Abstract
BackgroundWhile research continues into indicators such as preventable and amenable mortality in order to evaluate quality, access, and equity in the healthcare, it is also necessary to continue identifying the areas of greatest risk owing to these causes of death in urban areas of large cities, where a large part of the population is concentrated, in order to carry out specific actions and reduce inequalities in mortality. This study describes inequalities in amenable mortality in relation to socioeconomic status in small urban areas, and analyses their evolution over the course of the periods 1996–99, 2000–2003 and 2004–2007 in three major cities in the Spanish Mediterranean coast (Alicante, Castellón, and Valencia).MethodsAll deaths attributed to amenable causes were analysed among non-institutionalised residents in the three cities studied over the course of the study periods. Census tracts for the cities were grouped into 3 socioeconomic status levels, from higher to lower levels of deprivation, using 5 indicators obtained from the 2001 Spanish Population Census. For each city, the relative risks of death were estimated between socioeconomic status levels using Poisson’s Regression models, adjusted for age and study period, and distinguishing between genders.ResultsAmenable mortality contributes significantly to general mortality (around 10%, higher among men), having decreased over time in the three cities studied for men and women. In the three cities studied, with a high degree of consistency, it has been seen that the risks of mortality are greater in areas of higher deprivation, and that these excesses have not significantly modified over time.ConclusionsAlthough amenable mortality decreases over the time period studied, the socioeconomic inequalities observed are maintained in the three cities. Areas have been identified that display excesses in amenable mortality, potentially attributable to differences in the healthcare system, associated with areas of greater deprivation. Action must be taken in these areas of greater inequality in order to reduce the health inequalities detected. The causes behind socioeconomic inequalities in amenable mortality must be studied in depth.
Highlights
While research continues into indicators such as preventable and amenable mortality in order to evaluate quality, access, and equity in the healthcare, it is necessary to continue identifying the areas of greatest risk owing to these causes of death in urban areas of large cities, where a large part of the population is concentrated, in order to carry out specific actions and reduce inequalities in mortality
Given that the quality of healthcare and fair access to it must be considered objectives of health policy, amenable mortality can be considered an indicator of potential weaknesses in the healthcare system, in order to study these weaknesses in greater depth and has been used for decades to show the positive impact of healthcare on the health of the population in many industrialised countries [5,11]
These inequalities are in themselves a risk factor for the health of the population, and they must be studied in order to identify the most vulnerable groups and regions, and be able to carry out specific interventions [24]
Summary
While research continues into indicators such as preventable and amenable mortality in order to evaluate quality, access, and equity in the healthcare, it is necessary to continue identifying the areas of greatest risk owing to these causes of death in urban areas of large cities, where a large part of the population is concentrated, in order to carry out specific actions and reduce inequalities in mortality. Studies conducted in different countries have related certain population socioeconomic indicators with avoidable mortality and, in particular, with amenable, pointing to higher mortality rates among the more underprivileged groups [12,13,14,15,16,17,18,19,20,21,22,23] These inequalities are in themselves a risk factor for the health of the population, and they must be studied in order to identify the most vulnerable groups and regions, and be able to carry out specific interventions [24]
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