Abstract
BackgroundWide variations in mortality rates persist between different areas in England, despite an overall steady decline. To evaluate a conceptual model that might explain how population and service characteristics influence population mortality variations, an overall null hypothesis was tested: variations in primary healthcare service do not predict variations in mortality at population level, after adjusting for population characteristics.Methodology/Principal FindingsIn an observational study of all 152 English primary care trusts (geographical groupings of population and primary care services, total population 52 million), routinely available published data from 2008 and 2009 were modelled using negative binomial regression. Counts for all-cause, coronary heart disease, all cancers, stroke, and chronic obstructive pulmonary disease mortality were analyzed using explanatory variables of relevant population and service-related characteristics, including an age-correction factor. The main predictors of mortality variations were population characteristics, especially age and socio-economic deprivation. For the service characteristics, a 1% increase in the percentage of patients on a primary care hypertension register was associated with decreases in coronary heart disease mortality of 3% (95% CI 1–4%, p = 0.006) and in stroke mortality of 6% (CI 3–9%, p<0.0001); a 1% increase in the percentage of patients recalling being better able to see their preferred doctor was associated with decreases in chronic obstructive pulmonary disease mortality of 0.7% (CI 0.2–2.0%, p = 0.02) and in all cancer mortality of 0.3% (CI 0.1–0.5%, p = 0.009) (continuity of care). The study found no evidence of an association at primary care trust population level between variations in achievement of pay for performance and mortality.Conclusions/SignificanceSome primary healthcare service characteristics were also associated with variations in mortality at population level, supporting the conceptual model. Health care system reforms should strengthen these characteristics by delivering cost-effective evidence-based interventions to whole populations, and fostering sustained patient-provider partnerships.
Highlights
Population mortality rates vary within and between countries with developed health care systems [1]
Healthcare in England is free at the point of access [3], and virtually the entire population is registered with a primary care provider; wide variations in mortality rates persist between different areas [2]
We chose to undertake the study at the population level of primary care trusts rather than general practices, since we were unable to obtain mortality data at practice level from the Office for National Statistics and reliable data for several population characteristics, such as rates of obesity, smoking and ethnicity, were not available at practice level
Summary
Population mortality rates vary within and between countries with developed health care systems [1]. In England the directly age-standardised rates for all-cause mortality have declined steadily from 790 per 100,000 European Standard population in 1993 to 547 per 100,000 in 2009 [2]. Healthcare in England is free at the point of access [3], and virtually the entire population is registered with a primary care provider; wide variations in mortality rates persist between different areas (from 354 to 766 deaths per 100,000 in 2009 among the 152 primary care trusts, geographical groupings of population and primary care services, in England) [2]. Wide variations in mortality rates persist between different areas in England, despite an overall steady decline. To evaluate a conceptual model that might explain how population and service characteristics influence population mortality variations, an overall null hypothesis was tested: variations in primary healthcare service do not predict variations in mortality at population level, after adjusting for population characteristics
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
