Abstract
BackgroundPreventable mortality is a good indicator of possible problems to be investigated in the primary prevention chain, making it also a useful tool with which to evaluate health policies particularly public health policies. This study describes inequalities in preventable avoidable mortality in relation to socioeconomic status in small urban areas of thirty three Spanish cities, and analyses their evolution over the course of the periods 1996–2001 and 2002–2007.MethodsWe analysed census tracts and all deaths occurring in the population residing in these cities from 1996 to 2007 were taken into account. The causes included in the study were lung cancer, cirrhosis, AIDS/HIV, motor vehicle traffic accidents injuries, suicide and homicide. The census tracts were classified into three groups, according their socioeconomic level. To analyse inequalities in mortality risks between the highest and lowest socioeconomic levels and over different periods, for each city and separating by sex, Poisson regression were used.ResultsPreventable avoidable mortality made a significant contribution to general mortality (around 7.5%, higher among men), having decreased over time in men (12.7 in 1996–2001 and 10.9 in 2002–2007), though not so clearly among women (3.3% in 1996–2001 and 2.9% in 2002–2007). It has been observed in men that the risks of death are higher in areas of greater deprivation, and that these excesses have not modified over time. The result in women is different and differences in mortality risks by socioeconomic level could not be established in many cities.ConclusionsPreventable mortality decreased between the 1996–2001 and 2002–2007 periods, more markedly in men than in women. There were socioeconomic inequalities in mortality in most cities analysed, associating a higher risk of death with higher levels of deprivation. Inequalities have remained over the two periods analysed. This study makes it possible to identify those areas where excess preventable mortality was associated with more deprived zones. It is in these deprived zones where actions to reduce and monitor health inequalities should be put into place. Primary healthcare may play an important role in this process.
Highlights
Preventable mortality is a good indicator of possible problems to be investigated in the primary prevention chain, making it a useful tool with which to evaluate health policies public health policies
In the thirty-three cities studied, it has been observed in men, with great consistency, that the risks of death are higher in areas of greater deprivation, and that these excesses have not modified over time
This study shows that preventable mortality analysed decreased between the 1996–2001 and 2002–2007 periods, more markedly in men than in women, and that there were socioeconomic inequalities in mortality in most cities analysed, among the youngest population, associating a higher risk of death with higher levels of deprivation
Summary
Preventable mortality is a good indicator of possible problems to be investigated in the primary prevention chain, making it a useful tool with which to evaluate health policies public health policies. The WHO World Health Report 2000 [11] defines health systems inclusively, as systems whose primary aim is to promote, restore and maintain health From this point of view, preventable mortality must be considered a good indicator of possible problems to be investigated in the primary prevention chain, both in health promotion and protection and in health education [5], making it a useful tool with which to evaluate health policies, public health policies [12]. These inequalities are themselves a risk factor for population health and need to be studied in order to identify the most vulnerable groups and regions, to put in place specific interventions [28]
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