative expenditures and avoidable mortality from treatable causes. We find evidence of a long-run relationship between expenditures on public health and preventable mortality, and no consistent short-run associations between these two variables. Findings suggest that a 1% increase in expenditures on public health could lead to 0.22% decrease in preventable mortality. Reductions in preventable mortality are greater for males (−0.29%) compared to females (−0.09%). These results are robust to different specifications. Reductions in some cancer and cardiovascular deaths are among the probable drivers of this overall decrease. By contrast, we do not find evidence of a consistent short-run relationship between curative expenditures and treatable mortality, except for males. This study supports the argument that expenditures on public health reap health benefits primarily in the long run, which, in this case, represents a reduction in avoidable mortality from preventable causes. Reducing public health expenditures on the premise that they have no immediate measurable benefits might thus harm population health outcomes in the long run. • Literature on health expenditures and health outcomes rarely separates long-run and short-run. • Public health requires time to produce health effect, hence a need to model the long-run relationship. • Expenditures on public health are associated with a long run reduction of preventable mortality. • This long run relationship is stronger for preventable mortality among males than females. • There is a limited influence of curative expenditures on treatable mortality. [ABSTRACT FROM AUTHOR]

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.

BACKGROUND: Smoking, as the leading cause of premature death, has many negative consequences and represents an economic burden across the globe. There are several diagnoses caused wholly or partially by tobacco use. The groups of diagnoses that are mainly related to tobacco use are neoplasms and diseases of the circulatory and respiratory system. AIMS: This study aims to examine whether the probability of dying because of neoplasms and circulatory diseases is higher in the case of tobacco smokers compared to non-smokers. Supposing that there are economic differences between the regions of the Czech Republic, the differences between regions in terms of the number of deaths attributable to selected groups of diagnoses was examined. The differences between groups of regions based on the number of deaths related to neoplasms and diseases of the circulatory system were analysed. METHODS: To compare the probability of dying, the relative risks in the Czech Republic from 1994 to 2017 were calculated. Cluster analysis was conducted to compare the regions of the Czech Republic with regard to the number of deaths attributable to smoking. The comparisons are made within two disease categories. RESULTS: The results show the differences in regional mortality attributable to tobacco use in the Czech Republic. The probability of dying of a disease diagnosed as a smoking-related neoplasm is higher in comparison to that of death from a disease diagnosed as a smokingrelated disease of the circulatory system. The level of deaths as a result of smoking differs between the genders. CONCLUSION: Our findings demonstrate a relationship between smoking as a death risk factor and neoplasms and diseases of the circulatory system. The specificity of diagnoses might be the reason for the greater disparities in the mortality connected to neoplasms. [ABSTRACT FROM AUTHOR]

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.