Abstract
Socio-economic inequalities in amenable mortality rates are increasing across Europe, which is an affront to universal healthcare systems where the numbers of, and inequalities in, amenable deaths should be minimal and declining over time. However, the fundamental causes theory proposes that inequalities in health will be largest across preventable causes, where unequally distributed resources can be used to gain an advantage. Information on individual-level inequalities that may better reflect the fundamental causes remains limited. We used the Scottish Longitudinal Study, with follow-up to 2010 to examine trends in amenable mortality by a range of socioeconomic position measures. Large inequalities were found for all measures of socioeconomic position and were lowest for educational attainment, higher for social class and highest for social connection. To reduce inequalities, amenable mortality needs to be interpreted both as an indicator of healthcare quality and as a reflection of the unequal distribution of socio-economic resources.
Highlights
Despite the existence of a universal healthcare system in the United Kingdom, a socio-economic gap in health has persisted (Steel & Cylus, 2012)
Four individual level measures of socio-economic inequality that could be derived from the 1991 and 2001 Censuses were included as study exposures: two measures of occupation-based social class derived from occupational data, educational attainment, and whether the member lived as part of a married or cohabiting couple, or not
Numbers of amenable deaths should be minimal, and there should be little to no socio-economic gradient, given that access to prevention, detection, and treatment services, which are capable of averting amenable deaths, are free and universal in Scotland
Summary
Despite the existence of a universal healthcare system in the United Kingdom, a socio-economic gap in health has persisted (Steel & Cylus, 2012). Mortality amenable to healthcare intervention (amenable mortality) is an extension to this indicator, measuring unnecessary premature deaths (Rutstein et al, 1976). Amenable mortality was initially introduced as a measure of the quality of medical care delivered, as deaths resulting from the identified conditions could be avoided, given timely and effective healthcare (Nolte & McKee, 2004). Improving upon the existing evidence for socio-economic inequalities in amenable mortality in Scotland, we have examined a wider range of conditions considered to be amenable to healthcare intervention, using the Scottish Longitudinal Study (SLS). The use of two Census periods, with four harmonised measures of socio-economic inequality, provided a unique opportunity to identify any changes over time to inequalities in amenable mortality in Scotland, a country with some of the starkest mortality inequalities in Europe, despite having a universal and effective healthcare system
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