Abstract
BackgroundMortality amenable to health-care services (‘amenable mortality’) has been defined as “premature deaths that should not occur in the presence of timely and effective health care” and as “conditions for which effective clinical interventions exist.” We analyzed the regional variability in health-care services using amenable mortality as a performance indicator. Convergent validity was examined against other indicators, such as health expenditure, GDP per capita, life expectancy at birth, disability-free life expectancy at age 15, number of diagnostic and laboratory tests per 1,000 inhabitants, and the prevalence of cancer and cardiovascular diseases.MethodsAmenable mortality rate was calculated as the average annual number of deaths in the population aged 0–74 years per 100,000 inhabitants, and it was then stratified by gender and region. Data were drawn from national mortality statistics for the period 2006–08.ResultsDuring the study period (2006–08), the age-standardized death rate (SDR) amenable to health-care services in Italy was 62.6 per 100,000 inhabitants: 66.0 per 100,000 for males and 59.1 per 100,000 for females. Significant regional variations ranged from 54.1 per 100,000 inhabitants in Alto Adige to 76.3 per 100,000 in Campania. Regional variability in SDR was examined separately for male and females. The variability proved to be statistically significant for both males and females (males: Q-test = 638.5, p < 0.001; females: Q-test = 700.1, p < 0.001). However, among men, we found a clear-cut divide in SDR values between Central and Southern Italy; among women, this divide was less pronounced. Amenable mortality was negatively correlated with life expectancy at birth for both genders (male: r = −0.64, p = 0.002; female: r = −0.88, p <0.001) and with disability-free life expectancy at age 15 (male: r = −0.70, p <0.001; female: r = −0.67, p <0.001). Amenable mortality displayed a statistically significant negative relationship with GDP per capita, the quantity of diagnostic and laboratory tests per 1,000 inhabitants, and the prevalence of cancer.ConclusionsAmenable mortality shows a wide variation across Italian regions and an inverse relationship with life expectancy and GDP per capita, as expected.
Highlights
Mortality amenable to health-care services (‘amenable mortality’) has been defined as “premature deaths that should not occur in the presence of timely and effective health care” and as “conditions for which effective clinical interventions exist.” We analyzed the regional variability in health-care services using amenable mortality as a performance indicator
Amenable mortality rate was calculated as the average annual number of deaths over the population aged 0–74 years per 100,000 inhabitants, and it was stratified by gender, region (19 regions and the two autonomous provinces of Trentino and Alto Adige) and 10 disease categories defined by Gay et al in an OECD report [11]
We examined the relationship between amenable mortality and life expectancy at birth as well as disabilityfree life expectancy at age 15, using linear regression models stratified by gender as suggested in the literature [7,11]
Summary
Mortality amenable to health-care services (‘amenable mortality’) has been defined as “premature deaths that should not occur in the presence of timely and effective health care” and as “conditions for which effective clinical interventions exist.” We analyzed the regional variability in health-care services using amenable mortality as a performance indicator. Mortality amenable to health-care services (‘amenable mortality’) has been defined as “premature deaths that should not occur in the presence of timely and effective health care” and as “conditions for which effective clinical interventions exist.”. The concept of amenable mortality has been used as a proxy for performance of health-care systems by Nolte and McKee [7,8,9] and Tobias and Yeh [10]. Mortality amenable to health-care services (hereafter amenable mortality) has been defined as “premature deaths that should not occur in the presence of timely and effective health care” [9] and as “conditions for which effective clinical interventions exist” [10]. Amenable mortality correlates with disability-adjusted life expectancy with better face validity [7]
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